Procedure
Procedure 2
Pearls
Complications
Potpourri
100

What are your incision approach options?

What are - a lateral extensile approach to the ankle and subtalar joint, with the option of a posterior approach

100

Causes of Ankle and STJ Arthritis? (Name 5, if you get all 7, you get double the points)

What are Primary osteoarthritis, Trauma, Neuroarthopathy, Infection, Avascular necrosis, Inflammatory arthritis, Iatrogenic (failed surgery)

100

What should be used for autogenous bone graft (if needed) during this procedure?

What is the previously removed fibula

100

What percentage of these cases have complications?

What is up to 50%

100

Chiefs Favorite Basketball Team?


Double points for full name

What are:

Knicks

(Knickerbockers)

200

What muscle belly must be elevated to expose the subtalar joint?

What is the EDB

200

There are many fixation techniques, properly describe one.

I'll judge

200

Post op course? (can be variable, must make sense)

What is: Discharge home vs Admit for abx and pain management for 24 hours

10-14 day suture removal.

Non Wb cast for 6-8 weeks, followed by 6 weeks protective wb in splint/boot

CT recommended at 12 weeks for evaluation of fusion - if healed, full wb. if not, continue use of boot

During transition from Cam boot to shoe wear - it is recommend to use stiffer soled shoes, rocker-bottom modification and fixed ankle brace to extend above the ankle



200

Where is the bone likely to fail once the patient is fully weight bearing?

What is At the most proximal aspect of the plate, unless some forces are dissipated with stiff sole shoes or rocker bottom

200

How much of the Talus is covered by articular cartilage?

What is roughly 70%

300

What important nerve must you avoid during your dissection? And approximately where does that nerve exit the fascia?

What is The Superficial Peroneal nerve

 And what is Approx. 10-12 cm proximal to the fibular tip

300

What do you do if there is significant bone loss or fragmentation of your talus intra-op?  

What is fuse the tibia to the calcaneus. 


In this case the calcaneal articular process will need to be removed with an osteotome to create a flat surface that will lie flush to the tibial plafond.

300

If using a burr to prep the joints, what must be utilized and why?

What is use saline to cool the surface to avoid thermal and eventually avascular necrosis.

Avascular necrosis of the talus is the greatest cause of non union in a TTCA

300

How much does the Non-union rate go up if the patient is a smoker?

What is - anywhere from a 2.7x increase to a 14x Increase.  (If your answer is in this range, easy cash!)

300

Where did chief go to undergrad and podiatry school?


Double points if you know what his major was

Rutgers (exercise science)


NYCPM

400

What is the correct anatomic location of your fibular osteotomy?

What is approximately 6 to 10 cm proximal to the tip of the lateral malleolus

400

If you have large bony deficits, causing loss of limb length, what are your options for autograft and allograft? Gold standard?

What are Iliac crest autograft (GS) or femoral head allograft

400

What is the proper approach to the procedure if infection is your indication?

External fixation and washout, infection must be cleared before permanent fixation is placed.

400

What is the most likely scenario for a dorsiflexion nonunion?

What is during a total talectomy

400

What is the name for a tiny self retaining retractor?


Double points: what is the instrument called that holds both sides of a vessel while you repair it?

Heist 


Bulldog (Go Dawgs!)

500

What Nerve would you encounter distally? Where does it come from? Sensory or Motor? What does it innervate? Terminal Branches? 


Bonus for Double! How much of this nerve can you harvest for grafting?



What is the Sural Nerve. Made of branches from the common peroneal nerve and tibial nerve, from nerve roots: L4-S4.  Sensory Nerve, innervate posterolateral aspect of distal third of leg.  Lateral aspect of foot, heel, and ankle. Terminal Branches: lateral dorsal cutaneous nerve, Lateral calcaneal branches


25 cm

500

Give a detailed explanation on correct final positioning (hindfoot varus/valgus, ankle df/pf, internal/external rotation, and translation of talus)

What is - 

Hindfoot is in neutral to 5 degrees of valgus

Ankle is neutral in the sagittal plane.  

External rotation should be approximately that of the contralateral extremity, usually 5 to 10 degrees

5 mm of posterior talar translation

500

It is important to have longterm expectations clearly explained to your patient.  What is a likely future pathology the patient will encounter secondary to this procedure?

What is - Adjacent hindfoot arthritis.  They will attempt to find motion somewhere!  TN/CC joints will likely become arthritic next, which is why patient choice is vital, do this on somebody too young, and you are setting them up for failure.

500

Most common complications(4)?  and What is the average nonunion rate reported? and what is the highest reported nonunion rate?

What are Nonunion, malunion, infections, neuroma

Most commonly reported is 10%

What is 40% as the highest

500

What does AO stand for? 

What is Arbeitsgemeinschaft für Osteosynthesefragen