First Ray Surgery - 4 First Met Osteotemies

Front 1

Reverdin & Peabody osteotomies both correct what angle?

Back 1

An abnormal PASA

Front 2

The reverdin occurs at the ________ of the met.

Back 2

Head of the met.

Front 3

The peabody occurs at the _______of the met.

Back 3

Neck of the met.

Front 4

Reverdin-green (Distal L) corrects an abnormal pasa. The modification comes from the fact that you are avoiding damage to what structure?

Back 4

The sesamoids.

Front 5

The modification to this procedure is what?

Hint: the modification that prevents damage to the sesamoids

Back 5

The Reverdin-Green (Distal L) modification, which corrects the PASA, without damaging the sesamoids.

Front 6

This procedure shown here corrects what?

Back 6

The reverdin-laird corrects an abnormal PASA & IM angle up to 12*

. Again, there’s an instance of having an IM angle of 12-14 and a PASA of 30 where there is a possibility of doing this case. The reality is, if the IM is about 12 and the PASA is abnormal you can do this. If it’s closer to 14 (IMA) than there are better procedures available, but for test/board purposes I want you to understand that people stretch to 12 a little bit higher. This is what I want you to remember, but realize that there is some flexibility. I will make sure on a test question to make it very clear to you. So, when you have a high PASA and an IM of about 12, you can perform a REVERDIN-LAIRD. It’s a Reverdin, but you break through the lateral cortex and you take the capital fragment and shift it laterally to correct the IM.

Front 7

What does fixation entail for Reverdin procedures?

Back 7

28 guage monofilament wire
0.062” k-wire
Non-absorbable suture
2.0 cortical screw

Postop
monofilament wire. Non-absorbable suture is not recommended any more although people in other parts of the country do it. Since it’s an osteotomy, the post-op course is you take an x-ray post-op in the hospital, on the first post-op visit to make sure nothing has changed, take one again at 4 weeks because that’s how long it will take for this to heal. If at 4 weeks you see consolidation and clinically there is little pain or swelling, you can take them out of a surgery shoe and put them in a sneaker. If not, keep them in a surgery shoe a little longer. You can WB in a surgery shoe and it takes 4 weeks to heal.
Surgical shoe for 4 weeks

Front 8

What are the contraindications for the Reverdin/Peabody?

Back 8

Poor Bone stock

Bone cysts

Front 9

What are some major complications of the Reverdin?

Back 9

Avascular necrosis

Delayed union/non-union

Traumatic arthritis

Front 10

What are the distal/subcapital metaphyseal osteotomy techniques?

Back 10

Mitchell
Hohman
Wilson
Austin

Front 11

When are the Mitchell/Hohman/Wilson/Austin osteotomies indicated?

(IM angle)

Back 11

The next osteotomies are probably the more common that you are going to see and they are the distal/subcapital metaphyseal osteotomies. These are done distally within the
head. These are the AUSTIN, WILSON, MITCHELL, and HOHMANN. The most common is the AUSTIN. All of these procedures are done with an IM angle of 12-14 degrees.

Front 12

What is this procedure and how it is done?

Back 12

The first is the MITCHELL bunionectomy, which is commonly done by orthopods. It is a rectangular osteotomy. The first cut is made perpendicular to the long axis. The second cut is made distally. It is a predetermined wedge that you make from medial to lateral going about 80% of the way through the bone and you are making a jigsaw puzzle or spicule. So when you take this wedge out, and you finish the cut, you have this little interlocking piece of bone

Front 13

What procedure is this?

Back 13

The is the HOHMANN procedure. Some people also use this for hallux limitus when indicated. The HOHMANN is a trapezoidal wedge that is through and through the bone. You take the wedge out and shift the capital fragment laterally. Again, you are taking a large wedge of bone so you have to have a long met generally speaking.

Front 14

Osteoporosis

prophylaxis and treatment

Back 14

Prophylaxis: exercise and calcium injestion before age 30

Treatment: estrogen and/or calcitonin; bisphosphonates or pulsatile PTH for severe cases. Glucocorticoids are contraindicated.

Front 15

What procedure is this?

How is it performed?

Back 15

Austin Bunionectomy.

You go to the medial aspect of the 1st met (head) and you cut a very small sliver of bone so that the medial aspect of the met is a flat surface. You imagine a circle. You go to the center of that circle and that’s going to be your apex. You take your saw blade and this is a 60 degree angle. You make a dorsal cut and a plantar cut. The plantar cut ends were the plantar facet ends. You go all the way through the bone and the dorsal wing and the plantar wing should be equal in length. So if you practice on a saw bone, you could flip the met head and it should fit it it’s exactly right. Once you make this cut through and through, you take the capital fragment and shift laterally to correct for IM angle. You fixate it.

NEVER, NEVER, NEVER remove the bump first and then do the AUSTIN because if you cut too much you can’t put it back.

INDICATIONS: IM angle - 10-14*

BICORRECTIONAL AUSTIN: corrects pasa & IM angle

Front 16

Discuss some possible complications of the Austin.

Back 16

. Fracture of dorsal or plantar wing. How does that happen. As you put the saw blade in, the blade has a little bit of give to them so you have to be careful you don’t go too far into the head and fracture it. Otherwise, you have to fix the fracture.

You can get a delayed/non-union. It’s not common but you can. Why? People that walk on it. People that are not fixated. People that don’t follow directions. very common here at the college.

You can get AVN of the head, not common again. Shortening occurs, but you can get excessive shortening if you used it in the wrong indication.

You can get elevation of the capital fragment if you didn’t make your cuts right or in the right plane. If you do you’ll get transfer metatarsalgia. Either that or shortening of the 1st met.

Front 17

Tricorrectional austin corrects:
IM, PASA, & ____________?

Back 17

Met elevatus

Front 18

What is the Kalish procedure?

What angle is it indicated for?

Back 18

The KALISH is a modification of the AUSTIN described by Stan Kalish you still practices in GA. The purpose of this was to have a longer dorsal arm so that you can fixate with screws at 2 points of fixation. If you just had an AUSTIN for instance and you wanted to fixate with screws, you be lucky is you could get one. You have to be careful the screw head doesn’t go too near toe cartilage. If you make the dorsal wing longer and change the angle from 60 to 55, you know have enough room to put 2 screws in. Now, very important, since you are performing it in this fashion, KALISH corrects IM, but not PASA. KALISH cannot correct PASA.

Front 19

Describe these 2 procedures.

Back 19

The first one we are going to talk about is the Ludloff. The Ludloff is an oblique cut preformed midshaft. It starts from proximal dorsal to plantar distal.

Mau is OPPOSITE. It is dorsal distal to plantar proximal!




Other shaft procedures:
Offset V
Scarf

Front 20

Offset V bunionectomies are indicated when you have?

Back 20

INCREASE IN IMA
INCREASE IN PASA

Front 21

Offset Vs can fixed with?

Back 21

2.7 cortical screws in a lag fashion
K wires
Buried thread K wire

Front 22

Scarf/Z bunionectomies indications are:

Back 22

Increase in IMA
Increase in PASA

Front 23

For a MILD HAV deformity,
(normal to mild increase in IM)
Normal PASA,

what procedures are indicated?

Back 23

Silver
Modified McBride ( lateral release)

Front 24

For a MILD HAV deformity,
(normal to mild increase in IM)
Increase in PASA,

What procedures would you do?

Back 24

Reverdin
Reverdin-Green (L)
Reverdin Laird

Front 25

For a Mild to Moderate HAV deformity--

(Moderate increase in IM)
Normal PASA

what procedures would you do?

Back 25

AUSTIN
MITCHELL*
HOHMANN*
WILSON*
KALISH
OFFSET V
SCARF


*can correct PASA

Front 26

For a Mild to Moderate HAV deformity--

(Moderate increase in IM)
INCREASED PASA

what procedures would you do?

Back 26

BICORRECTIONAL:

AUSTIN
MITCHELL*
HOHMANN*
WILSON*

Front 27

For severe HAV,
w/ a NORMAL PASA-
what procedures would you do?

Back 27

CBWO
OBWO
CRESCENTIC BWO
-
Kalish
Offset V
Scarf

Front 28

For severe HAV,
w/ a INCREASE PASA-
what procedures would you do?

Back 28

All of the below w/ modifications!
---------
CBWO
OBWO
CRESCENTIC BWO
-
Kalish
Offset V
Scarf

Front 29

What procedure is this and when is it indicated/

Back 29

LAPIDUS

Indicated for SEVERE HAV, w/ excessive hyperpronation.

No need for medial eminence resection or lateral release

Front 30

What is the ideal position for a hallux fusion? BE SPECIFIC.

Back 30

ideal position of fusion hallux is in abductus 15-20 degrees, DF approximately 5 mm off the ground or 5-10 degrees off the ground. Never invert or evert. No frontal plane correction