Digital Deformities Flashcards
What is post axial polydactyly
Polydactyly of the 5th toe
What is pre axial polydactyly
Polydactyly of the 1st toe
Define polydactyly
Presence of supernumerary digits or metatarsals
Describe the hereditary of polydactyly
Transmitted as an autosomal dominant trait
Most common congenital deformity of the hand and foot
What are the two presentations of polydactyly
- single deformity in the foo (non syndromatic)
- associated with accessory digits in the hand, and there may be other congenital malformations as well (syndromatic)
What is the most common for of polydactyly
post-axial - 5th toe
What is brachymetatarsia
- aberrant condition in which a metatarsal is short and hypoplasicq
Which MT is most commonly affected by brachymetatarsia
4th MT
What happens to the digit in brachymetatarsia
Contracted and cosmetically unacceptable fourth digit
Is brachymetatarsia usually bilateral or unilateral
Bilateral
What are the 7 surgical procedures for surgical management of brachymetatarsia
- Callus distraction (Ilizarov technique)
- Syndactylization
- Bone graft
- Implants
- Auto-implants
- Step-up osteotomies
- Amputation
What is the callous distraction principles based on
The fact that living tissue, when subjected to slow, steady distraction can become metabolically activated in both the biosynthetic and proliferatio
What bone offer advantages for the location of callus distraction
Metaphyseal and diaphyseal bones
Which bone offers the greatest surface area for regeneration and more abundant blood supply for callus distraction
Metaphyseal bone, with its increased diameter and trabecular pattern
What is the most common procedure for brachymetatarsia
Bone graft
What type of osteotomy did Marcinko perform for brachymetatarsia
Z plasty of bone - to lengthen short metatarsal
What are some complications of brachymetatarsia
- Neurovascular compromise
- Overlenthening
- under correction
- malunion
- non-union
- transfer lesion
- recurrence
What is macrodactyly
An increase in the size of the digital elements or structures of the affected part including the theft bones, nerves, subcutaneous, fat nails and skin
Are tendons and blood vessels affected in macrodactyly
No
What type of tissue are involved in macrodactyly
Hypertrophy of plantar and distal tissues
Which are the digits most commonly involved in macrodactyly
1stm 2nd, 3rd
What is the primary treatment for macrodactyly
Surgery
What are the surgical techniques for macrodactyly
- digital amputation (partial versus total)
- ray resection - may be preferred to digital amputation with MT involvement
- digital salvage -
Describe the digital salvage for macrodactyly
- soft tissue procedure to reduce digital bulk
What is the mainstay treatment for the static milder deformity of macrodactyly
Digital salvage
When is Juvenile Hallux Valgus more common (type of condition)
Flexible pronated foot
What is the IMA at birth
12 degrees
What is the IMA at 6-9 years
10 degrees
What is the IMA of an adult
8-10 degrees
What are the treatment options for Juvenile Hallux Valgus
- conservative care options
- orthotics - Control of pronatory forces
- shoe selection - fit and function
- if flexible, treatment with toe spaces
What are indications for surgery for juvenile hallux valgus
Pain
Significant deformity
Chronic paronychia
Treat of global pathology
What is Engel angle at birth?
30
What is Engel angle at 6-9 yrs ?
25
What is Engel angle at adult
Less than 21
What is MA angle at birth
25-30
What is MA angle at 6-9 yrs
15-25
What is MA angle at adult
Less than 15
What is talocalcaneal (Kite) angle at birth
40-50
What is talocalcaneal (Kite) angle at 6-9 years
20–40
What is talocalcaneal (Kite) angle at adult
20-25
What is talar-fit MT angle at birth
Slightly medial
What is talar-fit MT angle at 6-adult
Parallel
What is tibiocalcaneal angle at birth
70-75
What is tibiocalcaneal angle at 6-9 yrs
65
What is tibiocalcaneal angle at adult
55
What is talar declination angle at birth
Slightly above 1st MT
What is talar declination angle at 6-9 yrs
Parallel
What is talar declination angle at adult
21
What is calcaneal inclination angle at birth
10 -15
What is talar declination angle at 6-9 yrs
15-20
What is talar declination angle at adult
Less than 21
What is talocalcaneal angle at birth
35-50
What is talocalcaneal angle at 6-9 yrs
30-40
What is talocalcaneal angle at adult
25-30
What did study Ferrari et al show us regarding juvenile hallux valgus and met adductus
Combined juvenile hallux valgus and met adductus in 55% of patients
What is a distal procedure for juvenile hallux valgus
Austin bicorrectional
What is a midshaft procedure for juvenile hallux valgus
Opening base wedge
Hemiepiphysiodesis - growth plate closure (10-12 F, 12-14M)
Lapidus - beware of growth plates
What is opening wedge of cuneiform for juvenile hallux valgus
Total avoidance of growth plate with reduction of the distal angle of the MC joint
What is the soft tissue procedure for juvenile hallux valgus
Release of the adductor from base of proximal phalanc with capsulorraphy
How to treat fixed flexed curly toes
Flexor tenotomy with pin fixation
When does syndactyly occur
6-8 weeks IU
What is claw toes
DF at MPJ, PF at IPJ
What is hammertoe
DF at MPJ, PF at PIPJ
What is the treatment for hammer toes
Flexor tenotomy with K wire in pediatrics
What is mallet toe
PF of DIP
