6. Star - Complications And The Star Ankle Webinar
Questions and Answers
- 1.
What caused the polyethylene to ride anteriorly?
- A.
Anteriorly subluxed talus
- B.
Anteriorly placed talar component
- C.
Posteriorly subluxed talus
- D.
Posteriorly placed talar component
Correct Answer
B. Anteriorly placed talar componentExplanation
The polyethylene riding anteriorly is likely caused by the placement of the talar component in an anterior position. This means that the part of the implant that is supposed to fit into the ankle joint is positioned too far forward, leading to the polyethylene component being pushed forward as well. This can result in instability and abnormal movement of the ankle joint.Rate this question:
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- 2.
What caused the polyethylene to dislocate posteriorly?
- A.
Talus positioned to anteriorly
- B.
Talus positioned to posteriorly
- C.
Soft tissue balancing
- D.
Talus tilted anteriorly
- E.
Talus tilted posteriorly
Correct Answer
D. Talus tilted anteriorlyExplanation
The polyethylene dislocated posteriorly because the talus was tilted anteriorly. When the talus is tilted in this direction, it causes the polyethylene to move out of its normal position and dislocate towards the posterior side.Rate this question:
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- 3.
Where should the datum be positioned for an anterior subluxed talus? (utilizing the posterior superior corner for reference)
- A.
Center of talar body (lateral process)
- B.
Posterior of the lateral process
- C.
Anterior of the lateral process
- D.
None of the above
Correct Answer
A. Center of talar body (lateral process)Explanation
The correct answer is the center of talar body (lateral process). When positioning the datum for an anterior subluxed talus, the posterior superior corner is used as a reference point. The center of the talar body, specifically the lateral process, is the appropriate position for the datum in this case. This ensures accurate measurement and assessment of the talus in relation to its subluxation.Rate this question:
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- 4.
Where should the polyethylene be positioned relative to the trial tibial base plate and talar component? (considering that it is not hung up in one of the tibial base plate grooves
- A.
Lateral to the barrel holes
- B.
Center of the barrel holes
- C.
Medial to the barrel holes
- D.
Wherever it wants relative to the positioning of the talus
Correct Answer
B. Center of the barrel holesExplanation
The polyethylene should be positioned in the center of the barrel holes. This ensures proper alignment and stability of the trial tibial base plate and talar component. Placing the polyethylene lateral or medial to the barrel holes may lead to instability or improper functioning of the components. The positioning of the polyethylene should not be determined by the positioning of the talus, as it should be specifically placed in the center of the barrel holes.Rate this question:
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- 5.
What is an acceptable amount of posterior lift-off of the tibial base plate before removing it and fixing the barrel holes?
- A.
2mm
- B.
3mm
- C.
1mm
- D.
1.5mm
- E.
None
Correct Answer
C. 1mmExplanation
An acceptable amount of posterior lift-off of the tibial base plate before removing it and fixing the barrel holes is 1mm. This means that a slight movement or gap of 1mm between the base plate and the tibia is considered acceptable before proceeding with fixing the barrel holes.Rate this question:
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- 6.
What complication(s) can lead to a lateral malleolar fracture?
- A.
Transverse saw cut
- B.
Oversized talus
- C.
Leverage against lateral malleolus during removal of distal tibia
- D.
A & B
- E.
A & C
- F.
A, B & C
Correct Answer
F. A, B & CExplanation
A lateral malleolar fracture can be caused by a transverse saw cut, an oversized talus, and leverage against the lateral malleolus during the removal of the distal tibia. These factors can put excessive pressure on the lateral malleolus, leading to a fracture.Rate this question:
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- 7.
What precautions can be taken for a patient with osteopenic bone?
- A.
K-wires
- B.
Screws
- C.
Plating
- D.
A & C
- E.
B & C
- F.
A, B & C
Correct Answer
F. A, B & CExplanation
Patients with osteopenic bone, which is characterized by low bone density, are at an increased risk of fractures. Therefore, precautions need to be taken to protect their bones. K-wires, screws, and plating are all surgical techniques that can be used to stabilize and support weakened bones, reducing the risk of fractures. Using a combination of these techniques (A, B & C) provides the most comprehensive approach to ensure the patient's safety and promote bone healing.Rate this question:
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- 8.
Where should the flange of the tibial cut guide be positioned?
- A.
Medial to the medial gutter
- B.
At the medial gutter
- C.
Lateral to the medial gutter
- D.
Depends on whether the surgeon is trying to remove medial malleolar arthritis
Correct Answer
B. At the medial gutterExplanation
The flange of the tibial cut guide should be positioned at the medial gutter. This is the correct answer because the medial gutter is the specific location where the flange needs to be placed for proper alignment and stability during the procedure.Rate this question:
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- 9.
What is the most common deformity in DJD arthritis of the ankle?
- A.
Anterior subluxation of the talus
- B.
Posterior subluxation of the talus
- C.
50/50 Posterior & Anterior subluxation of the talus
Correct Answer
A. Anterior subluxation of the talusExplanation
In DJD arthritis of the ankle, the most common deformity is anterior subluxation of the talus. This means that the talus bone, which is located in the ankle joint, is displaced or shifted forward from its normal position. This deformity can lead to pain, instability, and difficulty with walking and weight-bearing. It is important to address this deformity in order to prevent further damage to the ankle joint and to improve the patient's mobility and quality of life.Rate this question:
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- 10.
When would Dr. Nunley plate the fibula if a transverse cut is made during the tibial resection?
- A.
Always
- B.
When it is well aligned
- C.
Varus or Valgus malalignment of the talus
- D.
Never
Correct Answer
C. Varus or Valgus malalignment of the talusExplanation
Dr. Nunley would plate the fibula when there is varus or valgus malalignment of the talus. This suggests that if the talus bone is not properly aligned, a plate would be used to stabilize the fibula and correct the malalignment. This implies that in other cases, such as when the tibial resection is well aligned or when a transverse cut is made, plating the fibula may not be necessary.Rate this question:
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- 11.
What step can be taken to eliminate breaking the posterior tibia or posterior malleolus?
- A.
Drop tibial base plate trial deeper than the anterior cortex of the tibia
- B.
Aim superiorly with the 6.5mm drill bit
- C.
Correct Alignment during final tibial base plate impaction
- D.
All of the above
Correct Answer
D. All of the aboveExplanation
To eliminate breaking the posterior tibia or posterior malleolus, all of the above steps can be taken. Dropping the tibial base plate trial deeper than the anterior cortex of the tibia helps to avoid putting excessive pressure on the posterior tibia. Aiming superiorly with the 6.5mm drill bit ensures that the drilling is done in the correct direction and avoids damaging the posterior structures. Correct alignment during the final tibial base plate impaction ensures that the implant is placed in the proper position without causing any damage to the posterior tibia or malleolus.Rate this question:
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- 12.
How long before the surgeon will see a patient back in his office for the first cast change?
- A.
2 weeks
- B.
1 month
- C.
3 weeks
- D.
3 months
Correct Answer
C. 3 weeksExplanation
The correct answer is 3 weeks. After a patient undergoes surgery and has a cast applied, the surgeon typically schedules a follow-up appointment for the first cast change. This is usually done around 3 weeks after the initial surgery to ensure proper healing and to assess the progress of the patient's recovery. At this appointment, the surgeon may remove the initial cast, examine the surgical site, and replace the cast if necessary. This is an important step in the healing process and allows the surgeon to monitor the patient's progress.Rate this question:
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- 13.
If the wound is perfect after first post-op office visit what is the next step?
- A.
Cam Boot, ROM exercises, & Weight Bearing as tolerated
- B.
Recast for another 3 weeks
- C.
ROM exercises & full weight bearing
- D.
None of the above
Correct Answer
A. Cam Boot, ROM exercises, & Weight Bearing as toleratedExplanation
After the first post-op office visit, if the wound is perfect, the next step would be to use a Cam Boot, perform ROM exercises, and gradually increase weight bearing as tolerated. This approach allows for protection and support of the foot while also promoting range of motion and gradually increasing the amount of weight that can be put on the foot. This helps in the healing process and allows the patient to regain normal function and mobility.Rate this question:
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- 14.
When should a gastroc or a TAL be done?
- A.
Beginning of case
- B.
Middle of case
- C.
End of case
- D.
Never
Correct Answer
C. End of caseExplanation
A gastroc or a TAL (triple arthrodesis of the ankle and foot) should be done at the end of a case. This procedure is typically performed to correct severe deformities or instability in the ankle and foot. By performing it at the end of the case, the surgeon can address any other necessary procedures or adjustments before proceeding to the gastroc or TAL. This ensures that all other issues are addressed before focusing on the specific correction of the gastroc or TAL.Rate this question:
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- 15.
Should TAA’s be done in patients with OCD’s in the talus?
- A.
Yes
- B.
No
Correct Answer
B. NoExplanation
TAA stands for Total Ankle Arthroplasty, which is a surgical procedure to replace the ankle joint with an artificial implant. Patients with OCD (Osteochondritis Dissecans) in the talus, which is a condition where a piece of bone and cartilage detaches from the talus bone, may not be suitable candidates for TAA. This is because the presence of OCD can affect the stability and success of the implant. Therefore, TAA should not be done in patients with OCDs in the talus.Rate this question:
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- 16.
Should a thicker polyethylene be used for a heavier patient?
- A.
Yes
- B.
No
Correct Answer
B. NoExplanation
The answer is "No" because the thickness of the polyethylene does not directly correlate with the weight of the patient. The choice of polyethylene thickness depends on factors such as the intended use, durability requirements, and material specifications, but it is not determined by the weight of the patient.Rate this question:
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