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ABFAS /240 Questions And Answers 100% Score!!!
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ABFAS /240 Questions And Answers 100% Score!!!Quiz :Diastasis for Lisfranc = a fracture is present - Answer :2-5 mm of diastis
betwen 1st and second mt base
Chronic lisfrancs--->ct=1 mm diastasis betwen 1st and 2nd mt or an increase of
more than 15 degrees in the tarso-metatarsal joint
Quiz :signs of lisfranc on xray - Answer :fleck sign (1 and 2 met bases)
first ray elevated
arch flattens
Quiz :MCC direction lisfranc displaces - Answer :Dorsal and Lateral
Quiz :When to sx correct lisfranc - Answer :>2mm displaced
wait 14 days if too much edema
Quiz :Approach to ORIF lisfranc fx - Answer :middle cunii start proximal
superior medical >to the base of the 2nd mt possibly, 3rd mt.
the first lag screw=KEY to REDUCTION. T
if needed do a few more lag screws from the the bases metatarsals >cuni.
If cuni instability **screw across the cunis.communition=plates.
Quiz :Rules for bunions in the Juvenile pt - Answer :14-16 yrs. Ideal time
frame to do sx for them is near skel. Maturity 11-15 yoa.
Don't do anything joint destructive /don't remove the fib sesamoid.
take mt adductus into consideration in a peds patient.
Transpositional osteotomies ideal e.g. austin, kalish, offset V for rectus
foottype and mod. IMA. But if they have Mt Adductus, really high IM or really
high PASA
Quiz :Distal metaphyseal peds osteotomies - Answer :Austin, offset v,
reverdin, mitchell, wilson and peabody. Mitchell and wilson SE including
shortening, transfer lesions, elevatus, metatarsalgia
,Quiz :How to fix bunion in a peds pt with IM >15 - Answer :Base procedure
aka proximal metaphyseal osteotomy.
-closed or open base wedge, cresentic procedure, lapidus =goal to make first
and 2nd mt parallel without damaging the open physeal plate.
Quiz :base of proximal phalanx (aka proximal akin) of hallux what does it
correct - Answer :Distal Angle DASA
Fix pasa with mt head osteotomy like REVERDIN=lat cortex intact proximal cut
parallel to 1st mt and distal cut parallel to articular surface
Fix DASA W/ proximal akin
Quiz :disadvantage of the fusion vs plasty is the - Answer :fusion has less
hallux propulsion and it can shorten which can then lead to contracture of the
ehl or fhl
You can walk it immediately vs plasty you cant
Quiz :cancellous vs cortical screws - Answer :Cannulated cancellous screws
are used for metaphyseal fractures while cannulated and noncannulated
cortical screws are used as lag screws for fixation of diaphyseal fractures.
The main advantage of cannulated screws is that they can be inserted over a
guide wire or guide pin. The diameter of the guide pin is much smaller than the
cannulated screw
Cannulated screws have a hollow central shaft. Both cortical and cancellous
screws can be cannulated.
Quiz :1st MPJ arthrodesis position - Answer :neutral rotation of the hallux,
10-15 degrees of valgus
20-30 degrees of dorsiflexion in reference to the axis of the first metatarsal
Quiz :Which does not affect bone healing:
1. Nutritional status, Rheumatoid or methotrexate patient, DM, tobacco hx,
extent of initial injury, osteoporosis, other metabolic diseases, neuropathy -
Answer :all do
,Quiz :mcc for ex fix - Answer :1. m/c complications involve bone healing and
not infection
others: 1. delayed, nonunion, implant loosening, fracture, chronic pain, soft
tissue inflammation, ulceration, or gross infection including osteomyelitis
Quiz :blood supply to talus - Answer :i.posterior tibial artery, artery of the
tarsal canal
dorsalis pedis artery,
perforating peroneal artery.
Quiz :MCC of talar AVN - Answer :post-traumatic talar fracture
Quiz :Pain, swelling, with a history of previous injury or trauma. May have
mechanical symptoms such as clicking, locking, or grinding. - Answer :AVN
diagnose by a. Plain XR and MRI remain the most used and beneficial
modalities.
Quiz :Classification of AVN - Answer :i. Hawkins type I fractures are non
displaced vertical neck fractures.
AVN is 10%.
ii. Hawkins type II fractures consist of a vertical talar neck fracture with either
subluxation or displacement of the STJ.
AVN is 42%.
iii. Hawkins type 3 fractures are characterized by a vertical talar neck fracture
with subluxation or dislocation of both the ankle and STJs.
AVN 91%.
iv. Hawkins type IV fractures vertical talar neck fracture with subluxation or
dislocation of the ankle, STJ, and the TNJ.
AVN of 100%.
Quiz :what is Hawkins sign - Answer :AVN=Hawkins sign: subchondral
radiolucent line along the superior aspect of the talar dome, which classically
begins on the medial side of the talar dome, and appears 6-8 weeks after
injury.
indicative of talar revascularization; seen on AP or mortise view.
Quiz :MRI presentation of AVN - Answer :i. MRI is the most widely used
modality to dx and potentially prevent further talar damage due to AVN.
, a. Normal T1 images will show a strong SI due to bone marrow elements in
trabecular bone.
b. In early AVN, diffuse marrow edema produces low signal intensity on T1
images and high SI on T2.
c. In advanced stages, the diagnosis of AVN on MRI includes decreased SI on
both T1 and T2 weighted images indicative of areas of devascularization or
necrotic bone.
Quiz :Why perform arthroscopy for AVN - Answer :a. Arthroscopic
Debridement and Core Decompression:
i. Rationale: Thought to enhance revascularization and decrease intraosseous
pressure.
1. Indicated in treatment of F&A stages I and II (partial AVN and those without
collapse).
ii. Technique: Standard AM and AL portals used for arthroscopy with a lateral
sinus tarsi (lateral process) approach for retrograde drilling.
Quiz :post op avn sx - Answer :Posterior splint until sutures removed followed
by NWB cast for 4 weeks.
1.
5-6 weeks PO, patient placed into a patellar tendon WB boot walker or brace
but still kept strictly NWB (NWB ROM exercises started).
2. 8 weeks PO, XR are taken and the integrity of the talus is judged, PWB
allowed on the PTB boot and as healing continues WB is progressed. Patient is
then in rigid AFO for the first 6 months.
Quiz :types of Bone Grafts for Talar AVN - Answer :1. Nonvascularized
cancellous autograft can be taken from the iliac crest, calcaneus, or femoral
head. Useful only in small, contained defects since this does not supply
structural support.
2. Vascularized pedicle autograft:
Rationale: limited area of necrotic bone can be debrided and removed and a
vascularized graft is plugged in to bring in fresh, viable bone and perfusion.
3i. Bone allograft:
1. Nonvascular bulk allografts using fresh cadaver talus are a viable option for
partial talar AVN.
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