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Podiatry > Bunion Procedures > Flashcards

Bunion Procedures Flashcards

1
Q 
Pathogenesis of bunion
stage 1 → 
stage 2→ 
stage 3→ 
stage 4→
A

STAGE 1 → lateral subluxation of hallux
–unstable 1st ray→ unstable hallux→ strain trans. pedis

STAGE 2→ hallux abductus pressure against lesser toes

  • -unstable sesamoid, transverse pedis, FF adductus
  • -EHL & flexors → bow string
  • 1st MTPJ axis change

STAGE 3→ ↑ IM angle

  • -retroactive force to 1st met from hallux against 2nd digit
  • -cuneiform split
  • -*eversion throughout propulsive phase
  • -*worsening primus elevatus → ↓ hallux DF at 1st MTPJ

STAGE 4→ hallux and/or 2nd MTPJ dislocation

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2
Q

HAV angle

A

~15º

-describes deformity of hallux relative to 1st metatarsal

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3
Q

Intermetatarsal (IM) angle

A

8-12º

  • relationship b/w 1st and 2nd metatarsal
  • as IM increase the EHL is shorter
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4
Q

Interphalangeal joint (IPJ) angle

A

0-10º

-relationship of distal phalanx of hallux relative to the proximal phalanx

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5
Q

Proximal articular set angle (PASA)

A
  1. 5º
    - orientation of articular cartilage relative to 1st metatarsal
    - the more lateral the higher the PASA
    - *↑ causes the tracking
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6
Q

Distal articular set angle (DASA)

A
  1. 5º

- deviation of the proximal phalanx relative to 1st MTPJ

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7
Q

Metatarsus adductus (MA) angle

A

~15º
-relationship b.w 2nd metatarsal (represents metatarsus)
to the midfoot

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8
Q

Adjusted IM angle

A

measured IM angle + (measured MA angle - 15)

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9
Q

Tibial sesamoid position

A
  • range is 1-7 w/ 1-3 normal (4 is on midline of met)
  • looks at condition of crista
  • looks at overall severity of HAV deformity
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10
Q

Metatarsal protrusion

A

-length of 1st metatarsal relative to 2nd metatarsal

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11
Q

Positional deformity

A

HAV angle (~15º) > PASA + DASA

  • PASA and DASA are both normal (7.5º)
  • denotes soft tissue deformity
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12
Q

Structural

A

HAV angle = PASA + DASA

  • PASA and/or DASA are abnormal
  • osseous deformity
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13
Q

Combined

A

HAV angle > PASA + DASA

  • PASA and/or DASA are abnormal
  • osseous and soft tissue deformity
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14
Q

Silver

A
  • Bump ONLY
  • less than ideal bone stock
  • no effect on angles
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15
Q

McBride

A

Positional (soft tissue) correction

  • addresses bump as well
  • sufficient if ONLY abnormal value → HAV angle (15º)
  • performed w/ most of the other types of bunionectomies
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16
Q

Proximal Akin

A

Osteotomy → proximal phalanx of hallux near base

  • HIGH DASA
  • -7.5º is normal
  • crossed K-wires → best fixation
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17
Q

Distal Akin

A

Osteotomy → proximal phalanx of hallux near head

  • correct a high IPJ
  • -0-10º normal
  • crossed K-wires → best fixation
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18
Q

Cylindrical Akin

-oblique Akin

A
  • Corrects LONG proximal phalanx
  • Corrects DASA/IPJ abnormalities

-same as akin (?) just more room to put screw

19
Q

Reverdin

A

Osteotomy → 1st metatarsal head (metaphysis)

  • corrects high PASA (>7.5º)
  • removes tibial sesamoid
20
Q

Reverdin-Green-Laird

A

Osteotomy → 1st metatarsal head (metaphysis)

  • corrects PASA
  • avoids tibial sesamoid
  • can correct moderate ↑ of IM angle (8-12º normal)
  • -cut through and through w/ shelf and slide head
21
Q

Austin

A

Osteotomy → 1st metatarsal head (metaphysis)

  • corrects moderate ↑ of IM angle (8-12º normal)
  • doesn’t remove bone, just make < shaped cut & reposition
22
Q

Austin-Bicorrectional

A

Osteotomy → 1st metatarsal head (metaphysis)

  • corrects moderate increase of IM angle
  • can correct PASA
  • chevron wedge is removed
23
Q

Austin-Modified

A
  • offset V (superior arm is longer)
  • corrects larger IM angle than basic austin
  • can be swiveled → some PASA correction
  • allows use of 2 screws
24
Q

Peabody

A

Junctional osteotomy

  • corrects PASA
  • -similar to Reverdin, but at NECK → poorer blood supply
  • proximal enough to avoid sesamoid
25
Q

Mitchell

A

Junctional osteotomy

  • corrects moderate ↑ in IM angle (8-12º)
  • significantly shortens 1st metatarsal
  • -used for long 1st metatarsal
  • -cut out small shelf from distal segment and proximal segment slides into the new space
26
Q

Roux

A

Junctional osteotomy

  • bi-plane Mitchell → shortens 1st met.
  • corrects moderate IM
  • corrects PASA
27
Q

Hohmann

A

Junctional osteotomy

  • tri-plane correction → shortens 1st met.
  • corrects PASA
  • corrects moderate IM angle
  • can correct FRONTAL plane
  • EXTRA CAPSULAR
  • DRATO (derotational, angulational, transpositional osteotomy) ank
28
Q

Wilson

A

Junctional osteotomy

  • corrects moderate IM angle
  • -through and through angled cut and slide lateral
  • shortens 1st met.
  • EXTRA CAPSULAR
29
Q

Ludloff

A

Diaphyseal osteotomy

  • corrects *mod/high IM angle → transposition
  • -proximal cut is dorsal
  • can correct some PASA at loss of full IM correction
  • can shorten BUT → elevates
  • can lengthen BUT → plantarflexes
  • proper exposure → lots of dissection
  • good for screw fixation
  • poor vascularity balance by large bone to bone contact
30
Q

Mau

A

Diaphyseal osteotomy

  • corrects mod/high IM angle → rotation
  • -distal cut is dorsal (DD MAU)
  • -much more stable to weight
  • can correct some PASA at loss of full IM correction
  • can shorten BUT → plantarflex
  • can lengthen BUT → elevates
  • -b/c but is almost parallel to ground → not much sagittal change
  • proper exposure → lots of dissection
  • good for screw fixation
  • poor vascularity balance by large bone to bone contact
31
Q

Scarf

A

Diaphyseal osteotomy

  • corrects mod/high IM angle
  • -troughing
  • -very stable
  • can correct some PASA at loss of full IM correction
  • proper exposure → lots of dissection
  • good for screw fixation
  • poor vascularity balance by large bone to bone contact
32
Q

Indications for a base procedure

A
  • 1st IM angle >15º
  • previous failures or recurrent deformity
  • Elevatus
  • Rigid deformity
  • HAV w/ Met adductus → ↑ IM angle
  • Juvenile HAV
33
Q

Loison-Balacescu

A

Standard transverse base osteotomy

  • IM angle >15º
  • shorten mildly long 1st met (possible disadvantage)
  • minimal DF or PF w/ axis concept
  • no bone graft
  • cancellous bone → good blood supply/heals well
  • can combine w/ a head procedure for greater deformity
  • -always perform head osteotomy FIRST

Disadvantages

  • 6 weeks NWB
  • difficult to fixate → very close to joint space
34
Q

Juvara

A

Oblique base osteotomy

  • IM angle > 15º
  • better screw fixation/earler ROM
  • can correct multiple planes
  • can correct short or long (Juvara C)

Disadvantages

  • more *shortening & *dissection
  • longer NWB → *diaphysial bone → doesn’t heal as well b/c cortex is thicker
35
Q

Juvara A

Juvara B

A

Oblique base osteotomy → transverse correction

Type A + sagittal correction

36
Q

Juvara C1

Juvara C2

A

oblique bone cut → sagittal correction

C1 + length correction

37
Q

Proximal Austin

A
  • techically difficult

- relatively minimal shortening of 1st met

38
Q

Crescentic osteotomy

A

Advantages

  • can correct in all 3 planes
  • less bone shortening → no wedge removed
  • cancellous bone → better healing

Disadvantages

  • less stable & difficult to fixate
  • special instrumentation required
  • NWB 6-8 weeks
39
Q

Opening base wedge osteotomy

A
  • reserved for HAV w/ high IM angle & SHORT metatarsal
  • difficult post-op management
  • possible jamming 1st MPJ
  • requires bone graft → longer NWB
40
Q

Lapidus

A
  • Fusion of the 1st MC joint (and 2nd met bases)
  • stable, versatile, and predictable
  • addresses deformity AND etiology
  • stabilizes medial column

Indicated for:

  • -hypermobile 1st ray → 5º at 1st MC & 12.3 at 1st NC
  • -large IM angle
  • -elevated or PF 1st ray
  • -flatfoot/over pronated
  • -recurrent deformity
  • -ligamentous laxity
41
Q

Medial Cuneiform Osteotomy (Cotton)

A

Indications:

  • associated metatarsus adducts
  • flatfoot procedures
  • avoids growth plates → good for children
  • long radius arm → more correction
  • technically difficult
42
Q

Factors influencing rate of HAV development

A
  • severity of pronation
  • degree of FF adductus
  • extent of calcaneal eversion
  • extent of STJ & MTJ subluxation
  • declination of STJ axis → ↑ frontal plane motion
  • angle & base of gait
  • length of stride
  • ↓ propulsive phase → ↓ development
  • -need propulsive gait to develop HAV
  • severity of inflammation
  • obesity
  • hard flat terrain → ↑ GFR
  • shoe gear
43
Q

Predisposing factors for HAV

A
  • genetics
  • arthritis (RA)
  • trauma
  • neuromuscular conditions (CMT)
  • shoe gear
  • BIOMECHANICAL → excess pronation in midstance of gait
  • -hypermobile 1st ray & fixed soft tissue due to shoes
  • -FF valgus compensation → exacerbates HAV
  • -FF varus → less force on HAV development
44
Q

Iatrogenic causes of Hallux Varus

A
  • excision of Fibular sesamoid
  • Over-correcting → IM angle or PASA
  • Overzealous:
  • resection of medial eminence
  • -stalking the head → disrupts sagittal groove
  • lateral release
  • medial capsulorrhaphy/plication
  • tendon transfer
  • post-op dressings ↑ → ↓

Podiatry (1 decks)

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