Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
71 Cards in this Set
- Front
- Back
|
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 |
