DEX FINAL STUDY GUIDE
Most common mechanism of injury in distal radius fx - ANSFOOSH + Dorsiflexion
What complication is commonly associated with distal radius fx? - ANSmedian nerve dmg /
carpal tunnel compression sx
Describe the normal radiographic measurements for:
Radial inclination
Radial length(height)
Volar (radial) tilt - ANSIncline: 22
Length: 11
Tilt: 11
What is the Frykman classification used for? - ANSDistal Radius (usually Colles) fx
What is the most common type of distal radius fx? - ANSColles
What is a Smith fx? - ANS"Reverse Colles fx"
"garden spade"
Volar angulation (apex dorsal)
Volar displacement
+radial shortening
What is the most popular method of surgical distal radius repair? - ANSVolar locking plates
(Dorsal -> ext tendon complications)
What is PES PLANUS (flatfoot) deformity? - ANSLoss of the normal medial longitudinal arch
What is the MAIN FUNCTION of the subtalar (or talocalcaneal) joint? - ANSINVERSION and
EVERSION
Note: The subtalar joint plays NO ROLE in dorsal or plantar flexion
What is the SINUS TARSI? - ANSThe space between the talus and calcaneus
What are 2 FUNCTIONS of the spring (or calcanealnavicular) ligament? - ANS1. 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? - ANSTwo layers: superficial layer
and deep layer
Deltoid ligament: how many components make up each layer? What are their names? - ANS4
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? - ANS[T]ibialis posterior
flexor [D]igitorum longus
tibial [A]rtery
tibial [N]erve
flexor [H]allucis longus
What is the "Master Knot of Henry?" - ANSAn anatomical landmark made up of FDL tendon and
FHL tendon
Identifies the FDL for harvesting purposes
What NEUROVASCULAR STRUCTURES should you be aware of? - ANSSural nerve (lateral)
Superficial peroneal nerve (lateral)
Neurovascular bundle (medial)
Tibial artery (medial)
Tibial nerve (medial)
Pathology of Flatfoot Deformity - ANSCollapse 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? - ANSAbduction 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 - ANSPain 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 - ANSElongation & degeneration of PTT
Obvious deformity
Collapse of Talonavicular joint
Inability of single-limb heel rise with progression
Dynamic correction possible
Stage 3 Flatfoot Deformity - ANSRigid deformity
Tightness of gastrocnemius complex
Pain on lateral side due to its impingement
Inability to perform single limb-heel rise
Stage 4 Flatfoot Deformity - ANSFixed ankle deformity
Attenuation of the Deltoid ligament
Talar tilt
Meary's Angle - ANSSeen in Stages 2 through 4
On the weight bearing lateral foot
An increased talofirst metatarsal angle
Angles >4° indicate pes plantus (flatfoot)
Calcaneal Pitch - ANSNormal is between 17-32°
Indicates loss of arch height
Features: Distal Fibular Plate - ANSPre-contoured
1.5mm/2.0mm thin
5 distal 2.y mm
Features: Locking Fibular Avulsion Plate - ANSHooks to catch a distal fragment
1.0mm/1.5mm thick
Chamfer for TR
, Features: Locking Deltoid Avulsion Plate - ANS2.0mm/1.5mm thick
Infection rates are higher in... - ANSElderly
Overweight
Diabetic
Cat ladies (dirty)
What product should always lead an ankle discussion? - ANSTightRope
Pre-Call Plan for a Surgeon - ANSWhere 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 - ANSThe
TightRope allows for MICROmotion and allows for a small amount of tension
What is the strongest syndesmosis ligament? - ANSPiTFL
High sprains account for __% of all sprains - ANSHigh sprains account for 11% of all sprains
Describe: Weber A - ANSFracture of lateral malleolus at/or distal to tibia
Transverse fibular avulsion fracture below syndesmosis
Generally stable
Describe: Weber B - ANSOblique 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 - ANSProximal 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? - ANSLOCKING screws
There is a __% back to pre-injury rate for patients with an InternalBrace in the Lateral Ankle -
ANSThere is a 58% back to pre-injury rate for patients with an InternalBrace in the Lateral Ankle
Most common mechanism of injury in distal radius fx - ANSFOOSH + Dorsiflexion
What complication is commonly associated with distal radius fx? - ANSmedian nerve dmg /
carpal tunnel compression sx
Describe the normal radiographic measurements for:
Radial inclination
Radial length(height)
Volar (radial) tilt - ANSIncline: 22
Length: 11
Tilt: 11
What is the Frykman classification used for? - ANSDistal Radius (usually Colles) fx
What is the most common type of distal radius fx? - ANSColles
What is a Smith fx? - ANS"Reverse Colles fx"
"garden spade"
Volar angulation (apex dorsal)
Volar displacement
+radial shortening
What is the most popular method of surgical distal radius repair? - ANSVolar locking plates
(Dorsal -> ext tendon complications)
What is PES PLANUS (flatfoot) deformity? - ANSLoss of the normal medial longitudinal arch
What is the MAIN FUNCTION of the subtalar (or talocalcaneal) joint? - ANSINVERSION and
EVERSION
Note: The subtalar joint plays NO ROLE in dorsal or plantar flexion
What is the SINUS TARSI? - ANSThe space between the talus and calcaneus
What are 2 FUNCTIONS of the spring (or calcanealnavicular) ligament? - ANS1. 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? - ANSTwo layers: superficial layer
and deep layer
Deltoid ligament: how many components make up each layer? What are their names? - ANS4
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? - ANS[T]ibialis posterior
flexor [D]igitorum longus
tibial [A]rtery
tibial [N]erve
flexor [H]allucis longus
What is the "Master Knot of Henry?" - ANSAn anatomical landmark made up of FDL tendon and
FHL tendon
Identifies the FDL for harvesting purposes
What NEUROVASCULAR STRUCTURES should you be aware of? - ANSSural nerve (lateral)
Superficial peroneal nerve (lateral)
Neurovascular bundle (medial)
Tibial artery (medial)
Tibial nerve (medial)
Pathology of Flatfoot Deformity - ANSCollapse 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? - ANSAbduction 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 - ANSPain 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 - ANSElongation & degeneration of PTT
Obvious deformity
Collapse of Talonavicular joint
Inability of single-limb heel rise with progression
Dynamic correction possible
Stage 3 Flatfoot Deformity - ANSRigid deformity
Tightness of gastrocnemius complex
Pain on lateral side due to its impingement
Inability to perform single limb-heel rise
Stage 4 Flatfoot Deformity - ANSFixed ankle deformity
Attenuation of the Deltoid ligament
Talar tilt
Meary's Angle - ANSSeen in Stages 2 through 4
On the weight bearing lateral foot
An increased talofirst metatarsal angle
Angles >4° indicate pes plantus (flatfoot)
Calcaneal Pitch - ANSNormal is between 17-32°
Indicates loss of arch height
Features: Distal Fibular Plate - ANSPre-contoured
1.5mm/2.0mm thin
5 distal 2.y mm
Features: Locking Fibular Avulsion Plate - ANSHooks to catch a distal fragment
1.0mm/1.5mm thick
Chamfer for TR
, Features: Locking Deltoid Avulsion Plate - ANS2.0mm/1.5mm thick
Infection rates are higher in... - ANSElderly
Overweight
Diabetic
Cat ladies (dirty)
What product should always lead an ankle discussion? - ANSTightRope
Pre-Call Plan for a Surgeon - ANSWhere 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 - ANSThe
TightRope allows for MICROmotion and allows for a small amount of tension
What is the strongest syndesmosis ligament? - ANSPiTFL
High sprains account for __% of all sprains - ANSHigh sprains account for 11% of all sprains
Describe: Weber A - ANSFracture of lateral malleolus at/or distal to tibia
Transverse fibular avulsion fracture below syndesmosis
Generally stable
Describe: Weber B - ANSOblique 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 - ANSProximal 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? - ANSLOCKING screws
There is a __% back to pre-injury rate for patients with an InternalBrace in the Lateral Ankle -
ANSThere is a 58% back to pre-injury rate for patients with an InternalBrace in the Lateral Ankle
