Most common mechanism of injury in distal radius fx: FOOSH + Dorsiflexion
What complication is commonly associated with distal radius fx?: median nerve dmg / carpal
tunnel compression sx
Describe the normal radiographic measurements for: Radial inclination
Radial length(height) Volar (radial) ...
UPDATED DEX FINAL STUDY GUIDE 2024-2025
Most common mechanism of injury in distal radius fx: FOOSH + Dorsiflexion
What complication is commonly associated with distal radius fx?: median nerve dmg / carpal
tunnel compression sx
Describe the normal radiographic measurements for: Radial inclination
Radial length(height) Volar (radial) tilt: Incline: 22 Length: 11
Tilt: 11
What is the Frykman classification used for?: Distal Radius (usually Colles) fx
What is the most common type of distal radius fx?: Colles
What is a Smith fx?: "Reverse Colles fx" "garden spade"
Volar angulation (apex dorsal) Volar displacement
+radial shortening
What is the most popular method of surgical distal radius repair?: Volar locking plates
(Dorsal -> ext tendon complications)
What is PES PLANUS (flatfoot) deformity?: Loss of the normal medial longitu- dinal arch
What is the MAIN FUNCTION of the subtalar (or talocalcaneal) joint?: INVER- SION and EVERSION
Note: The subtalar joint plays NO ROLE in dorsal or plantar flexion
What is the SINUS TARSI?: The space between the talus and calcaneus
What are 2 FUNCTIONS of the spring (or calcanealnavicular) ligament?: 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?: Two layers: superficial layer and deep
layer
Deltoid ligament: how many components make up each layer? What are their names?: 4
Components of the superficial layer:
Tibionavicular ligament
Tibiospring ligament
Tibiocalcaneal ligament
Superficial posterior tibiotalar ligament
2 Components of the deep layer:
Deep anterior tibiotalar ligament
Deep posterior tibiotalar ligament (strongest portion, primary stabilizer in the medial ankle)
,UPDATED DEX FINAL STUDY GUIDE 2024-2025
What does "Tom, Dick, And Nervous Henry" stand for?: [T]ibialis posterior flexor [D]igitorum
longus
tibial [A]rtery tibial [N]erve
flexor [H]allucis longus
What is the "Master Knot of Henry?": 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?: Sural nerve (lateral)
Superficial peroneal nerve (lateral) Neurovascular bundle (medial) Tibial artery (medial)
Tibial nerve (medial)
Pathology of Flatfoot Deformity: 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?: 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: 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: Elongation & degeneration of PTT Obvious deformity
Collapse of Talonavicular joint
Inability of single-limb heel rise with progression Dynamic correction possible
,UPDATED DEX FINAL STUDY GUIDE 2024-2025
Stage 3 Flatfoot Deformity: 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: Fixed ankle deformity Attenuation of the Deltoid ligament
Talar tilt
Meary's Angle: 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: Normal is between 17-32° Indicates loss of arch height
Features: Distal Fibular Plate: Pre-contoured 1.5mm/2.0mm thin
5 distal 2.y mm
Features: Locking Fibular Avulsion Plate: Hooks to catch a distal fragment 1.0mm/1.5mm thick
Chamfer for TR
Features: Locking Deltoid Avulsion Plate: 2.0mm/1.5mm thick
Infection rates are higher in...: Elderly Overweight
Diabetic
Cat ladies (dirty)
What product should always lead an ankle discussion?: TightRope
Pre-Call Plan for a Surgeon: 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: The TightRope
allows for MICROmotion and allows for a small amount of tension
What is the strongest syndesmosis ligament?: PiTFL
High sprains account for % of all sprains: High sprains account for 11% of all sprains
Describe: Weber A: Fracture of lateral malleolus at/or distal to tibia Transverse fibular avulsion
fracture below syndesmosis
Generally stable
Describe: Weber B: Oblique fracture of lateral malleolus at distal tib/fib joint that extends proximall
With or without rupture to syndesmosis Supination external rotation
May or may not be stable
Describe: Weber C: Proximal distal tib/fib fracture of lateral malleolus Proximal to joint line
Rupture of tibiofibular ligament
Possible deltoid
, UPDATED DEX FINAL STUDY GUIDE 2024-2025
Possible medial malleolus avulsion fracture
What type of screws should be used if there is bad bone?: LOCKING screws
There is a % back to pre-injury rate for patients with an InternalBrace in the Lateral Ankle: Ther
is a 58% back to pre-injury rate for patients with an InternalBrace in the Lateral Ankle
Probing Questions: InternalBrace: 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: Stronger than native ATFL (allows for earl rehab) Knotless fixation (no
knot irritation)
Permanent seatbelt (resistance against Brostrom pulling)
What is the re-rupture rate with non-op for an Achilles rupture?: 21% re-rupture rate with non-op
for an Achilles rupture
What are the return and complications rate with PARS vs. Open?: PARS: 98% return; 5%
complications
Open: 83% return; 10.6% complications
Pullout Strength: PARS: 385 newtons (attributed to locking stitch)
Pullout Strength: Midsubstance SpeedBridge: 386 newtons
What are bone void fillers for DX?: Stimublast Arthrocell
Flexigraft Quickset
Define: Osteoinduction: Act or process of stimulating osteogenesis
Define: Osteoconductive: Providing a structure for bone to form
i.e. "scapholding"
Define: Osteogenic: Assured bone growth
What is the healing triad for orthobiologics?: Signal (osteoinduction) Cell (osteogenesis)
Scaffold (osteoconduction)
Maffulli study for ATFL Brostrom:
Clanton study for Brostrom w/ InternalBrace:
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