What is the Open Fracture classification and what are the antibiotic recommendations?
What is Gustillo Anderson
I. Clean Wound <1cm in diameter
-Abx choice: 1st generation cephalosporin
II. Wound 1.0-5.0cm in diameter with minimal soft tissue damage
-Abx choice: Ancef, Clindamycin
III. Wound >5cm in diameter with extensive soft tissue damage
-Abx choice: Ancef (or high dose PCN), Clindamycin and Aminoglycoside
-IIIA: Adequate soft tissue coverage
-IIIB: Extensive soft tissue damage with periosteal stripping and massive contamination
-IIIC: Arterial damage requiring primary repair
100
What are common pre-op labs you would order for a 65 y/o Diabetic patient undergoing an elective bunionectomy?
HgA1c, CBC, BMP, Vitamin D
100
What is Virchow's triad?
-Hypercoagulable state
-Immobilization
-Vessel Wall Injury
100
Name the parts of the screw
Screw Anatomy/Definitions
-Head: more efficient hexagonal vs. cruciate
-Land: underside of the head which contacts the near cortex. Want as much land-bone contact as possible to reduce stress at any one location. This is the same principle as washers and countersinking.
-Shank: unthreaded portion of the screw
-Run-out: junction between the shank and the threads. Represents the weakest portion of the screw.
-Thread diameter: diameter of threads + core (major diameter)
-Core diameter: diameter without the threads (minor diameter)
-Pitch: distance between threads
-Tip: can be round, trocar or fluted
-Axis: central line of the screw
-Rake Angle: thread to axis angle
-Thread Angle: angle between the threads
200
What is the name for osteochondrosis of the navicular?
Kohlers
200
How do you measure compartment syndrome? What are the P's of compartment syndrome?
What is wick's catheter (stryker stick). >30-40 mmHg
-Pain out of proportion and not controlled by analgesics -Paralysis
-Pain with passive dorsiflexion of the toes -Pulselessness
-Paresthesia
-Pallor
-Pressure
200
What are the principles of AO technique?
What is early ROM, atraumatic technique (preserve blood supply), accurate anatomic reduction, stable fixation
200
What does the FAT CIAZ acronym stand for? What does it apply to?
Common bugs:
-Most common?
-2nd most common?
-Puncture through shoe gear?
-Puncture involving soil or a farm?
-Human bites?
-Cat bites?
-Dog bites?
-Most common? Staph Aureus
-2nd most common? Beta-hemolytic strep
-Puncture through shoe gear? Pseudomonas
-Puncture involving soil or a farm? Clostridia
-Human bites? Eikenella corrodens
-Cat bites? Pasteurella multocida
-Dog bites? Enterobacter, Pseudomonas, Staph, Bacillus
300
What are the nerves affected in a Mayo block?
What is saphenous nerve, deep peroneal nerve, medial dorsal cutaneous, medial plantar nerve
300
What are the 2 mechanisms of stress fractures?
Between 80-95% of all stress fractures occur in the LE with the most common sites being the metatarsals-20% with 2nd metatarsal most commonly
-Stress fractures can occur via two mechanisms:
1. Chronic strain upon a normal bone
2. chronic, normally benign strain upon a weakened bone
300
Name LAG technique in order
What is thread hole, glide hole, countersink, measure, tap, insert (DOCMTV)
300
Name 2 drugs for PCN allergy pts
Clindamycin, levaquin, vancomycin, bactrim
300
What values for AAI's and TcPO2 are associated with healing potential?
-ABI: -Values >0.9 associated with good healing potential
-Values 0.5-0.9 associated with PVD and delayed healing
-Values <0.5 associated with ischemia and problematic healing
-Be wary of elevated values secondary to vessel calcification
-TcPO2: -Values >30mmHg associated with good healing potential
-Values <20mmHg associated with microcirculatory problems and delayed/problematic healing.
400
What are the types of non-unions?
What is hypertrophic (elephant, horsefoot, oligotrophic) and atrophic (torsion wedge, comminuted, defect, atrophic)
400
What is the Achilles rupture classification?
What is Kuwada -
Type I: Partial tear involving <50% of tendon.
-Type II: Complete tear with <3cm deficit
-Type III: Complete tear with a 3-6cm deficit
-Type IV: Complete tear with a >6cm deficit
400
Bunion procedures: Name 3 distal, 3 shaft, and 3 proximal metatarsal bunion procedures
What is DM, alcoholic, nutrition (B6, B12), Guillain Barre, toxins, hereditary, endocrine, recurrent, amyloidosis, porphyria, infections, systemic, tumor
(DANG THERAPIST)
400
What is the antidote for warfarin and heparin therapy?
What is vitamin K and protamine sulfate
500
What anterior ankle ligament can contribute to anterolateral impingement?
What is Bassett’s ligament (Thickened accessory anterior inferior tibiofibular ligament)
500
What are the Ottawa Ankle Rules?
-Bone tenderness along distal 6cm of posterior edge of fibula or tibia
-Bone tenderness at tip of fibula or tibia
-Bone tenderness at the base of the 5th met
-Bone tenderness on the navicular
-Inability to bear weight/walk 4 steps
500
What are the phases of bone healing?
Phases of Bone Healing
-Inflammation (10%)
-Hematoma fills the area with fibrin, RBCs, neutrophils, platelets, macrophages, fibroblasts (from PMNs).
-Mesenchymal cells from the cambium layer differentiate into osteoblasts and chondrocytes.
-Chemotaxis by growth factors (transforming growth factor beta, platelet derived, and macrophage derived)
-Reparative/Regenerative (40%)
-Soft callus forms and is replaced by bone.
-Cartilage, fibrocartilage, collagen and hydroxyapatite deposition
-Cartilage replaced by bone like endochondral ossification
-Remodeling (70%)
-Callus completely replaced by bone
-Vascular network is normalized
-Remodels according to Wolff’s Law