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Rolf > 1st ray pathology > Flashcards

1st ray pathology Flashcards

1
Q

What are the etiologies of HAV ( 3)

A
  • Structural
  • Positional
  • Other: Iatrogenic
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2
Q

Positional examples that may cause HAV (2)

A

Hypermobile first ray

  • –Metatarsus primus varus
  • –Metatarsus primus elevatus
  • –Normally +/- 5mm PF and DF

Frontal plane deformity
—-eversion/pronation/valgus rotation of 1st MT

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3
Q

Structural examples that may cause HAV (3)

A
  • First Ray insufficiency
  • –imbalance of forces between 1st and 2nd met
  • Atavistic cuneiform
  • —medial deviation which causes an adducted 1st met
  • Met head shape
  • —Rounder (greatest risk for met HAV)
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4
Q

OTHER examples that may cause HAV

A
  • Iatrogenic
  • –Plantar fasciotomy leading to hypermobility, FHL tendon transfer, Tibial sesamoidectomy, PL-PB tenodesis
  • Pathologic
  • —neuromuscular disorder, inflammatory arthropathy
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5
Q

Describe the 1st MTPJ joint (and its meaning)

A

It is a ginglymoarthroidal joint

-Ginglymo: sagittal motion responsible for first 20-30 DF

Arthroidal: transitional gliding responsible for next 30-60 DF

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6
Q

Stages of HAV

A

Described by Root, Orien, Weed

I: Lateral shift of proximal phalanx
II: Hallux abducts
III: Medial buckling of 1st MT head
IV: subluxed/dislocation 1st MPJ

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7
Q

What is Jacks test

A

same as reproduction of Windlass mechanism

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8
Q

What is the Transverse forefoot squeeze test

A

Check for reducibility of IM angle

—Reducible signifies a positional deformity not structrual

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9
Q

Tracking vs trackbound

A

Tracking: deviation of hallux only towards the end of DF and PF

Trackbound : C-shaped ROM. deviation of hallux throughout entire ROM

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10
Q

How to determine between structural and positional deformity of the hallux

A

Structural: PASA+DASA> HAA

Positional: PASA+DASA»HAA

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11
Q

Procedural selection based on positional vs. structural etiology

A

Positional deformity=distal osteotomy

Structural deformity: large IM angle will require a more proximal osteotomy

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12
Q

What is included in a Lateral release

A 
Adductor tendon
Lateral capsule
Transverse MT ligament 
Lateral sesamoid ligament 
FHB tendon 
Fibular sesamoidectomy
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13
Q

What procedures are considered to be capsule tendon balancing

A

Silver bunionectomy

McBride

Modified McBride

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14
Q

What is included in a Silver bunionectomy

A

Bumpectomy, lateral release and medial capsular imbrication

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15
Q

What is included in a McBride

A

Silver+ fibular sesamoidectomy+ adductor hallucis tendon transfer

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16
Q

What is included in a Modified McBride

A

No fibular sesamoidectomy to prevent hallux varus

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17
Q

What procedures are exclusively done on the proximal phalanx

A

Akin and Keller

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18
Q

What is the Akin procedure and what does it correct

A

Closing lateral wedge resection of proximal phalanx

-Proximal Akin: corrects DASA
Distal Akin corrects HIA

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19
Q

What is the Keller procedure and what is it used for

A

Joint destructive procedure to remove 1/3 base of proximal phalanx+ lateral release

Used for IMA > 15

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20
Q

What are the HAV osteotomies that can be done at the head (8)

A
  • Austin/Chevron
  • Youngswick
  • Reverdin
  • Reverdin Green
  • Reverdin Laird

Reverdin Todd

Waterman

Waterman Green

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21
Q

What is the Austin procedure

  • How much correcter
  • Pearls and Contraindications
A

60 degree cuts are made to allow lateral translation of capital fragment up to 50%

  • 1mm lateral shift = 1 degree of IMA correction
  • Pearls: limiting factors for correction are the width of the MT head. Good for bump pain

Contraindications: MTPJ pain

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22
Q

Youngswick What is it, what does it due and what is it used for

A

Chevron with removal of bone in dorsal arm

  • it shortens and plantarlexes
  • Used for MPE
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23
Q

Reverdin What is it and what does it correct

A

closing lateral wedge resection of MT head.

-corrects PASA

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24
Q

Reverdin Green. What is it, what does it correct?

A

Closing lateral wedge with preservation of the sesamoid apparatus

corrects PASA

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25
Q

Reverdin Laird: What is it and what does it correct

A

Reverdin Green osteotomy through lateral cortex and still preserve the sesamoids.

Corrects PASA+ IMA

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26
Q

Reverdin Todd: what is it and what does it correct

A

Reverdin laird but now through the plantar cortex. Will lose the sesamoid here

-corrects PASA+ IMA+ PLANTARFLEXION

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27
Q

Watermann: what is it and what does it treat

A

removal of dorsal wedge and the plantar cortex is kept intact

-treats hallux limitus and rigidus

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28
Q

Watermann Green: what is it and what does it correct

A

Watermann procedure with preservation of sesamoid

-will help treat hallux limitus/ rigidus

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29
Q

What are the neck procedures to correct HAV deformities (5)

A

Peabody

Mitchell

Hohmann

Wilson

DRATO

30
Q

What is the Peabody

A

just a reverdin that is proximal to the sesamoids

31
Q

Mitchell: What is it and what is the indication

A

removes medial shelf, shortens and plantarflexes the MT head

-Indication is IMA and MPE

32
Q

Hohmann: what is it and what is the indication

A

Reverdin with capital fragment plantarflexed and lateral shift

indications are IMA PASA and MPE

33
Q

Wilson: what is it and what is the indication for it

A

Shortens the met head with lateral displacement of head

indication is a long 1st MT

34
Q

What is the DRATO and what is the indication for it.

What is the big con with this procedure

A

Derotational abductory transpositional osteotomy

Indication: IMA, PASA, PF 1st MT, hallux limitus

VERY UNSTABLE

35
Q

What are the shaft procedures that can be done for HAV deformity

A
  • Scarf osteotomy
  • Mau/Ludloff
  • Kalish
  • Lambrinudi
  • Vogler
36
Q

What is a scarf osteotomy, what is the potential complication, what does it correct

A

60 degrees sideways Z is formed.

Large risk for troughing

-Corrects the IMA

37
Q

What is the Mau and Ludloff procedure

What does it correct

A
  • Mau: proximal plantar to dorsal distal

- Ludloff: proximal dorsal to distal plantar

38
Q

What is the Kalish procedure

A

long dorsal arm Austin, 55 degrees

-able to insert 2 screws

39
Q

What is the Lambrinudi procedure, and what is the indication

A

oblique cut at the shaft. Indication is for MPE

40
Q

What is the Vogler procedure

A

offset V osteotomy with apex at metaphyseal diaphyseal junction at a 40 degree cut

41
Q

What are the procedures that address HAV at the Base

A
  • Lapidus
  • Trethowan
  • Logroscino
  • CBWO
  • Proximal Austin
42
Q

What is the definition of hallux limitus / rigidus

A

When there is <65 degrees of hallux dorsiflexion

-painful aqcuired, arthritic condition of the 1st MPJ, decreased sagittal plane motion

43
Q

What is the definition of metatarsus primus elevatus

A
  • dorsiflexed 1st ray, which results in hallux tries to DF against elevated MT head, which results in decreased sagittal plane motion
44
Q

Etiology of hallux rigidus/limitus

A
  • structural
  • Functional
  • Post-traumatic
  • metabolic
  • Neuromuscular
  • Iatrogenic
45
Q

What are some of the structural reasons for hallux rigidus

A

Long 1st metatarsal

Metatarsus primus elevatus

-weak PL

46
Q

What are some of the functional reasons for hallux rigidus

A
  • Overpronation
  • Hypermobile 1st ray
  • unlocked MTJ
47
Q

Post-traumatic reasons for hallux rigidus

A
  • arthritis
  • OCD
  • 1st MPJ injury
48
Q

What are the classification systems for hallux limitus and rigidus

A

Drago, Orloff, Jacobs, and Regnauld

49
Q

Describe Regnauld

A

I: Functional limitus

  • –Pain on end range of motion
  • –No radiographic findings

II: Joint adaptation

  • –Limited range of motion
  • –X-ray: joint space narrowing with met head flattening

III: Arthrosis

  • –Pain with entire range of motion
  • –X-ray:Dorsal osteophytes

IV: ankylosis

  • –<10 degrees range of motion
  • –X-ray: obliteration of joint space
50
Q

Clinical presentation of hallux limitus/rigidus

A
  • Decreased DF from the 60-95 degrees
  • Hallux extensus deformity: IPJ hyperextension
  • Lateral foot pain
  • Apropulsive gait
51
Q

X-ray presentation of Metatarsus primus elevatus

A
  • Seiberg index: comparison of dorsal cortex of 1st and 2nd MT
  • First metatarsal declination is affected
52
Q

What are joint preserving procedures for Hallux limitus/rigidus (7)

A
  • Cheilectomy
  • Chondroplasty
  • Hyaluronate implantation
  • Waterman procedure
  • Watermann Green procedure
  • Youngswick
  • Proximal plantar displacement osteotomy
53
Q

What is a Cheilectomy and what test determines whether or not it can be done

A
  • Take off dorsal 1/3 of the articular surface of MT head and proximal phalanx
  • Grind test: pressing on sesamoids while dorsiflexing the hallux. If pain elicited then cheilectomy may not be effective
54
Q

What is the Waterman procedure

A

DFWO of MT neck

55
Q

What is the Waterman Green procedure

A

Preserves sesamoid apparatus, removes rectangular section of bone

56
Q

What is the Youngswick

A

Remove bone in dorsal arm and also corrects for high IMA

57
Q

What is the proximal plantar displacement osteotomy

A

corrects long MT

58
Q

What are joint destructive procedures that can be done for hallux rigidus (12)

A
  • Kessel and Bonney
  • Regnauld
  • Keller
  • Moberg
  • Heuter
  • Valenti
  • Stone
  • Mayo
  • 1st MTPJ arthrodesis
  • McKeever arthrodesis
  • 1st MTPJ implant arthroplasty
  • Interpositional arthroplasty
59
Q

What is the Kessel and Bonney procedure

A

DFWO of proximal phalanx base

  • Will decompress the joint
  • Originally for adolescents
60
Q

What is the Regnauld

A

Peg in hole, loss of flexor function

61
Q

What is the What is the Keller procedure

A

Resection of the proximal phalanx

62
Q

What is the Moberg procedure

A

osteotomy at base of proximal phalanx, with or without cheilectomy

63
Q

What is the Heuter

A

complete resection of MT head

-also used to treat osteo

64
Q

Valenti

A

Dorsal portion of proximal phalanx and 1st MT head removed

65
Q

What is the stone procedure

A

Resection of MT head

-Preserve sesamoids

66
Q

WHat is the Mayo procedure

A

-remove sesamoids

67
Q

What is the 1st MTPJ arthrodesis

A

Gold standard procedure

68
Q

What is the McKeever arthrodesis

A

when the toe is fused in a :

  • Abducted/valgus 10 degrees
  • DF at 15 degrees
  • Parallel to the 2nd digit in transverse plane
69
Q

What is the 1st MTPJ implant arthroplasty

A

Hemi-metallic

total: double stem flexible silicone hinge

Two component

70
Q

Interpositional arthroplasty

A

-Interposition of EHB and dorsal capsule sutured to the plantar plate

Rolf (45 decks)

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