Firecracker HAV Procedures Flashcards
What is the most likely name of a procedure performed in the proximal phalanx?
some sort of Akin
Describe the Distal Akin.
medial closing wedge osteotomy at the distal aspect of the proximal phalanx
What are the indications for a distal Akin?
abnormal HIA
long proximal phalanx
What are the indications for a proximal Akin?
increased DASA
Describe the proximal Akin.
medial closing wedge osteotomy in metaphyseal bone of the proximal phalanx
Name some procedures that are used to shorten a long proximal phalanx.
Cylindrical Akin
Chevron (2 V-osteotomies)
Z-osteotomy
Regnauld
What is the advantage of the oblique Akin?
can use cortical lag screw fixation because of orientation of osteotomy
Describe the Keller procedure.
is a resection arthroplasty of the base of the proximal phalanx used for end stage HL and geriatric bunions
Describe the Kessel-Bonney procedure.
resection of a dorsally based wedge from the base of the proximal phalanx used to correct early stages of HL
Describe the McBride bunionectomy.
- removal of medial eminence of 1st met
- transfer of ADH into medial met head
- removal of fibular sesamoid
Describe the Silver bunionectomy.
partial ostectomy of the medial eminence on the 1st metatarsal head
Describe the Reverdin procedure.
medial closing wedge osteotomy in the 1st met head for correction of abnormal PASA
Describe the Peabody procedure.
medial closing wedge osteotomy (similar to the Reverdin) but done in the metatarsal neck to avoid sesamoids
Describe the Reverdin-Green procedure.
Reverdin + plantar shelf to protect the sesamoids
Describe the Reverdin-Laird procedure.
medial closing wedge osteotomy of 1st met head that is through the lateral cortex with a plantar shelf
Name the historical procedures.
Peabody
Hohmann
DRATO
Describe the Hohmann procedure.
trapezoid wedge removed from anatomic neck of metatarsal
Describe the Mitchell procedure.
transpositional, step-down osteotomy in the 1st met that corrects IMA and plantarflexes met head
Describe the Capp procedure.
transverse osteotomy across the 1st met head
Describe the Wilson procedure.
oblique osteotomy in 1st met directed proximal-lateral to distal-medial
Describe teh Austin procedure.
horizontal V osteotomy with 60 deg apex in the central met head
What is the kalish modification to the Austin.
decreasing the apex angle to 55 deg to create a longer dorsal arm to allow for dorsal fixation with screws
What is the Youngswick modification to the Austin?
chevron cut + second dorsal cut to remove rectangular wedge of bone to shroten the met
Describe the Traditional scarf osteotomy.
Z osteotomy with shorter arms oriented proximal-plantar and distal-dorsal
How many times stronger is the inverted scarf osteotomy/
1.6x stronger (bc troughing plantarflexes the met head which is more desirable than dorsiflexing the head which is seen if troughing occurs in the traditional scarf)
Describe the Inverted scarf osteotomy
Z osteotomy with shorter arms oriented proximal-dorsal to distal-plantar.
Name two diaphyseal osteotomies.
Ludloff
mau
Describe the Ludloff osteotomy.
oblique diaphysesal osteotomy that runs dorsal-proximal to plantar-distal
Describe the Mau osteotomy.
oblique diaphyseal osteotomy that runs plantar-proximal to dorsal-distal
Name the proximal hallux osteotomies.
Loison-balacesu Juvara crescentic Trethowan` Logroscino
what are the iatrogenic causes of hallux varus?
- removal of fibular sesamoid
- staking of the 1st met head
- over-correction of IMA
- over-zealous capsulorraphy
- aggressive post-op bandaging
- over-extensive lateral release
- over-correction of PASA
What is the normal Hallux-abductus angle?
10-15 deg
What is the normal Hallux -interphalangeal angle?
0-10 deg
What are the possible 1st metatarsal diaphyseal osteotomies?
SCARF or Z-osteotomy
Ludloff
Mau
What are some proximal 1st metatarsal osteotomies?
Loison-bbalacescu Juvara Crescentic Trethowan Logroscino
Describe the Logroscino procedure?
(double 1st met osteotomy) CBWO + Reverdin
Describe the Trethowan procedure.
opening abductory wedge osteotomy used to correct abnormally high IMA on short metatarsals
*BONUS: Where does the opening wedge graft come from?
The Trethowan procedure is often combined with a bone graft. What is the harvesting procedure called?
Stamm procedure- taking a resected base of the proximal phalanx and using it as teh bone graft in the Trethowan
Where does the opening wedge bone graft in the Trethowan procedure come from?
medial eminence of 1st met head
OR resected base of proximal phalanx
Describe the Juvara osteotomy.
oblique medial closing wedge (CBWO) osteotomy of the metatarsal base
