Medical Imaging
Annual Radiation dose limit of the foot?
50 rems
Thurston Holland Sign = Salter Harris Type ______?
Salter Harris Type 2
What is the ASA Classification of patient w/diabetes and HTN?
ASA 111
What nerves are involved in Mayo block?
saphenous, medial plantar, deep peroneal, and medial dorsal cutaneous (superficial peroneal)
What is the Wagner classification?
What is the cyma line?
What is it for a pronated foot?
What is it for a supinated foot?
S-shaped line formed by the articulation of the TN and CC joints
Anterior break -> pronated foot
Anterior break -> pronated foot
Classification system for Lisfranc’s fracture?
Hardcastle:
1. A - Homolateral
2. B - Partial
• B1 – Partial: 1st ray medial dislocation only
• B2 – Partial/Complete: lateral displacement of lesser rays 2, 3, 4, 5, or all
iii. C – Divergent
• C1 Divergent Partial - 1st met medially and 2, 3, or 4th metatarsals laterally
• C2 Divergent Total - 1st met medially and lesser metatarsals 2-5 laterally
What angle does a Reverdin correct?
corrects PASA
Which nerve is not a part of the Sciatic Nerve?
Saphenous Nerve
Describe
1. SIRS
2. Severe Sepsis
3. Septic Shock
4. MODS
SIRS Criteria (≥2 meets SIRS definition)
Temp >38°C (100.4°F) or <36°C (96.8°F)
Heart rate >90
Respiratory rate >20 or PaCO₂ <32 mm Hg
WBC >12,000/mm³, <4,000/mm³, or >10% bands
Severe Sepsis
Suspected or present source of infection
Septic Shock
Lactic acidosis (lactate over 4), SBP <90 or SBP drop ≥40 mm Hg of normal
A 50-year-old patient presents with a tender mass on the lateral forefoot. A radiograph reveals an expansile “soap bubble” lesion in the 5th metatarsal. The most likely diagnosis is
Giant Cell Tumor
OCD of Talus Classification System?
Bernt-Hardy
1. Subchondral compression
2. Partial detached osteochondral frag
3. Completely detached, nondisplaced frag
4. Displaced osteochondral frag
Approx how much of its original strength does it retain after being in the body for 2 weeks?
75% of its original tensile strength at 2 weeks
What are the anatomic structures that make up the borders of Kager’s Triangle?
Achilles tendon, Calcaneus, FHL
Score for Necrotizing Fasciitis?
LRINEC SCORE
C-reactive protein- 4 pts
WBC- 2 pts
Hemoglobin- 2 pts
Na- 2 pts
Creatinine- 2 pts
Glucose- 1 pt
IF PATIENT IS LESS THAN 6=> RULE OUT NEC FAS
Best view to see Tarsal Coalitions: TC? CN?
TC = Harris beath, lateral, Isherwood
- halo sign, talar beak sign
CN = Medial Oblique
- Anteater Sign
TN = Lateral
Open fracture classification name?
1. Type 1: <1cm wound
- Type I Abx: Cefazolin /ANCEF (1st gen Cephalosporins)
2. Type 2: >1cm wound
- Type II Abx: Cefazolin / ANCEF (1st gen Cephalosporins)
3. Type 3: >5cm wound and dirty
• A: Adequate tissue coverage
• B: periosteal stripping
• C: arterial injury
- Type III Abx: Cefazolin + Gentamicin (1st gen Cephalo + Aminoglycoside)
When performing a 1st MPJ arthrodesis what position should it be fused?
10 degrees dorsiflexion and 10-15 degrees abducted
When doing a tarsal tunnel release, you have to go through the
Flexor Retinaculum
Treatment options for Pseudomonas?
1. Zosyn (pipercillin/tazobactam)
2. Carbapenam
3. Aminoglycosides (mycin)
4. Quinolones
What are the three phases of the Bone Scan (Tc-99 MDP)?
1.Flow Phase= Images are taken 1 to 3 seconds apart immediately following injection. Shows dynamic visualization of blood flow. Provides information about the relative blood supply to the extremity.
2. Blood pooling images= Images are taken 5 to 10 minutes following injection. Quantifies relative hyperemia or ischemia.
3. Delayed phase bone-imaging phase= Images are taken 3 to 4 hours following injection. Visualizes regional rates of bone metabolism. This phase is useful to determine cellulitis vs. osteomyelitis. By the 3rd phase
- With cellulitis=> flushing and cleaning returning toward normal density.
With osteomyelitis=> incorporation into the bone showing increased density.
Most common Lauge Hansen mechanism?
SER
LAUGE HANSEN- WEBER
supination-adduction (SAD)- WEBER A
without medial malleolar fracture
with oblique or vertical medial malleolar fracture
supination-external rotation: the most common form of injury (40-70%)- WEBER B
stage 1: the anteroinferior tibiofibular ligament is torn or avulsed
stage 2: the talus displaces and fractures the fibula in an oblique or spiral fracture, starting at the joint
stage 3: tear of the posteroinferior tibiofibular ligament or fracture posterior malleolus
stage 4: tear of the deltoid ligament or transverse avulsion fracture medial malleolus
pronation-abduction- WEBER C
stage 1: deltoid ligament disruption or transverse medial malleolus fracture
stage 2: posterior malleolus fracture
stage 3: oblique fibular fracture above the level of the joint, in a low medial high lateral fracture plane
pronation-external rotation- WEBER C
stage 1: deltoid ligament rupture, which may appear occult or as medial mortise widening, or transverse avulsion fracture of the medial malleolus
stage 2: involvement of the AITFL with extension into the interosseous membrane results in widening of the distal tibiofibular distance
stage 3: a spiral or oblique fibular fracture (>6 cm) above the talotibial joint
stage 4: involvement of the posterior inferior tibiofibular ligament (PITFL), or posterior malleolus fracture
What is lidocaine value for mg/kg max?
i. Max Lidocaine Plain = 4 mg/kg
ii. Max Lidocaine w/epi = 7 mg/kg
Ankle Block Nerves?
Charcot Pathophysiology Theories?
(hint-> three of them)
1. Neurovascular=> increase blood flow, increase osteoclasts, increase bone breakdown (French)
2. Neurotraumatic=> repetitive microtrauma
3. Uncontrolled Inflammation=> local hyperemia causes an increase in cytokines such as TNF-a, IL-1, IL-B. There is an increase in RANKL, which causes an increase in osteoclasts. OPG is decreased because it is an RANKL antagonist.