Hers Hey 2003 Contents

8/9/2019 Hers Hey 2003 Contents

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Hershey Board Certification ReviewOutline Study Guide

by

Jonathan M. Singer, D.P.M.Diplomate, American Board of Podiatric Surgery

Fellow, American College of Foot and Ankle SurgeonsDiplomate, American Board of Podiatric Orthopedics & Primary Podiatric Medicine

Fellow, American College of Foot & Ankle Orthopedics & Medicine

Edited by

Larry R. Goss, D.P.M.Diplomate, American Board of Podiatric SurgeryFellow, American College of Foot and Ankle Surgeons

Fellow, American College of Foot & Ankle Orthopedics & MedicineFellow, American Professional Wound Care Association

Residency Director, Parkview/Roxborough/MCP HospitalsClinical Instructor, Temple University School of Podiatric Medicine

Jason Miller, D.P.M.

Other Contributors

Christopher E. Attinger, M.D., Steven J. Berlin, D.P.M., Libby Cone, M.D.,Douglas Glod, D.P.M., Larry R. Goss, D.P.M., Arthur E. Helfand, D.P.M.,

Edwin J. Juda, D.P.M., Peter F. Kelly, D.P.M., Steven Kravitz, D.P.M., GuidoLaPorta, D.P.M., M.S., James Lawton, D.P.M., Jason Miller, D.P.M., Gene K.Potter, D.P.M., Ph.D., William H. Simon, D.P.M., John Walter, D.P.M., M.S.,

Fredrick E. Youngblood, M.D.

2003 Pennsylvania Podiatric Medical Association


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Acknowledgements

William Goldfarb D.P.M. and Nancy Sullivan, for supporting me andbelieving this book could be done

Larry R. Goss, D.P.M. and Jason Miller, D.P.M. for their academiccontributions and updating this new addition

James Lawton D.P.M. and Gene Potter, D.P.M. for their invaluablecontributions in the general editing these review notes in theprevious addition

Jordon Fersel, M.D., for editing the chapters on Anesthesia andEmergency Medicine

Deborah Wozniak, M.D., for editing the chapters on PerioperativeManagement, Fluid Management, and Postoperative Complications

Warren Joseph, D.P.M., and Steven Maffei, D.P.M. for editing thechapter on Infectious Diseases

Steven Kravitz, D.P.M., for editing the chapter on Biomechanics

George Vito, D.P.M. for editing the chapter on Internal Fixation

Peter F. Kelly, D.P.M. for writing the chapter on Lasers and LaserPhysics

Gene K. Potter, D.P.M., Ph.D. and Steven Berlin, D.P.M. for editingthe chapters on Dermatology, Bone Tumors, and Soft Tissue Tumors

Guido LaPorta, D.P.M., M.S. for writing the chapter on AnkleArthroscopy

Tracey Vlahovic, D.P.M. for editing the chapter on Dermatology


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The Hershey Board Certification

Review Outline Study Guideis prepared for distribution by the

Hershey Surgical Seminars Committee

Pennsylvania Podiatric Medical AssociationGuido La Porta, D.P.M., General Chairman

Author: Jonathan M. Singer, D.P.M.General Editors: Larry R. Goss, D.P.M. and Jason Miller, D.P.M.Copy/Content Editors: Larry R. Goss, D.P.M. and Jason Miller,D.P.M.Cover Design: Larry R. Goss, D.P.M.Coordinator: Nancy Sullivan

Published by the Pennsylvania Podiatric Medical AssociationISBN # 0-9639030-04

Copyright 2003

Pennsylvania Podiatric Medical Association 757 Poplar ChurchRoad Camp Hill, Pennsylvania 17011 (800)-841-3668All rights reserved

This book is protected by copyright. No part of this book may be reproducedin any form or by any means, including photocopying, or utilized by anyinformation storage or retrieval system without written permission from the

copyright owner.

Accurate indications, adverse reactions, and dose schedules for drugs areprovided in this book, but It is possible that they may change. The reader isurged to review the package information data of the manufacturers of themedications mentioned.

The author has made every effort to ensure the accuracy of the informationherein. However, appropriate information sources should be consulted,especially for new or unfamiliar procedures. It is the responsibility of everypractitioner to evaluate the appropriateness of a particular opinion in thecontext of actual clinical situations and with consideration to newdevelopments. The author, editors, and publisher cannot be held responsiblefor any typographical or other errors found In this book.

Printed in the United States of America.


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Table of ContentsChapter 1: Emergency MedicineCardiopulmonary Resuscitation:page 2-3Advanced Life Support:page 3-4Office Emergencies:page 5-7Medical Emergencies (CardiacDysrhythmias):page 7-9Summary of CPR:page 9

Other Medical Emergencies:page 9-12Shock:page 12-13Blood and Blood Products for EmergencyUse:page 13-17

Chapter 2: AnesthesiaAnesthesia Classifications:page 20General Anesthesia:page 20-23Intravenous Anesthesia:page 23Local Anesthesia:page 23-26Special Cases for Lowering the MaximumAllowable Dose:page 26Pediatric Anesthesia:page 26-27

Lumbar Epidural and CaudalAnesthesia:page 27-28Complications of Endotracheal Intubation:

page 31Nerve Injury During Anesthesia:page 31-32Other Medical Compliccations FromAnesthesia:page 32-34

Chapter 3: Perioperative ManagementThe Healthy Patient:page 36The Diabetic Patient:page 36-38The Hypertensive Patient:page 38-39

The Patient on Steroid Therapy:page 39-40

The Asthmatic Patient:page 40-41The Alcoholic Patient:page 41The Patient on Anticoagulant Therapy:page 41-42The Patient With Clotting Abnormalities:page 42The Rheumatoid Patient:page 43The Sickle Cell Patient:page 43-44The Cardiac Patient:page 44-45The Pulmonary Disease Patient:page 45Perioperative Management of the Infant

and Child:page 45-47Mitral Valve Prolapse patient:page 47-48

The Gouty Arthritis Patient:page 48

Chapter 4: Preoperative EvaluationScreening Procedures:page 50-61Summary of Perioperative Lab testing:

page 61-62

Chapter 5: Postoperative Care &Complications

Fever:page 64-65Altered Mental States:page 65Water and Electrolyte Imbalance:page 65-66Oliguria:page 66Chest Pain:page 67Postoperative Hypertension:page 67

Postoperative Infection:page 67-68Anxiety and Pain Management:page 68-69Nausea:page 69Constipation:page 69Shivering:page 69DVT:page 69-70Compartment Syndrome:page 70-73Hemorrhage:page 72-73Septic Syndrome:page 73

Thyroid Storm:page 73-74

Chapter 6: Infectious Diseases

Specific Diseases:page 76-81Principles of Antiinfective Therapy:page81-84Antibiotics:page 84-90Drug Fever:page 90-91Specific Antimicrobial Therapy:page 91-92Surgical Considerations:page 92-93Necrotizing Infections:page 93-94Osteomyelitis:page 94-102Septic Arthritis:page 102Mycology:page 102-103Viral Diseases:page 104Rickettsial Diseases:page 104

Protozoan and Metazoan Infections:page104-105

Chapter 7: Wound HealingRepair of Skin: page 108-111Factors That Interfere With WoundHealing: page 111-113Growth Factors in Wound Repair: page 113Surgical Approaches: page 113-114Wound Dressings: page 114Suture Materials and Needles: page 115-116

Tourniquets: page 116-118

Chapter 8: Plastic SurgerySkin Grafting: page 120-122Local Cutaneous Flaps: page 122-124Local Muscle and Cutaneous Flaps: Page124Fasciocutaneous Flaps: page 124-125Microsurgery and Free Flaps: page 125-126Diagrams of Skin Flaps: page 126-130


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Chapter 9: Bone HealingPrimary Bone Healing: page 132Complications of Bone Healing: page 133-135

Treatment of Nonunions: page 135Fusion: page 135Bone Grafting: page 135-137Aseptic Necrosis Following 1st Metatarsal

Osteotomy: page 138-139Electrical Bone Stimulation: page 40Cartilage Healing: page 140

Chapter 10: Burns and FrostbiteAssessment and Treatment of Burns: page142-145Burn Deformities: page 145-146Other Types of Burns: page 146Frostbite: page 146-147

Chapter 11: Fluid Management andReplacement in the Surgical Patient

Fluid Management: page 150-152Complications of Total ParenteralNutrition: page 152Replacement Therapy: page 152-153Blood Products and Indications for Use:page 153-156Composition of IV Fluids: page156-157

Chapter 12: Bone TumorsIntroduction: page 160Staging Techniques: page 160-161Surgical Staging System: page 161Radiology of Bone Tumors: page 161-162

Bone Tumors: Page 163-168Cystic Lesions of Bone: page 168-169Other Tumors and Cancers: page 169-170Bone Tumors: A Quick Reference Chart:page 170-171Phases in Cancer Development: page 171Benign vs. Malignant: page 172

Chapter 13: DermatologyThe Skin: page 174Dermatological Lesions: page 175-182

Chapter 14: The Arthropathies

Causes of Joint Pain: A Summary: page184The Arthropathies: page 184-195Lab Testing for the Arthropathies: page195Articular Disorders Affecting the Heel:page 195-196Synovial Fluid Analysis: page 197Charcot Foot: page 198-199

Chapter 15: Peripheral Vascular Disease

Patient Evaluation: page 202-212The Vascular Diseases: page 212-215

Chapter 16: Internal & External FixationObjectives of Fixation Devices: page 218Requirements of Implant Materials: page218Principles Affecting Internal Fixation: page

218Internal Fixation Devices: page 219-229AO Objectives: page 229AO Principles: page 229-230AO Technique: page 230-235

Jumping Screws: page 235-236Other Techniques: page 236-238Complications of Fixation Devices: page238External Fixation: page 239Large Bone Fixation: page 239-252Small Bone External Fixation: page 253-254

Chapter 17: Nail Disorders & SurgeryNail Entities: page 256-260Nail Anatomy: page 260Surgical Nail Procedures: page 262-263

Chapter 18: NeurologyNeurological Pathways: page 266Presenting Features: page 266-270Assessment of Clinical Problems: page270-278Innervation of the Lower Extremity: page278-281

Tarsal Tunnel Syndrome: page 282-284Classification of Nerve Injuries: page 284-285Neuromuscular Causes of Cavus Foot:page 285

Types of Nerve Surgery: page 285-288

Chapter 19: PediatricsEvaluation of the Pediatric Patient: page290-293Pedicatric Biomechanics-Normal Values:Newborn to Adult: page 293Congential Deformities: page 293-302

Pediatric Radiology: page 302-304Pediatric Gait Patterns:page 304-305Intoe Gait:page 306-307Pediatric Fractures:page 307-318

The Limp in Childhood:page 318-319Juvenile Hallux Valgus:page 319-320Biomechanical Examination of the Child:

page 320-323Corrective Casting Techniques in Infants:

page 323-324The Toe-Walking Child:page 324-326


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Chapter 20: Drugs and Drug InteractionsIntroduction to Drug Interactions:page328Antibiotic Drug Interactions:page 328-329Anticoagulant Drug Interactions:page 330Antihypertensive Drug Interactions:page330-331

Antipsychotic Drug Interactions: page 331Cardiac Drug Interactions:page 331-332Diuretic Drug Interactions:page 332Non Steroidal Anti-Inflammatory DrugInteractions:page 332-333Oral Contraceptive Drug Interactions:

page 333Mechanisms of Drug Interactions:page333-335Specific Drugs:page 335-344

Chapter 21: Surgery of the Congenital FootFlatfoot Surgery (flexible):page 346-355

Subtalar Joint Blocking Procedures:(Arhroereises and Arthrodesis):page 355-356Flatfoot Surgery (rigid): Convex Pes PlanoValgus:page 356-358Metatarsus Adductus Surgery:page 358-362Cavus Foot Surgery:page 362-367Clubfoot Surgery:page 368-373

Chapter 22: Generalized DiseaseConditions of BoneSoft Tissue Overgrowth:page 376

Abnormalities of Alignment:page 376-377General Increased Bone Density:page 377Osteopenia:page 377-378Marrow Abnormalities:page 378-379

The Dysplasias: page 379-380

Chapter 23: RadiologyStandard Radiographic Techniquesof the Foot and Ankle:page 382-383Specific Radiographic Studies:page383-391

Anatomic Angles:page 391-396Common Structural Measurements(Diagrams):page 396-402Pediatric Radiology:page 402-406

The Osteochondritities:page 406-407The Accessory Bones of the Foot:page 407

Chapter 24: Hallux Valgus &Related DisordersGoals of HAV Surgery:page 410

Anatomical Facts of the 1st MPJ:page 410-411Predisposing Factors:page 412Biomechanics:page 412-414Etiology of HAV:page 414-415Deformity Types:page 416-417Radiological Measurements for HAV:

page 417-418

Physical Examination:page 418-419Preoperative Considerations:page419Arthroplasty Procedures:page 419420Capsule-Tendon BalancingProcedures:page 421-422Implant Arthroplasty Procedures:page 422-426Arthrodesing Procedures:page 426429Proximal Phalangeal Osteotomies:

page 429-431

Distal Metatarsal Osteotomies:page432-436Proximal Metatarsal Osteotomies:

page 436-438Shaft Osteotomies:page 438-439Combination Procedures:page 439Other Procedures:page 439-440Hallux Rigidus and Limitus:page440-445Hallux Varus:page 445-446Hallux Hammertoe:page 446Diff. Diagnosis of Pain In theSesamoid Area:page 446

Complications of HAV Surgery:page447HAV Procedure Chart and TheirIndications:page 448

Chapter 25: TraumaMedical Management and GeneralAssessment of the Trauma Patient:

page 450-451Assessment of Lower ExtremityInjury:page 451General Evaluation and Treatmentof Fractures:page 451-452

Calcaneal Fractures:page 452-460Talar Fractures:page 460-463Osteochondral Fractures:page 463465Navicular Fractures:page 466-470Cuboid Fractures:page 470-472Cuneiform Fractures:page 472Fifth Metatarsal Base Fractures:page472-474Metatarsal Fractures:page 474-480Ankle Fractures:page 480-493


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Midtarsal Joint Dislocations:page 494Tarsometatarsal JointDislocations/Fractures:page 494-498Ankle Inversion Sprain:page 498505Deltoid Ligament Ruptures:page506-507Compartment Syndrome:page 507

508Open Fracture Classification Systemand Tx:page 508-510Soft Tissue Injuries:page 510-511Crush, Gunshot, and LawnmowerInjuries:page 511-512Puncture Wounds:page 512Epiphyseal Plate Injuries:page 512-514Digital Fractures and Dislocations:

page 514-5151st MPJ Trauma:page 516-517Nail Bed Trauma:page 517-518

Toe Tip Injuries With Tissue Loss:

page 518-519Dog and Cat Bites:page 519

Chapter 26: Digital Deformitiesand SurgeryHammertoe Syndrome:page 522-528Mallet Toe Syndrome:page 528-529Claw Toe Deformity:page 529Overlapping 5th Toe:page 529-532Hallux Hammertoe:page 532-533Lesser Digital Arthrodesis:page 533Hallux Interphalangeal Arthrodesis:

page 533Lesser Digital Arthrodesis:page 533-534Overlapping 2nd Toe:page 534Syndactylization:page 534-535Digital Implants:page 535-537Floating Toe Syndrome:page 537Blue Toe Syndrome:page 538-539Polydactylism:page 539-541

Chapter 27: Muscle and TendonPathologyMuscle Physiology:page 544-548

Principles of Tendon Repair:page548-552Tendon Lengthening andTenotomy:page 552-554Tendon Transfers:page 554-556Tendon Grafts:page 556-557Posterior Tibial Tendon Rupture:

page 557-559Posterior Tibial Tendon Dysfunction(Acquired Adult Flatfoot Syndrome):

page 559-560

Peroneal Tendon Pathology:page560-562Achilles Tendon Rupture:page 562-566Lateral Ankle StabilizationProcedures:page 566-571Postoperative Care and TrainingFollowing Tendon Transfer:page

571-572Tenosynovitis:page 572

Chapter 28: Lesser MetatarsalSurgeryAnatomy (Metatarsals 2-3-4):page574-575Differential Diagnosis ofMetatarsalgia:page 575Surgical Treatment of the IPK:page575-578Lesser Metatarsal Joint Replacement:

page 578-579

Panmetatarsal Head Resection:page579-581Metatarsus Adductus:page 581-585Freiberg's Disease:page 585-587

Tailor's Bunion:page 587-589Splayfoot:page 589Brachymetatarsia(Brachymetetopody):page 589-591Skewfoot:page 591-592

Chapter 29: Ankle ConditionsDifferential Diagnosis of ChronicAnkle Pain:page 594

Tarsal Tunnel Syndrome:page 594-597Sinus Tarsi Syndrome:page 597-599Peroneal Subluxation:page 599-600Ankle Arthrodesis:page 600-602Lateral Ankle Instability:page 603Chronic Lateral Ankle Instability:

page 604-607Chronic Medial Ankle Instability:

page 607Ankle Equinus:page 607-611

Malunion and Nonunion of theMalleolei:page 611-614

Chapter 30: Heel ConditionsAnatomy of the Heel:page 616-617Radiological Evaluation of the Calcaneus:

page 617-618The Heel in Systemic Disease:page 618-621Seronegative Arthritis and Heel Pain:

page 621-622


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Heel Spurs and Heel SpurSyndrome:page 622-623

Tumors of the Heel:page 623-626Tarsal Coalitions:page 626-629Sever's Disease:page 629-630Causes of Heel Pain (a summary):

page 630-631Haglund's Deformity:page 631-632

Chapter 31: AmputationsGeneral Surgical Technique:page634Digital Amputations:page 634-635MPJ Amputations:page 635

Transmetatarsal Amputations:page635-636

Tarsometatarsal Amputations(Lisfranc's):page 637Midfoot Amputations (Chopart's):

page 638Amputation of the Ankle (Syme's,

Boyd, Pirogoff):page 638-639Below Knee Amputation:page 639-640

Chapter 32: BiomechanicsNormal Values:page 641Criteria of Normalcy in the LowerExtremity:page 642-643Adult Biomechanical Examination:

page 643-645Common Structural Variations:page646-648Planes of Motion:page 648-649

Axes of Joint Motion:page 649-653Angular and Axial Deformities inChildren:page 654-656Anatomy of Gait: Activity of Muscles:

page 656-663Observation of Gait:page 663-664Subtalar Joint Measurements:page664-666Subtalar Joint Function:page 666-667Midtarsal Joint Function:page 667-668

Chapter 33: AnatomyNeuroanatomy:page 670-676Angiology:page 676-680Myology:page 680-695Arthrology:page 695-704

Chapter 34: Soft Tissue TumorsSoft Tissue Tumors:page 706-715

Chapter 35: Physical Medicineand Rehabilitation

Physical Modalities and Diseases:page 718-720Therapeutic Modalities andProcedures:page 720-730

Chapter 36: ArthroscopyAnkle Arthroscopy:page 731-740

Chapter 37: Laser Applications inPodiatric SurgeryLaser and Laser Physics:

page 741-751Clinical Applications in PodiatricSurgery:page 751-775

Chapter 38: Specific RadiologicalPathologyMRI Pathology:page 777-800

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Hers Hey 2003 Contents