Fixation - Prox Phalanx

Question 1

Juvara Modification of Akin

Answer 1

2.7 mm cortical screw

across osteotomy in proximal phalanx;

take medially based wedge but at 45 degrees

Question 2

hallux IPJ fusion (arthrodesis)

Answer 2

**4.0 mm Cancellous Screw, fully threaded**

or crossed K-wires

Question 3

Reverdin

Answer 3

2.0 mm or 2.7 m m CORTICAL screws

(or K-wire)

osteotomy at 1st MT head; done as PART of bunion procedure to correct PASA

Question 4

Austin (Chevron)

incl. long arm austin, bicorrectional, and tricorrectional

Answer 4

One 2.7 mm cortical screw, or

One 3.0 mm cannulated

Question 5

Kalish, Offset V, or Scarf (Z) osteotomies

(same fixation)

Answer 5

two 2.7 mm cortical screws, OR

two 3.0 mm cannulated screws

(does NOT correct for PASA; Kalish is made at 55 degree angle b/w cuts)

Question 6

Scarf fixation and names

Answer 6

• Barouk screw is distal screw; thrown 45 degree OBLIQUE angle plantarly
• Prox screw is oblique angle to reach plantar cortex

Question 7

Difference b/w osteotomy in Kalish and Offset V

Answer 7

Kalish: 55 degree angle b/w cuts –> long dorsal arm is DISTAL to midshaft

Offset V: 35 degree angle –> long dorsal arm is PROXIMAL to midshaft

Question 8

Ludloff, Mau

Answer 8

two 2.7 mm cortical screws, or

3.0 mm cannulated screws

(*recall, Mau “matches”, with distal dorsal –> proximal plantar)

Question 9

CBWO (Loison)

Answer 9

5/64th steinman pin, or 2 crossed k wires

Question 10

Juvara modification of CBWO

Answer 10

two screw fixation

• compression screw: 4.0 cancellous placed perpendicular to osteotomy
• anchor screw: 2.7 mm cortical perpendicular to long axis of the first met –> prevents shortening and rotation

Question 11

CRESCENTIC base wedge osteotomy

Answer 11

4.0 cancellous screw

Question 12

OBWO

Answer 12

• tubular plate w/ compression screws
• crossed K wires
• staple or pins

Question 13

McKeever (1st MPJ arthrodesis)

Answer 13

• Locking anatomic plate –> most aggressive and strongest
• Crossed 4.0 cannulated screw is MOST COMMON
• Crossed 0.062 K-wire
• Tubular plate
• External fixation

Question 14

Lapidus

(1st MT-MC fusion)

Answer 14

• 3.5 mm cortical screws;
• three solid cortical screws or an interfragmentary compression of solid cortical screw along with a medial based locking plate.
• Regardless of the construct, the first screw is the most important screw; this is often referred to as the “homerun screw”

Question 15

Transverse CBWO

(metaphyseal, 2ndary bone healing)

Answer 15

2.4mm, 2.7mm or 3.5mm cortical (1 anchor and 1 compression screw)

Question 16

Oblique CBWO

(junctional)

Answer 16

• 2.4mm, 2.7mm or 3.5mm cortical (1 anchor and 1 compression screw)
• primary bone healing
• less shortening
• more difficult and worse complications