Exam 1 Arthrodesis

1. Which of the following statements is false: a. With arthrodesis, we eliminate pain by eliminating motion b. Principle is a fundamental truth or preposition that serves as a foundation for a system of beliefs or behavior for a chain of reasoning c. Salividor Dali was a bum who lived off his dad's dime d. All of the above are true

1. D. All of the above are true (look for this as an answer)

6. What are some indications for Trephine fusion technique?

6. Arthrodesis in patient with limited deformity and multiple arthrodesis (tarsometarsal fusion, midfoot fusion, lateral column fusion)

7. What are the disadvantages of Trephine fusion technique?

7. Decreased ability to correct deformity, need special equipment, more difficult to assess fusion site on x-rays, and decrease surface for fusion

8. What were the findings of the Astion, Deland et al paper discussed in the lecture?

8. The talonavicular joint was the most important joint of the triple arthrodesis joint complex because it has the most motion and arthrodesis of the joint complex eliminated motion at all other joint complexes

9. What is the tripod of the bottom of the foot?

9. Heel, sub 1st metatarsal head, sub 5th metatarsal head

10. When performing a 1st MPJ capsulotomy, what test can be performed intra-operatively to assess the success of the procedure?

10. Kelikian push up test

11. Which prevents axial rotation better: one cannulated screw or multiple K-wires

11. Multiple K-wires

12. How should the calcaneus be fused/aligned in regards to the talus?

12. In a slight valgus position

13. What is the most common indication for ankle fusion?

13. Post traumatic DJD

14. What happens when you fuse a patient in equinus?

14. Knee will be in recurvatum and hip will be flexed

15. A patient has 9 degrees tibial varum, how do we want to correct?

15. Correct with 12 degrees valgum

16. Why is improved healing seen in miniarthotomy techniques?

16. Blood supply is preserved, blood vessel disruption is avoided

17. What is the definition of a pantalar arthrodesis

17. Ankle joint arthrodesis + triple arthrodesis (STJ, TNJ, CCJ)

18. What is the length of screws when fixating the STJ?

18. 85-100mm (95mm)

19. What is the gold standard treatment for end stage DJD

19. Arthrodiastasis

2. Which of the following is not one of Gissan's four requirements for arthrodesis: a. Requires complete removal of all cartilage and intervening tissue and material b. Accurate and close fitting of fusion surfaces (apposition) c. Optimal position of fusion (neutral) d. Preserve blood supply to fusion site e. Maintenance of bone apposition until complete fusion

2. D. Preserve blood supply to fusion site

20. What neurovascular structures must we be concerned about when incising medially?

20. Saphenous nerve and vein

21. What neurovascular structures must we be concerned about when incising laterally?

21. Small saphenous vein and sural nerve

22. Which wolf are you feeding?

22. Feed the good wolf, let the bad wolf starve

3. What position do we want the first MPJ in when we fuse the joint?

3. 15-25 degrees dorsiflexion, 15-20 degrees abduction, no frontal plane rotation, and parallel to second toe

4. Which rays are the least likely to fuse?

4. 4th and 5th rays

5. Describe the Trephine fusion technique.

5. Use a hollow tube to pull out arthrodesis site, which creates a trephine, rotate the internal segment 90 degrees, do not supplement with a graft and then leave the cartilage in the joint surface