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Orthopedic Surgical Procedures: Troch Nail, Femur Fractures, and Carpal Instability, Exams of Workplace Safety

Answers to various questions related to orthopedic surgical procedures, including the use of a troch nail, indications for different types of femur fractures, and the treatment of carpal instability. It also covers topics such as the anatomy of the ulnar collateral ligament (ucl) and its injuries, as well as the principles of fixation for pilon fractures.

Typology: Exams

2023/2024

Available from 04/03/2024

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DEX IOT DAY 5 TEST 2024 | TRAUMA AND
HAND & WRIST | ALL QUESTIONS AND
CORRECT ANSWERS | LATEST VERSION |
ALREADY GRADED A+
When covering a CMC Suspensionplasty using the FiberLock™
Suspension System, what should you bring for the back table? ------
CORRECT ANSWER---------------DX SwiveLock® SL, 1.3 mm SutureTape
DX FiberTak®, sterile Mini TightRope® button
The FiberLock™ Suspension System includes which drill bit sizes. (Select
all that apply) ------CORRECT ANSWER---------------3.0 and 2.7
True of False: Removal of the trapezium is not needed before completing
the CMC Suspensionplasty Using the FiberLock™ Suspension System. ----
--CORRECT ANSWER---------------False
When drilling the radial corner of the 1st metacarpal for the Thumb CMC
APL Suspensionplasty with InternalBrace™ Ligament Augmentation,
overdrill the guidewire with the gold 3.5 mm cannulated drill coupled with
the drill guide. The drill guide has a depth stop at ____: ------CORRECT
ANSWER---------------1 cm / 10 mm
True or False: The Hand and Wrist InternalBrace™ Ligament
Augmentation Repair Convenience Kit includes a 3.0 mm cannulated drill
bit for constructs with graft incorporation and a 3.5 mm cannulated drill bit
all-suture constructs. ------CORRECT ANSWER---------------False
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Download Orthopedic Surgical Procedures: Troch Nail, Femur Fractures, and Carpal Instability and more Exams Workplace Safety in PDF only on Docsity!

DEX IOT DAY 5 TEST 2024 | TRAUMA AND

HAND & WRIST | ALL QUESTIONS AND

CORRECT ANSWERS | LATEST VERSION |

ALREADY GRADED A+

When covering a CMC Suspensionplasty using the FiberLock™ Suspension System, what should you bring for the back table? ------ CORRECT ANSWER---------------DX SwiveLock® SL, 1.3 mm SutureTape DX FiberTak®, sterile Mini TightRope® button The FiberLock™ Suspension System includes which drill bit sizes. (Select all that apply) ------CORRECT ANSWER---------------3.0 and 2. True of False: Removal of the trapezium is not needed before completing the CMC Suspensionplasty Using the FiberLock™ Suspension System. ---- --CORRECT ANSWER---------------False When drilling the radial corner of the 1st metacarpal for the Thumb CMC APL Suspensionplasty with InternalBrace™ Ligament Augmentation, overdrill the guidewire with the gold 3.5 mm cannulated drill coupled with the drill guide. The drill guide has a depth stop at ____: ------CORRECT ANSWER---------------1 cm / 10 mm True or False: The Hand and Wrist InternalBrace™ Ligament Augmentation Repair Convenience Kit includes a 3.0 mm cannulated drill bit for constructs with graft incorporation and a 3.5 mm cannulated drill bit all-suture constructs. ------CORRECT ANSWER---------------False

True or False: Harvesting a graft wider than 2 mm to 2.5 mm is not advised and can compromise proper fixation in the blind ------CORRECT ANSWER- --------------True When harvesting the abductor pollicis longus tendon graft for the Thumb CMC APL Suspensionplasty with InternalBrace™ Ligament Augmentation, an ideal tendon graft that would fit through the eyelet of the 3.5 DX SwiveLock® SL anchor and have proper fixation in the blind tunnel, measures: ------CORRECT ANSWER---------------2 x 4 mm Key benefits of the InternalBrace™ Ligament Augmentation include: ------ CORRECT ANSWER---------------Minimally invasive surgical technique Durable, reliable, and stable fixation Shortened immobilization Improved functional results and return to play activities True or False: The Mini TightRope® system and InternalBrace™ Ligament Augmentation were introduced by Arthrex in 2009, enhancing the surgical options to treat the thumb carpal-metacarpal joint. ------CORRECT ANSWER---------------True Which structure is used as a biological tendon graft in conjunction with the InternalBrace™ Ligament Augmentation for thumb carpal-metacarpal arthritis? ------CORRECT ANSWER---------------Abductor Pollicis Longus (APL) True or False: The thumb carpal-metacarpal has a loose capsule allowing for multiple planes of motion in the thumb including flexion, extension,

What bone articulates with distal radius at radial styloid? ------CORRECT ANSWER---------------Scaphoid The torque limiting handle with the distal radius plates should be used for the distal 2.4mm screws to prevent over torquing or under torquing of these screws. ------CORRECT ANSWER---------------True What suture is on the DX fibertak anchor? ------CORRECT ANSWER-------- -------1.3 mm flat suture What is a way to incorporate biologic feature into Fiberlock? ------ CORRECT ANSWER---------------Harvest FCR tendon What is included in nanoscopic release system? ------CORRECT ANSWER---------------180 mm NanoNeedle Scope, a Centerline™ device, and a dilator/synovial scraper instrument. Advantages of ECTR? ------CORRECT ANSWER---------------Cosmetic scar Less pain and faster return to activities End results = equal Surgeon = higher reimbursement Do not have full visualization with mini open / have to cut through thick connective tissue Shiny tissue = antebrachial fascia = continuous with transverse carpal ligament When doing an ECTR what is the main reason a surgeon should avoid making an incision between the flexor carpi radialis tendon and the

palmaris longus tendon? ------CORRECT ANSWER---------------They run the risk of palmar cutaneous branch of median nerve Which of the following conditions can mimic the symptoms of carpal tunnel syndrome? ------CORRECT ANSWER---------------Cervical radiculopathy Thumb CMC arthritis Median nerve entrapment at the elbow Nonspecific Tenosynovitis Where should you make incision for ECTR? ------CORRECT ANSWER------ ---------Proximal wrist crease

  • in between flexor carpiulnaris and the palmaris longus What ligament should you cut for ECTR? ------CORRECT ANSWER---------- -----cut only 1/3 of ligament distally and proximal Start and end point for troch nail ------CORRECT ANSWER---------------Start point: Tip of the greater trochanter End point: For standard and ES Nail, the superior pole of the Patella What are the lengths of the troch nail? ------CORRECT ANSWER------------- --ES and long - 30 - 42cm in 3cm increments ES and long Short nail is only 20 cm Fractures and treatment types for troch nail? ------CORRECT ANSWER----- ----------Fractures that are treatable with a Troch nail and indications: Basicervical→ short and ES Intertrochanteric→ short and ES

What are the most common size distal diameter? ------CORRECT ANSWER---------------10 and 11 mm How many degrees of lateralization? ------CORRECT ANSWER--------------- 5 degree Surgical Steps for Troch Nail: ------CORRECT ANSWER---------------- Find start point with guide wire or awl

  • Open with proximal reamer
  • Insert ball tip guidewire, prepare with flexible reamers (long & ES nails only)
  • Measure and implant nail with aiming rig / jig
  • Prep for lag screw with 3 piece cannula
  • Implant lag screw with insertion driver and compression knob
  • Distal interlocking cannula (3 pieces) and drill What does the anto-rotational screw prevent? ------CORRECT ANSWER---- -----------rotational control of the femoral head What is intracapsular versus extracapsular? ------CORRECT ANSWER------ ---------Intracapsular: femoral neck Extracapsular: intertroch What tendon is harvested for Scapholunate reconstruction? ------ CORRECT ANSWER---------------ECRB (extensor carpi radialis brevis) Where is the insertion point of the ECRB? ------CORRECT ANSWER--------- ------Base of 3rd met

What suture should you use to whipstitch your tendon in a SL recon? ------ CORRECT ANSWER--------------- 2 - 0 fiberloop How many guidewires come in the H&W IB? What size are they? ------ CORRECT ANSWER---------------1.35 x What do you need to bring in addition to IB for an all-dorsal scapholunate? ------CORRECT ANSWER---------------An additional 3.5x8.5 SL What do you need to bring in addition to IB for an interossoeus SL recon? - -----CORRECT ANSWER---------------3x8 teno Lasso 3.5x8.5 dx swivelock What suture comes in hand and wrist IB? ------CORRECT ANSWER--------- ------1.3mm suturetape What is your bailout if the lunate tunnel is too short / small for a 3x8 teno screw? ------CORRECT ANSWER---------------If the length of the tunnel is less than 8 mm, the body from a 3.5 mm DX SwiveLock SL anchor can be used. The tunnel should be overdrilled with the 3.5 mm drill if this fixation method is preferred. What bones should you pin for post op scapholunate repair? ------ CORRECT ANSWER---------------Scaphoid & capitate

what nerve is responsible for sensory information of the tip of the index and long finger of the hand? ------CORRECT ANSWER---------------median what area of the hand does the median nerve give sensory information? ---- --CORRECT ANSWER---------------palmar aspect of the thumb, index, long finger, and radial half of the ring what anatomic structure sets the floor for carpal tunnel? ------CORRECT ANSWER---------------proximal carpal row what is the significance of identifying kaplan's cardinal line when using the nanoscopic centerline for ECTR? ------CORRECT ANSWER--------------- identifies distal margin of transverse carpal ligament when doing ECTR what is the main reason a surgeon should avoid making an incision between the flexor carpi radialis and palmar longus tendon? -----

  • CORRECT ANSWER---------------they run the risk of innjuring the palmart cutaneous branch of the median nerve what position is the thumb while tensioning the internal brace? ------ CORRECT ANSWER---------------30 degrees flexion Skier's Thumb ------CORRECT ANSWER---------------- acute tear of UCL
  • outside force cause
  • causes valgus stress of metacarpal

Steiner Lesion ------CORRECT ANSWER---------------UCL kicked from abductor AP neurosis Acute injury Palpable mass / edema Gamekeeper's thumb ------CORRECT ANSWER---------------Chronic attenuation or overuse of UCL > pain and instability Timeline of UCL with IB versus without? ------CORRECT ANSWER----------- ----Range of motion within 1st week Strengthening by 2 weeks (with IB) versus ROM 3-4 weeks, strengthening at 6 weeks What allows pinch grasp? ------CORRECT ANSWER---------------UCL + collateral ligaments What are the three ranges of motion for CMC? ------CORRECT ANSWER-- -------------adduction-abduction, flexion-extension and axial rotation. The thumb carpal-metacarpal is classified as which type of joint: ------ CORRECT ANSWER---------------Bi-concave convex saddle joint The FiberLock™ Suspension System features which of the following advantages: ------CORRECT ANSWER---------------Knotless fixation Single incision Direct visualization while drilling

What degree of anteversion do long & ES nails have? ------CORRECT ANSWER---------------10 degree anteversion in the troch nail system, the lag screw and AR screw cannot be used together. ------CORRECT ANSWER---------------False The Arthrex ES nail is indicated for subtroch fractures that extend into the diaphysis ------CORRECT ANSWER---------------False The subtroch region is defined by area that is just inferior to the lesser troch extending approximately: ------CORRECT ANSWER---------------5cm T/F: All troch nails have a 5 degree lateral bend to accomodate for troch start point ------CORRECT ANSWER---------------true the femoral calcar region of the femur has the strongest bone in the proximal femur. ------CORRECT ANSWER---------------True which type of femur fx makes up 10-30% of all hip fractures, has bimodal distribution in the 20's and 60's age population, and is often associated with biphosphonate drug treatment? ------CORRECT ANSWER--------------- subtroch Pre-op radiographs oof injured femur may be used to establish ------ CORRECT ANSWER---------------- Proper nail diameter

  • lag screw angle and length
  • troch nail length The arthrex troch ES nail carries same indications for use as short troch nail ------CORRECT ANSWER---------------True Which anatomic structure landmarks best describe start point for troch nail: ------CORRECT ANSWER---------------Tip of greater troch T/F: The ArhtroFX ex-fix system shanz pins should be placed out of the zone of injury or definitive hardware placement to avoid cross- contamination with pin sites. ------CORRECT ANSWER---------------True The __ mm diameter, carbon fiber rods included in the ArthroFX are suitable for indications outside of the distal tibia, including the femur, pelvis, and humerus ------CORRECT ANSWER---------------11mm Potential advantages for the use of the ArthroFX™ External Fixation System include: ------CORRECT ANSWER---------------In some cases, it can provide definitive stabilization and care for a fracture Adaptable to widely varied injury patters Permits dressing changes and visualization of wounds Surgical access to neurovascular structures while osseous length is maintained The ArthroFX™ External Fixation System 6.0 mm Transfixation Pin should be placed medial to lateral to avoid which neurovascular structures on the medial aspect of the foot and ankle complex: (select all that apply) ------ CORRECT ANSWER---------------Tibial nerve

What is the setting time for Quickset? ------CORRECT ANSWER--------------

  • 8 minutes What is quickset? ------CORRECT ANSWER---------------Sodium phsophate injectable, hardening, resorbable bone cement What is bonesync? ------CORRECT ANSWER---------------Calcium Phosphate cement self-drilling and self-absorbing saline, blood, and BMA, Appropriate indication for products? ------CORRECT ANSWER--------------- Allosync: fusions, non-unions, simple fractures Bonesync, Quickset: Large voids, highly comminuted fractures What type of carrier is within AlloSync DBM putty, gel, and paste which allows it to become more viscous and harden, at body temperature? ------ CORRECT ANSWER---------------reverse phase medium = more viscous at body temp When preparing to cover a pilon fracture case, what Orthobiologic product should be on hand that typically would NOT be used in a standard ankle fracture case? ------CORRECT ANSWER---------------quickset Which of the following Arthrex Bone Void solutions provide cell, signal, and scaffold? ------CORRECT ANSWER---------------arthrocell

What are the contents of our allosync gel, putty, paste ------CORRECT ANSWER---------------Allosync putty, Gel and Paste Demineralized Bone Matrix (36%) +Carrier (64%) what is the shelf life of arthrocell? ------CORRECT ANSWER--------------- 3 years True or False: An anterolateral distal tibia fragment (Chaput) can be stabilized with the Straight Plate from the Distal Tibia Plating System. ------ CORRECT ANSWER---------------True All of the following are plate options found in the Pilon Fracture Distal Tibia Plating System, EXCEPT: ------CORRECT ANSWER---------------All of the following are plate options found in the Pilon Fracture Distal Tibia Plating System, EXCEPT: What ankle injury is summarized by the expression "bimalleolar equivalent fracture"? ------CORRECT ANSWER---------------lateral malleoulus fx, medial mal intact, deltoid rupture Which plate included in the Pilon Fracture Distal Tibia Plating System comes in a straight and anatomic option? ------CORRECT ANSWER--------- ------Posterolateral distal fibula plate Which finding is not commonly seen in low-energy pilon fractures? ------ CORRECT ANSWER---------------severe metaphyseal and articular comminution

When a surgeon is using the Arthrex Small External Fixator for a distal radius fracture what position should he/she place the metacarpal pins? -----

  • CORRECT ANSWER--------------- 30 - 40 degrees in sagittal plane Minimal fixation when using the Arthrex Small External Fixator to achieve lateral column lengthening for a cuboid crush fracture can be achieved with? ------CORRECT ANSWER---------------1x2.0 mm or 3.0 mm metatarsal pin and 2x3.0 mm calcaneal pin What are some technical pearls that you can provide to help a surgeon who is having trouble getting the rods to snap in place when using the Arthrex Small External Fixator? ------CORRECT ANSWER---------------B. Completely loosen the clamp bolts before trying to snap the rods in place C. Slide the rods in from the side and tighten the clamp bolts afterwards What are some technical pearls that you can provide to help a surgeon increase the construct stiffness when using the Arthrex Small External Fixator? ------CORRECT ANSWER---------------Add neutralization rods Add pins in each segment Place the rods closer to the bone When using the Arthrex Small External Fixator which size pins would a surgeon most commonly use for distal forefoot and metacarpal fractures? -- ----CORRECT ANSWER---------------2.0 mm

The Arthrex Small External Fixator consists of __mm and __mm threaded pins and __mm carbon fiber bars. ------CORRECT ANSWER--------------- 2.0, 3.0, 5. Restore lateral column length ------CORRECT ANSWER--------------- What are the 3 types of proximal femur fractures? ------CORRECT ANSWER---------------Subtroch, Intertroch, Femoral Neck What is the challenge of intra-articular fractures? ------CORRECT ANSWER---------------Synovial fluid in joint capsule is detrimental to healing What defines the subtroch region? ------CORRECT ANSWER--------------- Extends 5 cm distal to lesser trochanter What is the normal neck shaft angle of proximal femur? ------CORRECT ANSWER---------------130 degrees +/- 7 degrees What is the normal femoral anteversion angle and why does it exist? ------ CORRECT ANSWER---------------10 degrees +/- 7 degrees; femoral head is anterior to shaft What is the femoral calcar? ------CORRECT ANSWER---------------Thick cortex running from lesser troch along neck to femoral head; best bolster region in inferior posterior aspect