Download Lisfranc Fixation: Types, Techniques, and Advantages and more Exams Workplace Safety in PDF only on Docsity!
DEX IOT DAY 3 TEST 2024 | ALL
QUESTIONS AND CORRECT
ANSWERS | ALREADY GRADED A+ |
LATEST VERSION
What is a temporary perc fixation of lisfranc ------CORRECT ANSWER------- --------k wire while ligaments heal but does not maintain compression and cant use for fusion Lisfranc screw fixation ------CORRECT ANSWER---------------no good, chewing up cartilage lisfranc plate fixation ------CORRECT ANSWER---------------maintains stability without crossing articular surface (diamond) lisfranc fusion does what ------CORRECT ANSWER---------------loses micromotion lisfranc ligament augmentation has to be what ------CORRECT ANSWER--- ------------has to be purely ligament injury, no fractures lisfranc internal brace and TR needed for ------CORRECT ANSWER---------- -----low energy purely ligament ligamentous injury
When would you try not to fuse lisfranc injury ------CORRECT ANSWER----- ----------young patient or athlete IB lisfranc downside ------CORRECT ANSWER---------------IB you need multiple people in the room to pull tapes and SL in Supplemental fixation for lisfranc ------CORRECT ANSWER---------------TR with plate so that when plate gets removed the reduction it still being assisted with tightrope Snap off pin sizes ------CORRECT ANSWER---------------1.9 or 2. 10 - 50 in 2mm increments TR button lisfranc has what feature ------CORRECT ANSWER--------------- antibirds nest: as sutures are coming down there is an extra stitch that will pull your sutures back to prevent any twisting and knotted Compression FT pin snap off pin (SOLID) options ------CORRECT ANSWER---------------sterile
- sterile doesnt have snapping features at end threads have to cut with wire cutter Lisfranc joint spans where ------CORRECT ANSWER---------------spans entire midfoot
Lisfranc complex ------CORRECT ANSWER---------------middle cueniform, medial cueniform, 2nd met, 1st met What comes in the mini tightrope implant system ------CORRECT ANSWER---------------tensioning handles 2.7 mm knotless mini tightrope implant 2.7mm cannulated drill nutunol passing wire x 1.24 mm kwire x #2 coreless suture 6 suture construct 5.5 round button 2.6 oblong Is there a fear of overtensioning mini tightrope for lisfranc ------CORRECT ANSWER---------------no- there is an instability but not deformity Is there a need to do joint prep for lisfranc injury ------CORRECT ANSWER- --------------no What dorsal structure to be aware of on top of cueniform ------CORRECT ANSWER---------------neurovascular bundle located under the extensor hallucis brevis dorsal pedis (pick and side and go down to bone) What to be aware of for your medial incision ------CORRECT ANSWER------ ---------extensor tendons tibialis anterior
Lisfrance tightrope incisions ------CORRECT ANSWER--------------- 2 incisions 1 - dorsal between 3st and 2nd met bases 2 - medial along medial cueniform and inferior to tibial anterior tendon insertion What is the drill diameter and depth for lisfranc tightrope Ib on medial cueniform ------CORRECT ANSWER---------------3.5 drill diameter 15mm depth Process of wire for lisfranc TR ------CORRECT ANSWER---------------1. tightrope starting at dorsal lateral edge of 2nd base aim plantar to medial cuneirform through the interosseous lig For a lisfranc ligament where should the gw exit ------CORRECT ANSWER- --------------inferior to the tibialis anterior tendon Process of drilling for Lisfranc TR ------CORRECT ANSWER--------------- overdrill the wire with 2.7 drill starting at the 2nd met and exit medially through medial cuneiform What do you do after you drill for lisranc TR ------CORRECT ANSWER------ ---------pass wire retrograde insert TR needle and pass medial to lateral while keeping tension to ensure button remains flat remove lateral slack and guide round button down to bone on medial side tension with handles
midfoot lateral column ------CORRECT ANSWER---------------flexible, allows us to balance on uneven surgface biomechanically how does lisfranc happen ------CORRECT ANSWER-------- -------direct or indirect high or low direct lisfranc force is what ------CORRECT ANSWER---------------forcce applied to mid foot being run over standing force is going from bottom up and somethign else is coming from top to bottom pushing down or vise versa keystone configuration ------CORRECT ANSWER---------------middle cuneiform is shorter and the second met comes down further to give midfoot stability lisfr ------CORRECT ANSWER--------------- indirect lisfranc force is what ------CORRECT ANSWER---------------indirect force applied to midfoot caused by something else oplantar flexed foot with acial load, anterior or posterior displacement goes through mid foot and tarsal bones go anterior or posterior high enerfy lisfranc injury is what ------CORRECT ANSWER---------------fell off room, car wreck
low enerfy lisfranc injury is what ------CORRECT ANSWER--------------- soemthing falls on back of foot role of hardware in ORIF ------CORRECT ANSWER---------------maintains reduction hardware removed Role of hardware for fusion ------CORRECT ANSWER--------------- compresses fusion hardware left in place classic fixation device ------CORRECT ANSWER---------------k wire screws plates imaging for lisfranc ------CORRECT ANSWER---------------anterioposterior oblique lateral weight bearing and fluoro fleck sign ------CORRECT ANSWER---------------avulsion fracture lisfranc ligament ------CORRECT ANSWER---------------medial cueniform to base of second met
claw toe ------CORRECT ANSWER---------------extended MTP, flexed PIP and flexed DIP neuromuscular disorder and lesser toes? ------CORRECT ANSWER---------- -----claw What is the most common toe deformity ------CORRECT ANSWER----------- ----hammertoe what is the cause of toe deformities ------CORRECT ANSWER--------------- imbalance between flexors and long extensors extensor digitorum longus insertionf ------CORRECT ANSWER--------------- inserts on the distal and middle phalanges of 2-5 on dorsal aspect extensor digitorum brevis insertion ------CORRECT ANSWER--------------- inserts on the middle phalanges of 2-4 and proximal phalanx of the 1st on plantar aspect flexor digitorum longus insertion ------CORRECT ANSWER--------------- inserts on plantar base of 2-5 distal phalanx flexor digitorum brevis insertion ------CORRECT ANSWER--------------- plantar surface of distal phalanges 2- 5
solutions to forefoot deformities ------CORRECT ANSWER--------------- fusion what does plantar plate do ------CORRECT ANSWER---------------keeps MTP from excessive extension where does plantar plate insert ------CORRECT ANSWER--------------- inserts at proximal base when plantar plate ruptures what does it cause ------CORRECT ANSWER-- -------------displacement or rupture what is the static stabilizers ------CORRECT ANSWER---------------plantar plate accessory collateral proper collateral plantar fascia plantar plate solution ------CORRECT ANSWER---------------CPR crossover toe is caused by ------CORRECT ANSWER---------------plantar plate collateral ligaments
HVI ------CORRECT ANSWER---------------hallux valgus interphalangeal angle < Akin osteotomy ------CORRECT ANSWER---------------osteotomy of proximal phalanx dont cut lateral cortex Weil osteotomy ------CORRECT ANSWER--------------- 1 - 2mm below dorsal aspect of met articular surface push met back 5-10mm and pin most common cut ------CORRECT ANSWER---------------transverse
- rotational correction Healing of bunion ------CORRECT ANSWER---------------bone frill in over screw and corrects mechanical axis MIS power ------CORRECT ANSWER---------------AR-200 power unit
- power=speed x torque
- high torque low speed what is RPM ------CORRECT ANSWER--------------- 6000 10,
NCM ------CORRECT ANSWER--------------- 100
irrigation ------CORRECT ANSWER--------------- 2 green reverse ------CORRECT ANSWER---------------delay for 2 seconds yellow what burr do you use for mis bunion ------CORRECT ANSWER--------------- 2mm angled slightly to shift toe slightly up pitfalls of plantar lapidus ------CORRECT ANSWER---------------prolonged non weight bearing wound complications and prolonged swelling nonunion what does the plantar lapidus plate irritate ------CORRECT ANSWER--------- ------tibialis anterior plantar lapidus plate upsides ------CORRECT ANSWER---------------tensions side of the joint good soft tissue faster weight bearing compression dorsal medial plate ------CORRECT ANSWER---------------is plantar gapping
lisfranc plates ------CORRECT ANSWER---------------fixation or fusion 3.5 locking (kreulock) and comp high or low energy injuries L and R S,M,L 1.4 thickness alone or with screws, KMTR, IB always bring with flexible fixation options lisfranc IB ------CORRECT ANSWER---------------purely ligamentous ideal for athletes standard construct should include over the top what are watchouts for lisfranc IB ------CORRECT ANSWER--------------- proper tensioning soft bone benefits of lisfranc iB ------CORRECT ANSWER---------------low profile fixation string biomechanical data what comes in lisfranc IB ------CORRECT ANSWER----------------ss oblong button
- 4.75 PEEK anchor 2mm CC fibertape
- 3.5 PEEK anchor
knotless mini TR ------CORRECT ANSWER---------------purely ligamentous injury ideal for athletes additional fixation for intercuneiform istability required alternative to those who struggle with tensioning the IB what to watchout ------CORRECT ANSWER---------------prominence of medial button benefits of lisfranc tightrope what comes in kit ------CORRECT ANSWER---------------knotless tensionable oblong button 6 stand, #2 coreless machine suture round button gold standard: screws or plates ------CORRECT ANSWER--------------- highest complication is hardware breakage requires 2nd surgery for HWR flexible fixation of lisfranc ------CORRECT ANSWER---------------knotless, stronger than not knotless mini TR robust fixation less disruption of MC-2nd joint auxillary support to joint after healing burns no bridges Lisfranc Mini TR vs screw ------CORRECT ANSWER---------------TR provides comparable fixation, stability, and clinical outcomes as compared to screw fixation
whats the strongest construct ------CORRECT ANSWER---------------lisfranc fixation in the medial cuneiform if there is mild instability in the sagittal plane what todo ------CORRECT ANSWER---------------fixate with dorsal plate snap off screw features ------CORRECT ANSWER---------------laser marked for percutaneous insertion snap off feature variable stepped thread pitch self tapping snap off screw pitch ------CORRECT ANSWER---------------variable wider tip enters first and get smaller causing compression snap off screw features ------CORRECT ANSWER---------------self drilling and self tapping compression FT pin snap off screw STERILE ------CORRECT ANSWER---- -----------1.9 x 30 or 50 2.4 x 30 or 50 snap off screw ------CORRECT ANSWER---------------smaller footprint- able to use in conjuction with plates, staples, screws fewer steps
no need to change power attachment no driver issues preliminary fixation with compression that you can leave in easy to relocate during a case removable tissue protector ------CORRECT ANSWER---------------used to maintain entry point of pin minimize risk of premature breakage fulcrum for controlled snapping of pin pin cutters ------CORRECT ANSWER---------------two cutting surfaces helps to cut flush rubber inserts capture fragments manageable size pin driver ------CORRECT ANSWER---------------fine tuning by hand advance/backout after early snap extraction option extractors ------CORRECT ANSWER---------------size specific can remove 2.5 comp ft and competitive products minimal bone loss extractor technique pearls ------CORRECT ANSWER---------------before running power, trephine head of implant by hand to eliminate skiving apply downward force in same axis as implant until threads engage, unless bone quality is poor
