60: Radiographic Planning HAV - Frush

Question 1

should radiographs be WB or NWB?

Answer 1

WB

Question 2

systematic review of radiograph

Answer 2

1. soft tissue
2. bone and cartilage quality
3. angles and alignment

Question 3

Answer 3

osteoporotic bone and bone cysts w/i 1st met head

AP view

Question 4

Answer 4

jt space narrowing and exostosis

AP view

Question 5

what view is this?

Answer 5

sesamoid axial radiographic view

Question 6

Hallux interphalangeus angle

Answer 6

• —Angle formed by the longitudinal bisection of proximal phalanx and distal phalanx of the hallux
• normal less than 10 degrees

Question 7

Hallux abductus angle

Answer 7

• —Angle formed by bisection of the longitudinal axis of the proximal phalanx and 1st metatarsal
• normal range is less than 15 degrees

Question 8

distal articular set angle DASA

Answer 8

• —Angle formed by longitudinal bisection of the proximal phalanx of the hallux and the perpendicular of the line formed by marking the medial and lateral aspects of the cartilage of the base of the proximal phalanx
• —Looks at angular deviation of the cartilage of base of the proximal phalanx
• Normal = 0-8 degrees

Question 9

proximal articular set angle PASA

Answer 9

• —Angle formed by a line perpendicular to longitudinal bisection of the 1st met and a line formed by marking points of medial and lateral aspects of 1st met head cartilage
• —Evaluates position of articular cartilage of the 1st met head
• žNormal = —0-8 degrees

Question 10

intermetatarsus angle

Answer 10

• —Angle formed by longitudinal bisection of the 1st metatarsal and the second metatarsal
• žNormal = 0-10 degrees
• žMild-Moderate deformity = —10-15 degrees
• žSevere deformity = —> 15 degrees

Question 11

metatarsus adductus angle

Answer 11

• —Angle formed by line perpendicular to midfoot bisection and longitudinal bisection of the second
• —Points used to create perpendicular of midfoot are
  
  • Medial most aspect of
    
    • —1st met cuneiform joint
    • —Talonavicular joint
  • Lateral most aspect of
    
    • —Calcaneal cuboid joint
    • —4th met cuboid joint
• —0-15 normal
• —16-25 mild
• —26-35 moderate
• —> 35 severe
• *alternative method to measure = angle formed by longitudinal bisections of the intermediate cuneiform and the 2nd metatarsal. žNormal is 5-10 degrees higher for this form of measurement.

Question 12

why is metatarsus adductus important in bunions?

Answer 12

• žIn patients with increased met adductus, patient may have severe bunion deformity even with mildly increased IM angle
• žIf met adductus angle > 15 degrees
• —True IM = (met adductus – 15) + IM

Question 13

what are joint positions?

Answer 13

• žDefined by the relationship of a line representing the effective articular surface of the first metatarsal head and a line representing the effective articular surface of the proximal phalanx:
• —Congruous joint-lines are parallel
• —Deviated joint-lines intersect outside the joint space
• —Subluxed joint-lines intersect inside the joint space

Question 14

types of deformity

structural (bone) vs. positional (soft tissue) vs. combined

Answer 14

***

Question 15

most unstable metatarsal head shape

Answer 15

Round = most unstable

square/oblique = relatively stable

square with ridge = most stable

Question 16

normal metatarsal protrusion distance

Answer 16

• žA measurement for the relative length of patterns of first and second metatarsals:
• —Normal is +/- 2mm

Question 17

what is medial cuneiform obliquity?

Answer 17

orientation of 1st met - cuneiform joint

may or may not be relevant to bunion

Question 18

tibial sesamoid position

Answer 18

• The is the relationship of the tibial sesamoid to the bisection of the shaft of the first metatarsal:
  
  • Normal-positions 1,2,3
  • Abnormal-positions 4,5,6,7
• žUsed an an indication for removal of fibular sesamoid.

Question 19

what should you look for on a lateral view?

Answer 19

• 1st ray elevation
• hammer toes
• hallux crossing over second