Clinical Procedures and Protocols Flashcards

Which surgical approach is used to access the posterior ankle for os trigonum excision or flexor hallucis longus decompression?

Answer: Posterolateral approach

The posterolateral approach between the Achilles tendon and peroneal tendons provides direct access to the posterior ankle compartment while protecting the neurovascular bundle.

A patient undergoing foot surgery under spinal anesthesia develops hypotension intraoperatively. What is the first-line intervention?

Answer: IV fluid bolus and IV ephedrine or phenylephrine

Spinal-induced hypotension is managed first with IV fluid bolus and vasopressors such as ephedrine or phenylephrine to restore sympathetic tone.

When performing a primary repair of a lacerated flexor tendon in zone 2 of the foot, which core suture technique is most commonly used?

Answer: Modified Kessler suture

The modified Kessler technique provides strong core suture purchase with minimal disruption of tendon vascularity, making it the standard in zone 2 tendon repairs.

Which bone graft substitute contains both an osteoconductive scaffold and demineralized bone matrix (DBM) to provide osteoinductive properties?

Answer: Combination DBM with calcium sulfate carrier

DBM combined with a calcium sulfate carrier provides both osteoconductive scaffold properties and osteoinductive growth factors from the demineralized matrix.

In which clinical scenario is a transmetatarsal amputation (TMA) the preferred level of amputation for a diabetic foot patient?

Answer: Full-thickness forefoot infection with viable midfoot and adequate perfusion

TMA is indicated when infection or necrosis involves the forefoot but viable tissue with adequate perfusion is present at the midfoot level.

Which antibiotic is added to bone cement during diabetic foot osteomyelitis surgery to achieve local high-concentration delivery while minimizing systemic toxicity?

Answer: Vancomycin or tobramycin

Vancomycin and tobramycin are heat-stable antibiotics commonly mixed into polymethylmethacrylate (PMMA) bone cement for local elution against gram-positive and gram-negative organisms.

During a flatfoot reconstruction involving posterior tibial tendon augmentation, which tendon is most commonly used as a transfer to supplement the weakened posterior tibial tendon?

Answer: Flexor digitorum longus tendon

The flexor digitorum longus (FDL) tendon transfer is the standard augmentation for posterior tibial tendon dysfunction due to its favorable line of pull and expendable nature.