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71 Cards in this Set

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Proximal Akin
Medially based wedge resection 5-10 mm distal to hallux MPJ, lateral cortex intact

Indication: Abnormal DASA
Central Akin
Two parallel cuts are made perpendicular to long axis of hallux proximal phalanx

Indication: Excessively long hallux
Distal Akin
Medially based wedge resection of the distal aspect of the proximal phalanx

Indication: Abnormal hallux abductus interphalangeal angle (>10)
Hallux IPJ Sesamoid Excision

(Suture to repair tendon?)
Indication: Painful hyperkeratosis at the hallux IPJ

*Repair FHL tendon with Ethibond suture
Hallux Condylectomy
Condylectomy of the plantar medial condyle of the head of the hallux proximal phalanx

Indication: Hallux pinched tyloma
Hallus IPJ Arthrodesis

(How to fixate?)
Fusion of the hallux IPJ

Many indications

Fixate with 4.0 cancellous screw
Silver Bunionectomy
Resection of the 1st met bump ONLY

Indication: Angles should be WNL, bump pain
True McBride
Capsulotomy, bump resection, lateral release, fibular sesamoid excision, adductor tendon transfer, medial capsulorraphy

Indication: Slight increase in IM angle and sesamoid position, abnormal HAA
Modified McBride
Capsulotomy, bump resection, lateral release, medial capsulorraphy

Indication: IM angle > 10, abnormal HAA
Hiss Procedure
Dorsal transfer and advancement of abductor hallucis tendon

Indication: Slight increase in IM angle or sesamoid position
Mini Tightrope Procedure

(What type of suture?)
Relocation of 1st and 2nd metatarsals to a normal IM angle using a drill hole technique

*Use Fiberwire
Strongest type of medial capsulotomy of HAV?
Washington monument

Distal rectangular flap, suture space, pull flap distally to tighten
Riverdin
Medially based wedge resection at the head of the 1st metatarsal, lateral cortex intact

Indication: Corrects PASA
Peabody
Medially based wedge resection at the neck of the 1st metatarsal, lateral cortex intact.

Indication: Corrects PASA
Riverdin-Green
Medially based wedge resection, plantar shelf to protect sesamoids, lateral cortex intact

Indication: Corrects PASA
Riverdin-Laird
Medially based wedge resection through and through, then slide distal fragment laterally

Indication: Corrects abnormal PASA (30-35) and IM angle up to 12
How much bone shortening is made with a single osteotomy?
3mm. 1mm from the blade thickness, and 1mm on either side due to bony necrosis
Mitchell
Rectangular wedge of bone taken from metatarsal neck, medially

Indication: IM angle 12-14, long 1st met, and elevatus
Hohmann
Trapezoidal wedge of bone resected from medial metatarsal neck, move distal fragment laterally

Indications: IM angle 12-14, hallux limitus, long 1st met
Wilson
45 degree osteotomy at metatarsal neck from distal medial to proximal lateral, distal fragment shifted laterally

Indications: Abnormal PASA, IM angle 12-14
Austin (Chevron)
Inverted 60 degree "V" osteotomy from medial to lateral through the 1st metatarsal head

Indication: IM angle 12-14, bicorrectional if moderate PASA, tricorrectional if moderate PASA and elevatus
Youngswick Modification
Austin-type osteotomy with an additional dorsal cut to remove wedge

Indication: Hallux limitus, corrects IMA and elevatus
Drato
Derotational, angulational, transpositional osteotomy in metatarsal neck

Indication: to reorient plantar cartilage more dorsally
Kalish
Inverted 55 degree "V" osteotomy, dorsal arm is extended to allow screw fixation

Indication: IM angle 12-15, CANNOT FIX PASA
Ludloff
1st metatarsal oblique midshaft osteotomy from proximal-dorsal to distal-plantar

Indication: IM angle 12-17
Mau
1st metatarsal oblique midshaft osteotomy from distal-dorsal to proximal-plantar

Indication: IM angle 12-17
Offset "V" (Vogler)
35 degree inverted "V" osteotomy with apex at the proximal end of the 1st metatarsal head

Indication: IM angle 12-15 and moderate to severe increase in PASA
Scarf

(What should you beware of?)
"Z" type osteotomy along shaft of 1st metatarsal

Indication: IM angle 12-15, moderate increase in PASA

*Beware of "Trough Effect"
Closing Base Wedge

(How to fixate?)
(Another name?)
Lateral wedge osteotomy at the base of the 1st metatarsal

Indication: IM angle > 15

*0.062 cross K-wires

*Loison-Balacescu
Juvara
An oblique lateral wedge osteotomy at the base of the 1st metatarsal

Indication/Benefit: removes less bone than CBWO, allows screw fixation
Crescentic Base Osteotomy
Curved dorsal osteotomy at the base of the 1st metatarsal. Can include plantar shelf

Indication/Benefit: less shortening, bi/tricorrection
Opening Base Wedge

(Another name?)
Medial wedge osteotomy at the base of the 1st metatarsal, 1cm distal to met-cune. joint

Indication:

*Trethowan
McKeever
1st MTPJ arthrodesis, removes only cartilage, position should be 15-20 abducted, 5-10 DF, no frontal correction

Indication: Severe HAV, hallux rigidus/limitus, hallux varus, NM disease, failed previous sx, DJD, can also be modified to correct for DASA, PASA, and HAA for bunion
Lapidus
Fusion of the 1st met-cune. joint w/ or w/out 2nd met-medial cune. fusion

Indication: IM angle 18-20, hypermobile 1st met-cune. joint, and long 1st ray
How to evaluate HAV surgery radiographically?
1. Is the joint congruous?
2. Are the sesamoids in their appropriate position?
3. Have the angles that you are attempting to correct corrected?
4. Is the fixation correct?
5. Is the medial aspect of the base of the proximal phalanx sitting in the sagittal groove?
Stepwise approach to surgical correction of hallux varus?
1. Soft tissue release at 1st MTPJ
2. Medial capsulotomy
3. Tibial sesamoidectomy
4. EHL release and transfer to plantar lateral prox. phalanx
5. Osteotomy
6. Joint destructive procedure (implant/arthroplasty)
7. Arthrodesis
Bonney-Kessel
Dorsiflexory osteotomy of base of proximal phalanx, moves plantar WB forces dorsally

Indication: Hallux limitus/rigidus, may also me modified to correct for abnormal DASA in bunion
Waterman
Dorsiflexory osteotomy of the 1st metatarsal head, allowing patient to roll off bent toe

Indication: Hallux limitus/rigidus
Cheilectomy
Removal of the dorsal osteophyte of metatarsal head

Indication: Hallux rigidus/limitus
Regnauld
Base of the proximal phalanx is fashioned into a peg, then re-inserted into the proximal phalanx

Indication: Hallux rigidus/limitus, can also be modified to correct abnormal DASA and proximal phalanx length
Cotton
Opening wedge osteotomy of the medial cuneiform, dorsally

Indications: Flatfoot, FF supinatus, hallux rigidus/limitus
Lambrinudi
Plantarflexory wedge osteotomy at the base of the 1st MTPJ

Indications: Hallux rigidus/limitus
Keller
Arthroplasty of the 1st MTPJ, involves resection of the base of the proximal phalanx

Indication: Hallux rigidus/limitus, also corrects abnormal HAA for bunion
Fowler
Medial opening base wedge osteotomy of the medial cuneiform

Indications/benefits: HAV, adds length
Logroscino
Double osteotomy: distal Riverdin, proximal opening or closing

Indication/benefit: can address 2 separate problems, IMA and PASA
Jones Suspension

(What procedure is typically done in combo?)
Transect EHL at hallux IPJ, re-route from med to lat through the 1st met neck, EHL stump attached to EHB

Indications: Cock-up hallux, flexible cavus foot, flexible PF 1st ray, prophy w/sesamoid removal

*Hallux IPJ fusion
Hibbs Suspension
Detach EDL tendons 2-4 distally, attach prox stump to 3rd cune, distal stumps to EDB tendons

Indications: Flexible forefoot cavus, flexible cavus with clawtoes secondary to extensor substitution
Split Tibialis Anterior Tendon Transfer (STATT)
Split TA, lateral half attaching to peroneus tertius or cuboid via EDL tendon sheath, anchor

Indication: Spastic RF varus, fixed equinovarus, excessive supination, outpowering of evertors by invertors, flexible cavovarus, weak DF
Tibialis Anterior Tendon Transfer
Detach tendon at insertion, pass down peroneus tertius sheath, attach to cuboid (Clubfoot) or 3rd cuneiform (Drop foot)

Indications: Recurrent clubfoot, flexible FF equinus, dropfoot, TMA
FDL Transfer
Detach FDL tendon at Master knot of Henry, attach distal stump to FHL, anchor tendon into navicular and suture along TP

Indication: Tibialis posterior dysfunction
Tibialis Posterior Tendon Transfer
Harvest TP at its insertion, re-route into anterior compartment, attach to 3rd cuneiform

Indications: Weak/paralyzed anterior muscles, equinovarus deformity, spastic equinovarus, dropfoot, recurrent clubfoot, CMT deformity, permanent peroneal palsy
Peroneus Longus Tendon Transfer
Release PL at cuboid, re-route through extensor sheath, attach to 3rd cuneiform

Indications: Dropfoot, anterior muscle group weakness, CMT, paralytic calcaneus gait
Peroneus Brevis Tendon Transfer
Release PB at 5th met base, transfer down extensor sheath, attach to talar neck

Indications: Remove ABD force in flatfoot or TPD, weak posterior muscle group, anterior group weakness
Murphy Tendo Achilles Advancement
Detach tendon from insertion, advance forward to just behind STJ

Indication: Spastic equinus
Surgical Procedures for MPJ Release
- Extensor hood release
- EDL tenotomy at MTPJ, or Z-lengthening
- PIPJ head resection via collateral release
- MTPJ capsulotomy
- Flexor plate release with McGlamry elevator
- Arthrodesis if still rigid
Dwyer Osteotomy
Closing base wedge osteotomy from the lateral side of the calcaneus, just postero-inferior and parallel to the PL tendon

Indication: Structural varus deformity of the calcaneus
Cole Osteotomy

(MC complication?)
DF "V" osteotomy fusion of the cuboid and navic-cune. across the midfoot

Indication: PF forefoot on rearfoot, apex of deformity at the midfoot

Indications: Non-progressive, anterior cavus, apex in lesser tarsus
JAPAS Osteotomy
Dorsal "V" displacement osteotomy across lesser tarsus, apex proximally, creates dorsal bump

Indication: PF forefoot on rearfoot, apex of deformity at the midfoot
Steindler Stripping
Proximal release of the 1st intrinsic layer of muscles (ABD hallucis, FDB, ABD digiti quinti)

Indication: Significant contracture of both plantar aponeurosis and plantar musculature
Triple Arthrodesis
Fusion of STJ, TNJ, and CCJ, should be in rectus position

Two incision technique, resection of lateral collateral ligaments, joint resection (CCJ, STJ, then TNJ), fixation (STJ, CCJ, then TNJ)
Keller-Brandis Arthroplasty
Removal of the proximal 2/3 of the proximal phalanx

Indications: Hallux limitus/rigidus, can also be modified to correct for abnormal HAA
IPJ Fusion
Fusion of the hallux IPJ

Indications: Corrects abnormal hallux abductus interphalangeus
Distal Hemi Implant
Implant at base of the proximal phalanx

Indications: Hallux limitus/rigidus, can be modified to correct for abnormal HAA or DASA
Total Implant
Both the base of the proximal phalanx and distal aspect of the 1st metatarsal head are resected to allow for insertion of implant

Indications: Hallux limitus/rigidus, can be modified to correct for HAA
Mayo
1st metatarsal head resection

Indications: Hallux limitus/rigidus, can also be modified to correct for HAA
Stone
1st metatarsal head resection, leaving the sesamoid articulation intact

Indications: Hallux limitus/rigidus, can also be modified to correct for HAA
Reverdin-Todd
Indications: Corrects PASA, IMA, and sagittal plane deformity
Roux
Wedged Mitchell

Indications: Corrects for IMA, metatarsal length, also PASA
Miller
Oblique Mitchell

Indications: Corrects for further IMA and metatarsal length
Distal L
Similar to Reverdin-Green without correction of PASA

Indications:
Mygrind
Mexican hat procedure for distal first metatarsal

Indications: Corrects IMA and metatarsal length