Wound Healing | Trauma | Anatomy | Ankle Arthroscopy | Infection |
---|---|---|---|---|
1. Hemostasis
2. Inflammation 3. Proliferation 4. Maturation.
What are the 4 stages of Wound Healing
|
LHS: A screw with a thread cut into its head which provides a mechanical couple, or linkage, to a threaded screw hole in a plate, thereby creating a fixed-angle device. They work rather like bolts than screws and may be monocortical; the axial force produced by the screw is minimal. The screw provides fixation based on the fact that the screw head is locked in a position perpendicular to the body of the plate which is not pressed against the bone.
NLHS: Any screw with a smooth outer surface of the head (ie, without threads) that is used for fracture or plate fixation.
Explain the difference between locking and non-locking screws
|
1. Posterior Tibial
2. Superficial Peroneal 3. Deep Peroneal 4. Sural 5. Saphenous
What are the 5 nerves blocked in an ankle block
|
osteochondral lesions of the talus microfracture of OCD debridement of post-traumatic synovitis ATFL anterolateral impingement AITFL anterolateral impingement resection of anterior tibiotalar spurssuch as anterior bony impingement os trigonum excision removal of loose bodies cartilage debridement in conjunction with ankle fusions
Indications for Ankle Arthroscopy ( Name 4 )
|
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
What is SIRS Criteria
|
Cicatrix
Surgical Term for Scar
|
Push-pull screw ( AO principle )
Ex: Distraction Technique for Obtaining Fibular Length.
A temporary anchor screw which provides a point of fixation for an instrument to reduce a fracture by distraction and/or compression, is called
|
perineurium
A peripheral nerve is a complex structure consisting of fascicles held together by the epineurium, an enveloping, external connective sheath. Each fascicle contains many nerve fibers and capillary blood vessels embedded in a loose connective tissue, the endoneurium. The perineurium is a multilayered epithelial sheath that surrounds individual fascicles.
The *** is a multilayered epithelial sheath that surrounds individual fascicles.
|
Triangulation
involves orienting the camera lens and an instrument within the ankle joint at the point of pathology at the same time. This principle allows the surgeon to inspect the pathology while the instrument manipulates it and visualize the location as the treatment occurs.
|
gram positive bacteria (57%) of which S. aureus accounted for 42%
According to literature on wound care Majority of deep wound swabs cultures exhibit predominance towards gram positive or gram negative bacteria?
|
TGF-B
This growth factor initiates the Initial stimulus of migration of epithelial cells.
|
Dynamization ( AO Principle )
Diverting the mechanical load from a fixation device to load the fracture site in order to enhance bone formation is called
|
Pseudoarthrosis --> literally means false joint.
When a nonunion is mobile and allowed to persist for a long period, the bone ends become sclerotic and the intervening soft tissues differentiate to form a type of synovial articulation, is termed
|
Pistoning
is the advancement and withdrawal of the camera within the joint space as the camera scans the joint. *** allows the inspection of the talar neck, synovium and ankle gutters and recesses.
|
Sepsis: SIRS + Source of Infection
Severe Sepsis: (Organ Dysfunction, Hypotension, or Hypoperfusion) Ex:Lactic acidosis, SBP <90 or SBP drop ≥ 40 mm Hg of normal Septic Shock: Severe sepsis with hypotension, despite adequate fluid resuscitation and Evidence of ≥ 2 organs failing
What is difference between ( 100 pos each )
Sepsis Severe Sepsis Septic Shock |
PDGF
This growth factor is responsible for the proliferation of fibroblasts leading to production of extracellular matrix during wound contraction
|
anteromedial (sustentacular) frag is rarely comminuted but varies in size; it remains attached to the talus by strong deltoid ligament and by the interosseous ligament lies in the interosseous sulcus between the posterior and middle facets; allows lag fixation to occur.
ST: - Projects medially and supports the neck of the talus - FHL courses inferior - Deltoid and talocalcaneal ligaments connect it to the talus. BONUS for 500. Best viewed on which
What is the constant fragment in calcaneal fractures
|
1. CC
2. Intercuneiform 3. Medial TMT 4. NC Joint
These 4 joints have a minimal impact for normal gait and are considered " non-essential" in reference to normal gait patterns.
|
Antero-central --> Right over Extensor tendons. Not typically used 2/2 damage of DP artery.
What is the least common used portal and why?
|
Cierny’s
Type I (medullary osteomyelitis) diffusely involves the intramedullary cavity, usually after medullary nailing. The entire medullary canal is involved, and will require surgical clearance (nail removal and reaming). Type II osteomyelitis is superficial, may be present under a plate, but is rarely, if ever, seen with fracture-site infection. Type III osteomyelitis (localized full-thickness cortical involvement), will require excision of all necrotic bone. During the excision, the full extent of the necrotic area becomes evident. This may weaken the bone, or produce significant dead space. Soft-tissue cover may be inadequate and therefore require reconstruction. Fracture healing may be a problem requiring additional treatment. Type IV osteomyelitis diffusely involves the entire circumference of a segment of the bone. The entire bone segment must be removed to eliminate necrotic tissue and persistent bacteria.
What is the name of the anatomical classification of osteomyelitis which is important for understanding and localizing the infection.
|
Type 3 to Type 1
the maturation phase is when collagen is remodeled from type *** to type *** and the wound fully closes.
|
15 degrees , another conclusion from this point is, if above 15 degrees conservative treatment can be warranted considering other fracture components.
Normal Bohler's Angle is considered between 20-40 degrees, According to AO Bohler's angle below *** is a strong indicator for operative fixation.
|
Kager's Fat pad
- At the posterior portion of the superior surface of the calcaneus you have the ** which separates the achilles tendon from the ankle joint. Purpose of this structure is to reduces friction from the tendon and the bone.
|
Posterior lateral
Remember Posteromedial portal risks posterior tibial artery
Best portal for access of os trigonometry
|
MSSA
Most common bug in septic arthritis ? (non-gonoccal )
|