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**Forefoot > 1st ray > Flashcards

1st ray Flashcards

1
Q

true IM angle

A

IM angle + (MAA - 15)

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2
Q

youngswick

A

shorten and plantarflex met head, for metatarsus elevatus

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3
Q

Reverdin

A

Reverdin: medial wedge that Corrects pasa on metatarsal head

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4
Q

Reverdin Laird

A

completion of osteotomy on lateral hinge

corrects PASA and IM

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5
Q

Reverdin Todd

A

reverdin todd: corrects PASA, IM, and allows plantarflexion of metatarsal head

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6
Q

Watermann osteotomy

A

indicated for hallux limitus, plantar cortex left intact

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7
Q

watermann green

A

indicated for hallux limitus, lreserves sesamoid articulation

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8
Q

Peabody

A

metatarsal neck procedure :similar to reverdin but osteotomy made proximal to sesamoids to avoid sessamoids

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9
Q

Wilson

A

shortens and laterally displacese IM head . (medial distal to proximal lateral)

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10
Q

Mitchell

A

neck procedure: corrects IM angle

shortens, plantarflexes, and laterally displaces metatarsal head`

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11
Q

Kalish

A

modified (long arm) austin, does not correct pasa

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12
Q

ludloff osteotomy

A

Distal-plantar to dorsal proximal osteotomy ; correct IM angle. Not stable construct

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13
Q

mau osteotomy

A

dorsal distal-to plantar proximal osteotomy, cpital fragment is rotated to correct IM

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14
Q

Lambrinudi osteotomy

A

closing plantarflexory base wedge. corrects metatarsus primus elevatus

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15
Q

which osteotomy has the advantage that it does not shorten the metatarsal but able to put in dorsiflexed/plantarflexed position

A

crescentic

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16
Q

trethowan

A

opening medial base wedge

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17
Q

juvara

A

closing oblique base wedge osteotomy

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18
Q

Loison- Balaceu

A

laterally closing base wedge to correct IM angle

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19
Q

Logroscino

A

reverdin plus loison balacescu.

Corrects IM and PASA

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20
Q

keller

A

metatarsal head is remodeled and the 1/2 to 1/3 of proximal phlaanx is resected

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21
Q

Mayo- Hueter osteotomy

A

excision of two-thirds of metatarsal head; the remaining portions is rounded off

a soft tissue flap used to preveent bone to bone contact at the base

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22
Q

stone osteotomy

A

oblique resection of the metatarsal head

The weight bearing portion of the head articulating with the sesamoids are left intact

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23
Q

what is the 1st MPJ fusion alignment

A

frontal: 0 deg
Sagittal: 10-15 deg DF
transverse: 15-20 abducted

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24
Q

proximal akin vs central akin vs distal akin

A

proximal akin: corrects DASA
central akin: long proximal phalanx
distal akin: corrects IPJ

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25
Q

Fowler osteotomy

A

medial cuneiform opening wedge with bone graft is inserted into opening wedge

26
Q

Grade I limitus

A

Functional limitus:

  • No DJD
  • paint at the end of ROM
  • full ROM NWB, limited WB
27
Q

Grade II Hallux Limitus

A

joint adaptation:
Pain at end of ROM
flattening of met head
PASSIVE ROM limited; so WB and NWB limited
small dorsal exostosis and periarticular lipping

28
Q

Grade III Hallux limitus

A

joint destruction/arthritis. Cystic formation
Crepitus on ROM
continued DJD and osteophytic
pain on full ROM

29
Q

Graade IV hallux limitus

A

Ankylosis

less than 10 deg ROM, complete loss of joint space and majority of articular cartilage

30
Q

functional vs structural hallux limitus

A

functional: hallux dorsiflexion decrease only when forefoot is loaded. will respond well to orthotics by keeping foot in neutral position
structural: hallux dorsiflextion decreased whether forefoot is loaded or unloaded. orthotics will not help

31
Q

causes of Hallux varus

A 
iatrogenic (failed bunionectomy), overcorrecting bunion
staking the head 
removal of fibular sesamoid 
excessive lateral release 
trauma 
congenital
32
Q

how much length is lost if only articular cartilage removed for lapidus?

A

0.5 cm

33
Q

When do you fixate 1st ray in slight plantar flexion for Lapidus?

A

If between 0.5-1.0 cm of shortening occurs, then the first metatarsal should be fixated in slight plantarflexion.

34
Q

When is a weil osteotomy recommended with lapidus

A

For shortening greater than 1.0cm, weil osteotomies are recommended on the 2nd and 3rd metatarsals or a bone graft may be added at the 1st metatarsal cuneiform joint.

35
Q

normal Metatarsus adductus angle/ engel’s angle

A

normal: 15 deg

(<24-engle angle)

36
Q

hohmann osteotomy correction

A

corrects IM, PASA, and metatarsus elevatus (plantarflexes capital fragment)

37
Q

for crescentic, is the concavity placed proximally or distally

A

proximally

38
Q

hiss procedure

A

advancement of abductor hallucis tendon to reestablish joint medial balance

39
Q

When performing a Lapidus procedure for hallux abductovalgus, what structure should be avoided when exposing the first metatarsocuneiform articulation?

A

deep perforating artery of dorsalis pedis

40
Q

When utilizing the Ilizarov technique for repair of brachymetatarsia, which of the following steps could cause inadequate lengthening to occur?

A

too long of a latency period

41
Q

Which of the following studies would be the most helpful to differentiate between sesamoiditis and a sesamoid fracture?

contralateral xray
MRI
CT
Bone scan

A

MRI

42
Q

what is the cause of bone troughing for a scarf osteotomy? how can this be prevented?

A

Bone troughing is created when osteotomy is performed in the diaphysis allowing the cortices of bone to collapse in the medullary canal.

osteotomy should be performed in both the distal and proximal METAPHYSIS to stabilize both ends of osteotomy and decrease incidence of bone troughing.

43
Q

The addition of grommets to 1st implant allows what

A

Prevents implant erosion, prevents bone growth over implant

44
Q

What is reactive/dendritic synovitis?

A

Giant cell/inflammatory reaction to silicone. Micro fragments break off from implant and get into lymphatic system.

45
Q

What is the most common reason for non-union of the Lapidus bunionectomy?

A

inadequate joint prepping and/or poor fixation. It is important that the entire plantar ledge of the 1st metatarsal base and medial cuneiform are removed in entirety. Inadequate and improper alignment and union may occur.

46
Q

What complication would likely to occur following an opening base wedge osteotomy to correct an abnormal IM angle?

A

hallux limitus

47
Q

traditional mcbride vs modified mcbride

A

(original McBride included lateral sesamoidectomy)

48
Q

how should the periosteum be incised for a proximal osteotomy of the 1st ray?

A

periosteum incised from proximal and medial extend of the 1st met base and extends lateral dorsally on 1st met shaft and then medially distally toward pervious periosteal incision at first met head

It is improtant to NOT free periosteum from area adjacent to proposed apex of the osteotomy, otherwise stability is compromised

49
Q

Why is it important to have the axis perpindicular to the weight bearing surface on the sagittal plane during 1st met base osteotom

A

maniupulation of the axis in the frontal plane is based on this axis. It allows full rotation of distal segment of metatarsal without elevating or plantarflexing met head in relation to weight bearing surface

50
Q

If you want to plantarflex the 1st ray on a proximal osteotomy, how should you place your axis

A

the superior pole of axis laterally creates dorsomedial hinge and plantarflexing distal segment of metatarsal with lateral rotation.

in patient with normal alignment and length, it is important to plantarflex the distal segment to offset the degree of shortening and elevate met

51
Q

what happens if you tilt axis medially for proximal osteotomy of 1st ray

A

axis tilted medially creates plantar medial hinge and dorsiflexes distal segment with closing base wedge osteotomy

52
Q

Do you perform distal or proximal cut first for proximal 1st ray osteotomy? why? what does second cut determine

A

Distal cut is more stable if performed first, proximal cut determines final angle of oseotomy and mount of space required for screw fixation

second cut determine amount of correction necessary to close IM angle

53
Q

How should optimal fixation be fixated for proximal osteotomy closing base wedge of 1st ray?

A

1st screw “anchor screw” is perpindicular to metatarsal and placed distal enough to medial cortical hinge to no compromise hinge- and also placed more superior position to allow for placement of 2nd screw - purpose of anchor screw is to prevent shortening of osteotomy if hinge fails

2nd screw “compression screw” oriented perpendicular to osteotomy and distal and inferior to anchor screw.

compression screw maximally tightened and then anchor screw further tightened after clamp removed

54
Q

what is the average shortening of 1st met following a closing base wedge

A

1.77 mm

55
Q

what structure plantarly is at most risk during dissection at the metatarsocuneiform joint

A

FHL

56
Q

What is the hallmark for juvenile bunion?

A

Metatarsus primus varus. Increased flexibility of the first metatarsal phalangeal joint leads to increased deformity. The hallux valgus angle is less than the adult bunion. Bursal thickenings and prominence of the medial eminence are less in a juvenile bunion.

57
Q

When the great toe deviates into a valgus position, the action of the abductor hallucis muscle creates what kind of forces to hallux

A

plantarflexion and pronation

58
Q

nutrient artery branches off what artery for 1st met head

A

first dorsal metatarsal artery

59
Q

what is important to be repaired after removing either or both sesamoids to prevent further deformity

A

FHB

60
Q

when pt has bilateral sesamoiditis, what should you be concerned for

A

reiters dz, psoriatic, or serognegative dz

61
Q

what structure is most at risk when using a dorsomedial incision 1st TMT dissection

A

the medial dorsal cutaneous nerve is often directly over the 1st TMT

62
Q

When performing the crescentic procedure, how should the saw blade be oriented?

A

90 deg from medial to lateral transverse osteotomy at the base of the metatarsal. provides optimal bone contact.

**Forefoot (4 decks)

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