1st ray

Question 1

siebergs index measurement

Answer 1

measures sagittal plane on degree of parallelity to 2d met

if += 1st ray plantarflexed, - = dorsiflexed

Question 2

what is the line of progression alignment of forefoot to rearfoot

Answer 2

when the 2nd toe is aligned with long axis of rearfoot

Question 3

sequence for lateral release

Answer 3

1. adductor hallucis tendon- release adductor from insertion into proximal phalanx and fibular sesamoid
2. fibular sesamoid ligament
3. tenotomy of lateral FHB
4. excision of fibular sesamoid

Typically leave the lateral collateral ligament of 1st Mpj intact

Question 4

Indication for reverdin; osteotomy technique

Answer 4

PASA

distal portion cut 1st parallel to articular surface.
Proximal segment cut 2nd perpindicular to the long axis of 1st met

Question 5

Logroscino

Answer 5

double 1st met osteotomy: proximal closing base wedge with riverdin green

Question 6

Indication for reverdin laird

Answer 6

pasa and IM angle- breaking the lateral hinge for lateral transposition

Question 7

where should the apex axis guide be place for traditional austin? which cut should be made first

Answer 7

slightly superior to midpoint to increase surface and strenght of WB portion and surface for fixation

plantar cut 1st: orientation dictates placement of fixation anf helps avoid sesamoid articulation

Question 8

wire direction on axis if want to lengthen/shorten metatarsal, Dorsiflexion or plantarflex

Answer 8

Aim:
Distal: lengthen
Proximal: shorten

Dorsiflex–> up
plantarflex–> down

Question 9

Kalish osteotomy axis guide placement and cut order

Answer 9

long arm austin–can correct larger IM angle (55 deg)

since dorsal arm is longer, want axis guide a little below midpoint to affor firm site for screw fixation

DOrsal arm determines orientation of fixation–so cut 1st and plantar second

Question 10

indications for proximal 1st ray osteotomy

Answer 10

1. High IM angle >15
2. Rigid first ray
3. elevated first met
4. Juvenille hallux abducto valgus (most effective!)
5. Hallux abducto valgus with metatarsus adductus
6. Iatrogenic deformity

Question 11

what is an important thing to remember when doing the anatomic dissection at the base of the 1st met for proximal osteotomy

Answer 11

important not to free the periosteum from area adjacent to the apex of osteotomy because it will compromise stability `

Question 12

orientation of the axis/cut for closing base wedge osteotomy

Answer 12

Perpendicular to weight bearing surface -then able manipulate of frontal plane , if its perpinducular to 1st met, it would cause elevation of metatarsal to weight bearing surface

Question 13

Changes on axis tilting lateral vs medial for closing base wedge osteotomy

Answer 13

if axis is more lateral–> dorsomedial hinge created–>plantarflexionof distal segment

if axis is tilted more medially–>plantarmedial hinge created–> dorsiflexion of distal segment with closing base wedge

Question 14

which cut should be cut first for closing base wedge osteotomy? which cut determines amount of correction necessary

Answer 14

distal cut is more stable if performed 1st.

2nd cut determines amount of correction for IM angle

Question 15

what are the two point fixation for the proximal osteotomy

Answer 15

1. 1st screw aka anchor screw: perpendicular to long axis of metatarsal/bone- purpose of anchor screw is to prevent shortening of osteotomy if hinge fails
2. 2nd screw: compression screw oriented perpendicular to osteotomy– compression is maximally tightened and then the anchor screw if further tightened

Question 16

what is a complication to opening base wedge osteotomy of 1st ray

Answer 16

hallux limitus defomity by increasing tension to MPJ

Question 17

Crescentic osteotomy concavity is directed at what direction? indication

Answer 17

correction in all planes with minimal shortening (1-2 mm) so good for pt with short met

Question 18

oblique vs transverse opening base wedge for 1st met more stable?

Answer 18

oblique opening base wedge is more stable beaue of strong ligamentous attachments and insertion of peroneus longus tendon

Question 19

Angle for the offset-V osteotomy?

How long is the dorsal arm

Answer 19

40-45 deg

Dorsal arm should be 50-75% of metatarsal length depending on length and width of bone and degree of pasa that needs to be corrected

Question 20

what is a complication of offset V osteotomy that involves 2nd met

Answer 20

synostosis may develop between 2nd me and dorsal wing of the osteotomy cut