DEX FINAL STUDY GUIDE
Most common mechanism of injury in distal radius fx - Answer- FOOSH + Dorsiflexion
What complication is commonly associated with distal radius fx? - Answer- median nerve dmg / carpal tunnel compression sx
Describe the normal radiographic measurements for:
Radial incl...
What is the Frykman classification used for? - Answer- Distal Radius (usually Colles)
fx
What is the most common type of distal radius fx? - Answer- Colles
What is a Smith fx? - Answer- "Reverse Colles fx"
"garden spade"
Volar angulation (apex dorsal)
Volar displacement
+radial shortening
What is the most popular method of surgical distal radius repair? - Answer- Volar
locking plates
(Dorsal -> ext tendon complications)
What is PES PLANUS (flatfoot) deformity? - Answer- Loss of the normal medial
longitudinal arch
What is the MAIN FUNCTION of the subtalar (or talocalcaneal) joint? - Answer-
INVERSION and EVERSION
Note: The subtalar joint plays NO ROLE in dorsal or plantar flexion
What is the SINUS TARSI? - Answer- The space between the talus and calcaneus
What are 2 FUNCTIONS of the spring (or calcanealnavicular) ligament? - Answer- 1.
Provides support to the medial arch
2. Supports the talar head
Note: If the spring ligament is injured it is the main reason for flat foot deformity
Deltoid ligament: how many layers? What are their names? - Answer- Two layers:
superficial layer and deep layer
,Deltoid ligament: how many components make up each layer? What are their
names? - Answer- 4 Components of the superficial layer:
1) Tibionavicular ligament
2) Tibiospring ligament
3) Tibiocalcaneal ligament
4) Superficial posterior tibiotalar ligament
2 Components of the deep layer:
1) Deep anterior tibiotalar ligament
2) Deep posterior tibiotalar ligament (strongest portion, primary stabilizer in the
medial ankle)
What does "Tom, Dick, And Nervous Henry" stand for? - Answer- [T]ibialis posterior
flexor [D]igitorum longus
tibial [A]rtery
tibial [N]erve
flexor [H]allucis longus
What is the "Master Knot of Henry?" - Answer- An anatomical landmark made up of
FDL tendon and FHL tendon
Identifies the FDL for harvesting purposes
What NEUROVASCULAR STRUCTURES should you be aware of? - Answer- Sural
nerve (lateral)
Superficial peroneal nerve (lateral)
Neurovascular bundle (medial)
Tibial artery (medial)
Tibial nerve (medial)
Pathology of Flatfoot Deformity - Answer- Collapse of entire medial longitudinal arch
with the entire sole of the foot in contact with the ground
Thought to be caused by the dysfunction of the posterior tibalis tendon, PTT, which
provides the dynamics support to maintain medial longitudal arch
Can also be caused by deficiency of the Spring ligament complex, which supports
the Talar head on the medial side
The peek incidents of flatfoot deformity in the adult population is seen between 50 to
70 years old
The incidents are greater in females than males
What does FLATFOOT DEFORMITY look like? - Answer- Abduction of tarsals &
metatarsals
Lateral translation of the Navicular on the Talus
Abduction of the Calcaneus
Valgus tilt of the Calcaneus (this rotation will allow for depression of the Talar head
in a pronated, everted, abducted foot)
Exposed Talar head
Lateral impingement of Calcaneus on Fibula
,Stage 1 Flatfoot Deformity - Answer- Pain and swelling medial aspect (tip and distal
to medial malleolus)
Tenosynovitis
Clinically:
• Valgus hindfoot: Absent
• Too many toes sign: Absent
• Deformity: Absent
Stage 2 Flatfoot Deformity - Answer- Elongation & degeneration of PTT
Obvious deformity
Collapse of Talonavicular joint
Inability of single-limb heel rise with progression
Dynamic correction possible
Stage 3 Flatfoot Deformity - Answer- Rigid deformity
Tightness of gastrocnemius complex
Pain on lateral side due to its impingement
Inability to perform single limb-heel rise
Stage 4 Flatfoot Deformity - Answer- Fixed ankle deformity
Attenuation of the Deltoid ligament
Talar tilt
Meary's Angle - Answer- Seen in Stages 2 through 4
On the weight bearing lateral foot
An increased talofirst metatarsal angle
Angles >4° indicate pes plantus (flatfoot)
Calcaneal Pitch - Answer- Normal is between 17-32°
Indicates loss of arch height
What product should always lead an ankle discussion? - Answer- TightRope
Pre-Call Plan for a Surgeon - Answer- Where did he train? What is his/her
worldview?
, What does the surgeon currently use? Screws? Why?
What are his/her hot buttons? (Efficacy, safety, cost, and/or convenience)
The TightRope allows for _____motion and allows for a small amount of tension -
Answer- The TightRope allows for MICROmotion and allows for a small amount of
tension
What is the strongest syndesmosis ligament? - Answer- PiTFL
High sprains account for __% of all sprains - Answer- High sprains account for 11%
of all sprains
Describe: Weber A - Answer- Fracture of lateral malleolus at/or distal to tibia
Transverse fibular avulsion fracture below syndesmosis
Generally stable
Describe: Weber B - Answer- Oblique fracture of lateral malleolus at distal tib/fib joint
that extends proximally
With or without rupture to syndesmosis
Supination external rotation
May or may not be stable
Describe: Weber C - Answer- Proximal distal tib/fib fracture of lateral malleolus
Proximal to joint line
Rupture of tibiofibular ligament
Possible deltoid
Possible medial malleolus avulsion fracture
What type of screws should be used if there is bad bone? - Answer- LOCKING
screws
There is a __% back to pre-injury rate for patients with an InternalBrace in the
Lateral Ankle - Answer- There is a 58% back to pre-injury rate for patients with an
InternalBrace in the Lateral Ankle
Probing Questions: InternalBrace - Answer- How do you currently address lateral
ankle instability?
What post-op concerns do you have about early weight bearing or non-compliancy?
Literature shows that activity level significantly decreases after current modified
Brostroms. What has been your experience?
What impact does tissue quality have in your decision?
Features: InternalBrace - Answer- Stronger than native ATFL (allows for earl rehab)
Knotless fixation (no knot irritation)
Permanent seatbelt (resistance against Brostrom pulling)
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