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EBM Nelson > Bunions > Flashcards

Bunions Flashcards

1
Q

Which two measurements are meant to determine joint congruity in HAV?

A

PASA

DASA

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2
Q

what procedure is historically used to treat a pathologic PASA?

A

Reverdin or rotational osteotomy

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3
Q

What procedure is traditionally used to treat an elevated DASA?

A

Proximal Akin

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4
Q

What procedure is traditionally used to treat an elevated hallux interphalangeal angle?

A

Distal akin osteotomy.

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5
Q

What is the difference between a bunion structural vs positional deformity?

A

Positional deformity: the bones themselves are normal, there is a change in the relationship of one bone to another. These are corrected with soft tissue procedures.

Structural deformities show an increased DASA or PASA and need an osteotomy to fix these problems within the bone.

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6
Q

At which IM angle must an osteotomy be considered?

A

IM angles larger than 12

Under that may be corrected with a soft tissue rebalance.

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7
Q

What is the Silver Bunionectomy?

A

Partial ostectomy of the first metatarsal head.

Does not correct the etiology of the problem and removes the bump only

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8
Q

What is the McBride Bunionectomy?

A

Removal of the medial eminence (silver)
Plus
Release or transfer of the adductor hallucis tendon into the medial met head.

May remove the fibular sesamoid.

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9
Q

When did Akin originally describe his phalangeal osteotomy?

A

In 1925

Originally included the Silver procedure with a resection of medial base proximal phalanx and osteotomy.

Indicated with a high DASA more proximally within the phalanx,

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10
Q

Where is the wedge placed for a proximal akin?

A

Medial closing wedge made in the metaphysis of the hallux.

Lateral hinge left in tact perpendicular to the WB surface.

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11
Q

Where is the wedge placed for a distal akin?

A

Medial closing wedge osteotomy of the distal aspect of the proximal phalanx of the hallux.

Indicated when there is an abnormal hallux interphalangeal abductus angle (HIA)

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12
Q

When can an oblique akin osteotomy be used?

A

when there is an abnormal hallux interphalangeus angle or abnormal DASA

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13
Q

The Regnauld and Sagittal Z procedures are used for which hallux pathology?

A

Correct for a long phalanx

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14
Q

Name the 14 Osteotomies of the proximal metatarsal head?
RRRRRPD
SALCHOWMM

A 
Reverdin 
Reverdin Green
Reverdin Todd
Reverdin Laird
Roux
Peabody
DRATO
Scarf
Austin
Ludloff
Capp
Hohman
Mitchell
Mau
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15
Q

What is the most common metatarsal head osteotomy to correct PASA?

A

Reverdin
Lateral cortex is left intact
Distal cut made first parallel to joint surface

Proximal cut is made second perpendicular to the long axis of the metatarsal

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16
Q

What IMA can the Reverdin correct if any?

A

Only a slight correction <8 degrees

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17
Q

What is the Green modification to the reverdin’?

A

A plantar shelf tyhat is used to protect the sesamoids.

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18
Q

What is the Laird modification to the reverdin?

A

Allows for lateral transfer of the metatarsal head to correct for IMA in addition to PASA.

in opposition to the original reverdin, the Laird modification penetrates both cortices.

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19
Q

What does the Todd modifcation do for the Reverdin?

A

Allows for IMA and PASA correction while protecting the sesamoid apparatus unlike the Reverdin Laird

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20
Q

Describe the Hohman metatarsal osteotomy

A

An osteotomy meant for the metatarsal head in which a trapezoid wedge at the anatomic neck is taken out and the capital fragment is transposed laterally and depressed plantarly.

21
Q

What IMA is the Hohmann indicated for?

A

Abnormal PASA with an IMA of 9-14 degrees.

Also helps with an elevated metatarsal.

22
Q

What is the Mitchell osteotomy?

A

this osteotomy is for the metatarsal head and works as a transpositional step down osteotomy.

correct IM angle and plantarflexes the metatarsal head.

IMA of 9-14 and also indicated for metatarsus elevatus.

23
Q

What is the DRATO osteotomy?

A

This is a metatarsal neck austiotomy that allows for derotation, angulation and transposition.

Can dorsiflex the capital fragment if needed.

24
Q

What is the advantage of the DRATO osteotomy?

A 
It adresses 4 deformities 
IMA
Abnormal PASA
Valgus rotation of met head
Plantar deviation of the articular cartilage
25
Q

What is the Roux osteotomy?

A

Also known as the angulated mitchell osteotomy of the metatarsal neck.

Used to take care of PASA and IMA

Cannot correct for IMA >15

26
Q

What is the Austin osteotomy?

A

Also known as the chevron osteotomy.

It is a horizontal osteotomy with the apex in the central met head angled at 60 degrees!!!

BUZZWORD IS ANGLE OF APEX AT 60 DEGREES.

27
Q

what does the Austin osteotomy accomplish?

A

unicortical will reduce IMA

bicortical will reduce IMA and PASA

biplane austin reduces the ima and adresses the sagital plane

28
Q

What is the Kalish modification of the austin osteootmy and what are the benefits?

A

Long dorsal arm
Increases surface area for fixation.

Angle is 55 degrees instead of the normal 60.

29
Q

What is the youngswick modification for the austin osteotomy?

A

Removes a rectangular wedge from the dorsal arm.

allows for shortening and slight plantarflexion of the first met head.

30
Q

What are the indications for the austin osteotomy?

A

IMA 9-15
Moderate hallux abduction angle

Congrous to deviated first metatarsal phalangeal joint.

31
Q

What is the major contraindication to an austin osteotomy

A

Significant elevatus
Abnormally high met protrusion.
IMa >18 degrees

32
Q

An osteotomy loses how much bone length?

A

each osteotomy removes 1 mm bone length

33
Q

What is the Scarf osteotomy?

A

A Z shaped osteotomy in the diaphyseal and metaphyseal bone.

three cuts oriented from medial to lateral through the first met shaft.

Arms angled between 60 to 80 degrees from the longitudinal osteotomy.

34
Q

How does the metatarsal width relate to the Scarf osteotomy?

A

the wider the metatarsal the higher the IMA that can be corrected.

note that the SCARF can slightly accomodate PASA changes as well.

35
Q

what is the traditional cutting pattern for the scarf osteotomy?

A

Proximal plantar

distal dorsal

36
Q

What are the IMA that a Z-scarf osteotomy can correct?

A

13-20 degrees!

Can be performed with an open physeal plate!

37
Q

Which bunion procedure is generalized for use in a patient with an open physeal plate?

A

Z-scarf osteotomy.

38
Q

What happens to the capital fragment in a Z-scarf osteotomy that has resulted in troughing?

A

Results in elevation of the capital fragment.

39
Q

what aspect of the bone does the Ludloff and Mau osteotomy cover?

A

these are both made within the diaphysis of the metatarsal.

40
Q

What is the offset V osteootmy?

A

Long dorsal arm osteotomy with the apex in the met head.

It is a modification of the dorsal to plantar Ludloff

41
Q

What IMA can the Offset V osteotomy fix?

A

Up to 18 degrees

and a PASA of up to 40

42
Q

What is a Juvara osteotomy?

A

A closing base wedge osteootmy using the hinge axis theory.

43
Q

What is the Juvara A osteotomy modification?

A

Closing wedge osteotomy for transverse plane correction

44
Q

What is a Juvara B-1 osteotomy modification?

A

Same as Juvara A (Closing wedge osteotomy for transverse plane correction)
the hinge is then disrupted and sagittal plane correction is obtained

45
Q

What is a Juvara B2 modification?

A

Same as Juvara B-1 (Closing wedge osteotomy for transverse plane correction)
but also the length of the metatarsal is addressed

46
Q

What is the Loison/balacescu osteotomy?

A

A transverse closing abductory wedge of the met base

47
Q

What is the Trethowan osteotomy?

A

This is an opening base wedge osteotomy which lengthens the met

48
Q

What is the Logroscino osteotomy?

A

A base wedge osteotomy (trethowan) combined with a first met head procedure (reverdin) to adress the PASA.

49
Q

What is the Crescentic osteotomy?

A

Base osteotomy that allows for translation of the met.

EBM Nelson (1 decks)

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