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55 Cards in this Set
- Front
- Back
- 3rd side (hint)
list the ligaments of the 1st MPJ and tell whether they are extra or intracapsular
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1. medial collateral (met to phalanx) 2.lateral collateral (met to phalanx)3. medial and lateral met sesamoid suspensory 4. medial and lateral phalangeal sesamoidal 5. intersesamoidal 6. DTIL; all are intracapsular except the DTIL
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what is the capsularis actually a branch of
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TA
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what is the axis of the first ray and how does this dictate its motion
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medial/proximal/dorsal to plantar/lateral/distal. There is almost no transverse plane motion bc of the horizontal positioning of the axis. The first ray DF/inverts and PF/everts.
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what should you suspect as the cause of HAV in a 3-4 yo
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an anatomical anomaly or NM dz because you must have propulsion for HAV to form
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when the crista erode in Grade 4 HAV, how can you hold the sesamoids in the correct position
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transfer the adductor hallucis to the tibial sesamoid ligament
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If PASA + DASA = HAA; what type of deformity is this
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Structural, joint is congruent, PASA or DASA is abnormal
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If PASA + DASA < HAA; what type of deformity
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Positional deformity, joint is deviated or subluxed, PASA and DASA are normal
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If PASA + DASA > HAA; what type of deformity
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Combined deformity; joint is deviated or subluxed, PASA or DASA is abnormal
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If HAA = 35, DASA = 2, PASA = 6; what is the condition/position of the MPJ
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6+2< 35; DASA is abnormal, so MPJ is deviated or subluxed
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If HAA is 35, DASA is 8, PASA is 27; what is the position of the MPJ
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27+8 = 35, DASA is normal, MPJ is congruent
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If HAA is 35, DASA is 2, PASA is 17; what is the position of the MPJ
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19 < 35, but PASA is abnormal, MPJ deviated and deformity is combined
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define a structural deformity in HAV
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-this is a boney deformity in which there is osseous change in either PASA or DASA, the structural deformity has a congruent joint
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Define a positional deformity in HAV
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-this is a soft tissue deformity in which the PASA and DASA are normal and the joint is either deviated or subluxed
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what does PASA attempt to quantify
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the structural adaptation of the 1st MTPJ
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when should PASA be corrected
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when it is greater than the IM angle, so a PASA of 12 can be normal as long as the IM angle is >12. The PASA should be corrected by atleast the amount that it is larger than the IM angle.
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will a capsulotomy correct a structural deformity
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no, it is a boney deformity
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list the indications for a Keller
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-HAV with DJD, 2nd/3rd degree HR (loss of joint), geriatric bunion
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how much does a Keller reduce IM angle
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3-5 degrees
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list some disadvantages of Keller
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-short hallux, loss of purchase, sesamoid retraction, limited ROM, metatarsalgia, stress fx to 2/3rd met
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what does a true McBride entail
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-medial eminence removed, fibular sesamoid excision, adductor tendon transfer (its a capsule-tendon balancing procedure)
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what is a true silver
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-just remove the bump
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what is the final position of a McKeever
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5-10 degrees DF, slight abduction so its parallel to the 2nd toe or 10-15 on the transverse plane (no varus or valgus)
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appropriate fixation for a McKeever
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4.0 cancellous screw, 3.5 cortical lag screw, 2 crossed 0.45 wires, wire loops, herbert screw
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with a lapidus; how should the met be manipulated before fixation
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adducted and slightly plantarflexed
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what can correct a high DASA
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Proximal Akin
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what can correct a high HIA
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distal akin, HIA > 10, can be used when hallux is putting pressure on the 2nd toe
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what can be used to shorten a long proximal phalanx
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central akin
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dorsal wedge osteotomy of the base of the prox phalanx
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Kessel Bonney, used for HL
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when performing an Austin, how much will 1mm in lateral shift adjust the IM angle
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1mm of lateral shift will decrease the IM angle 1 degree (you can safely shift the met head laterally ⅓ of the width of the met, so if met is 21 mm wide, you can safely slide the bone 7 mm and get 7 degrees of correction)
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angle of Austin
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60 degrees
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what happens if the capital fragment hits the ground….
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place in a basin containing: 1 Liter saline, 1 cc neosporin G.U irrigant and 1;100,000 bacitracin for 5 minutes, then a new basin with same solution for 5 minutes, third basin for 1 minute with same solution; also ancef post op for 3 doses. Other lit states that a 30 min soak in 4% chlorhex gluconate, saline rinse, then triple abx solution as above, then saline rinse again is more effective.
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how can u use an Austin to correct PASA
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thicker cut is made after the intial cut; remova a dorsal medial trapezoid from met head
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what is the location of prox met osteotomies for HAV
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1-1.5 cm distal to the base
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which osteotomies can correct an increased PASA
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Austin with a dorsomedial wedge, All Reverdins, Peabody, Offset V, Keller, Mau
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which osteotomies can correct an increased DASA
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Proximal Akin, Central Akin, Keller
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What is the normal declination of the lesser metatarsals
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15 degrees
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What is the normal metatarsal parabola
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142
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Which sx should be performed? IPK’s under met heads, atrophy of plantar fat, ,met heads are palpable, DJD, contracted toes, RA, psoriatic arthritis
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pan met head resection –
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What adjunct procedure can be used with a pan met to add stability to the forefoot
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syndactyly the toes
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Disadvantages of a pan met head resection
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loss of propulsive gait, flail toes post op, incidence of hematoma, loss of digit stability
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Where is the apex of deformity with Met adductus
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lisfranc joint
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Why is the met adductus angle not always accurate
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because the lesser tarsal bones in the neonate are not measurable bc they are radiographically silent and in many cases the TC relationship is abnormal ( talo -2nd met angle; N=16)
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When is a Heyman, Herndon, Strong procedure indicated and what is it
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for flexible met adductus; usually in kids less than 5, deformity present at the lisfranc joint. Soft tissue procedure that releases the dorsal, interossei and plantar ligaments of the tarso-met and inter-met joints, manipulate the foot into abduction, K wire fix the first met cune joint and 5th met cuboid joint. LEAVE THE PLANTAR LATERAL LIGAMENTS INTACT
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What do you want to avoid damaging with a Heyman, Herndon, Strong ST release for met adductus
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avoid damage to the 1st met growth plate, do not confuse this with the met cuneiform joint
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What procedure would you use? Child 5-8 yo with a met adductus deformity
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cartilaginous procedure (Johnson Osteochondrotomy); Closing abductory BWO of 1st met, wedge resection of cartilage nad bone from the bases of the lesser mets, fixate with wire or staples.
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Which procedure would you use? Met adductus in a child older than 6-8 yo
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Osseous procedure (MA may be a residual deformity of tx TEV) Berman-Gartland Procedure; transverse or oblique closing abductory wedge of 1st met, similar osteotomies of lesser mets with medial cortical hinge; fix with wire, staples or screws or LEPIRD procedure
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Describe the Lepird procedure and when it is used
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Osseous procedure for MA in pts older than 6-8 yrs; usually residual MA from TEV treatment. Juvara of the 1st and 5th met, rotational osteotomy of lesser mets. Lesser met rotational osteotomies are dorsal distal to plantar proximal, 45 degrees from the WB surface, (Mau?) distal fragment is rotated laterally into a corrected position and fixed with screws.
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What is the general algorithm for met adductus treatment based on age
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Birth – 4 yo (stretching or casting), Less than 5 yo (Soft tissue procedures-HHS), 5-8 yo (cartilage procedure – Johnson),> 7 yo (Osseous – Berman Gartland or Lepird)
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Treatment for Freibergs
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Conservative: casting and cortisone, then orthotics. Surgical: implant arthroplasty/met head remodeling/bone graft to restore the head contour/rotational osteotomy to rotate the lower aspect of the met head dorsally/excision of loose bodies
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List etiologies of Tailors bunion
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1. Uncompensated varus FF or RF, congenital PF 5th ray deformity, dorsiflexed 5th ray deformity, lateral deviated or wide 5th met head
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When tailors bunion is present, what deformity should you also check for
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Splay foot (IM angle > 12 and 4th/5th IM angle > 8
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Radiographic findings of Tailors bunion
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IMA: >8, N=6, Lateral deviation angle: 8, N = 2.6, rotation of lateral plantar
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MC procedures for Tailors bunion
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-bumpectomy, reverse Wilson (oblique), Hohman (transverse osteot)
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What is a Skewfoot
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Met adductus with RF valgus
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What are the radiographic findings of skewfoot
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adducted FF with pronated RF, MA >21, cuboid abduction angle >5
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