First Ray Surgery - 2 Soft Tissue Procedures For Hav

Front 1

Generally speaking, when performing SX on a mild bunion, you ONLY perform a ______________ procedure without a metatarsal osteotomy.

However, if you are doing a metatarsal osteotomy, you would use a MODIFIED McBride procedure.

Back 1

Generally speaking, when performing SX on a mild bunion, you ONLY perform a ___Soft Tissue___ procedure without a metatarsal osteotomy.

However, if you are doing a metatarsal osteotomy, you would use a MODIFIED McBride procedure.

Front 2

Pre-operative symptoms that would indicate a need for a Soft tissue procedure would include>>

Back 2

Bump pain
Medial pain with shoe gear
Medial skin & soft tissue irritation over the 1st metatarsal head
NO sesamoid or deep pain

Front 3

Pre-Op radiographic signs for Soft tissue procedures are:

Back 3

The angles should be WNL
IM angle should be 9-10*

Front 4

Describe the operative technique for the soft tissue procedure, the Silver:

Back 4

Incision (dorso medial?)
Capsulotomy
Resection of bump
Closure

Front 5

Post operative course for all soft tissue procedures:

Back 5

2 weeks in a SX shoe

Sutures off in 14 days

Sneaker 2-4 weeks

Post-op x ray on 1st visit

ROM exercises

Front 6

What is the major disadvatanges to doing a Silver?

Back 6

-Doesn't correct etiology of HAV

-Weakening medial structures (hallux abductus)

-Recurrence (COMPLICATION)

-Joint stiffness (COMPLICATION)

Front 7

A true McBride bunionectomy includes:

Back 7

REMOVING FIBULAR SESAMOID (gives you more aggressive lateral release)

-Possible Adductor Transfer

(lateral release will include release of conjoined adductor tendon, capsulotomy, fibular sesamoid ligament)

Front 8

Lateral release will include release of what 3 structures:

Back 8

conjoined adductor tendon
capsulotomy
fibular sesamoid ligament

Front 9

A modified McBride does not include what steps:

Back 9

Removal of fibular sesamoids

Adductor transfer

Front 10

What are the steps to a McBride (full)

Back 10

Incision
Capsulotomy
Resection of bump
Lateral Release
Excision of fibular sesamoids
Adductor transfer
Medial capsulotomy
Closure

Front 11

What is staking in relation to this radiograph?

Back 11

Taking too much of the bump off, where the medial facet becomes compromised.

Front 12

For a Modified McBride the IM angle should be?

Back 12

Up to 10*

Front 13

For a Silver, the IM angle should be?

Back 13

NORMAL 8*

Front 14

Describe the Hiss Procedure

Back 14

Dorsal transfer and advancement of the abductor hallucis tendon.

Attach the tendon to the base of the prox phalanx to hold the toe straight.

Front 15

What are the skin incisions for bunionectomies?

Back 15

Longitudinal (curved to straight): gives ADEQUATE exposure to joint, and allows you follow everything in the same plane


Medial incision (problem is it takes longer to get back into shoe)

Front 16

The medial elliptical incision is not a good idea b/c:

Back 16

All the vascular structures are located there!

Front 17

Describe the mini tightrope procedure.

Back 17

Relocates the 1st and 2nd met to a normal IM angle without the use of an osteotomy using a drill hole technique

Hint 17

Usually uses a C arm. mark the medial aspect of the 2nd met, where u want to make your accessory incision.

Front 18

What is the suture used in the Mini Tight Rope procedure?

Back 18

Fiberwire-- which is a polyester suture with a polyethylene core.

Front 19

The complications seen w/ the Mini Tight rope are:

Back 19

Splaying b/c the fiberwire stretches

Continuing pain

Bone fx (2nd met)

Front 20

Name some capsulotomies (specifically medial types)

Back 20

Vertical Incision
H incision
U shaped
I shaped
L shaped (dorsomedial inverted)

Front 21

What kind of dorsolinear capsulotomy is this?

Back 21

Washington monument.

Strongest capsulotomy.

Front 22

The exostectomy is also referred to as:

Back 22

The Schede procedure (1980)

It removes the bump
&
Assists in tightening the medial capsule.

Front 23

What is the difference between capsuolotomy & capsulorrhaphy?

Back 23

capsulorrhaphy is actually removing a piece of the capsule in order to aid in tightening.

Uses osteome and mallets.
Power equipment.