Flexor tenotomy (Surgery)

Question 1

What are the indications for Flexor tenotomy?

1 ?

2?

3?

4?

5?

Answer 1

1. Reducible MPJ contracture
2. Flexible contracture dominant feature
3. Apical callus/ulcer
4. Mallet toe/ Claw toe
5. Adducto-varus claw toe

Question 2

what are the benefits for flexor tenotomy?

1?

2?

3?

4?

5?

6?

Answer 2

1. Simple
2. Low risk
3. No bone involvement
4. Good alternate in high risk patients
5. Good adjunctive procedure
6. Minimal complications

Question 3

What are the complications for flexor tenotomy?

1. ?
2. ?
3. ?
4. ?
5. ?

Answer 3

1. Failure to correct deformity
2. Failure to resolve painfull callus
3. Overcorrection
4. Infection
5. Need for more surgery

Question 4

Assessment for hammertoe procedure?

1. ?
2. ?
3. ?
4. ?
5. ?
6. ?

Answer 4

1. MTPJ procedure
2. NWB vs loaded
3. Hyperkeratosis location
4. Adjacant digit
5. Ulceration
6. Health/circ status

Question 5

What’s the traditional technique for flexor tenotomy?

1?

2?

3?

4?

Answer 5

1. Ring block with lignocaine or marcaine
2. Use the blade
3. Stab incision while extending the toe
4. Steristep reinforcment

Question 6

Ganglion

Wrist 1?

Foot 2?

Position 3?

Gender ratio 4?

Age 5?

Answer 6

1. 62%
2. 7%
3. Dorsum of the foot
4. Women 2:1
5. 3rd to 6th decade

Question 7

What’s the etiology for ganglions?

1?

Answer 7

1. Cystic degenration of connective tissue

Question 8

What are the differential diagnosis for ganglions?

1. ?
2. ?
3. ?
4. ?
5. ?
6. ?
7. ?

Answer 8

1. Lipoma
2. Aneurysm
3. Neuroma
4. Synovial cyst
5. Fibroma
6. Giant cell tumour
7. Sarcoma

Question 9

What are the clinical presentation for ganglion?

1?

2?

3?

Answer 9

1. Pain
2. Cosmetics
3. Change in size

Question 10

What’s the name of the injection for Ganglion?

What the mechanism of action?

Answer 10

Triamcinolone (Kenacort)

Suppresses fibroblastic secretion of hyalurenic acid

Question 11

What’s the % of the ganglion in the foot?

Answer 11

Question 12

Success rate

1. Injection/Aspiration?
2. Aspiration/Injection?
3. Surgical incision?

Answer 12

1. 100% recurrance, 59% recurrance
2. 33% recurrance
3. 43% recurrance, 31% recurrance, 7% recurrance

Question 13

What are the general complications for surgery of ganglions?

1?

2?

3?

4?

Answer 13

1. Scar formation- Keloids
2. Nerve damage, entrapment
3. Recurrance
4. Joint pain, stifness

Question 14

What is Exostectomy?

e. g. 1?
e. g.2?

Answer 14

Excision of bony bump usually on the medial or lateral side of the phalanx

e. g. 1. subungual exostosis
e. g. 2.Conylectomy for interdigital lesion

Question 15

What are the indications for digital conylectomy?

Ideal for 1?

What is the procedure 2?

Answer 15

1. Inter Digital HD, 5th medial dital interphalangeal joint
2. Digital tornequit
3. 5 cm curviliner incision to the bone

Seperate skin from bony prominance

Rasp Soomth

Flush

Suture

Question 16

What is digital arthroplasty?

Answer 16

Excision of the head of the proximal phalanx

HD 5th proximal inter phalangeal joint

De-rotational digital arthroplasty

Question 17

What is Arthroplasty

good?

AND

Not good?

Answer 17

Good for isolated hammer toes especially 5th toe lesions

Not good for 2nd toes

Question 18

What is digital arthrodesis?

What does the procedure involve?

Answer 18

Fusion of a joint to provide stability

1. Cartilage removed from head of phalanx and base of middle phalanx
2. Fixate with K-wire for 4-6/52
3. Correction maintained with Coban 2/52

Question 19

What are the indications for Arthrodesis?

Answer 19

Hammertoe with MPJ contracture

2nd toe

Multiple digits

Neuropathy, neuromuscular disease

Question 20

What is the step by step method for Arthrodesis?

1. ?
2. ?
3. ?
4. ?

Answer 20

1. Longituidinal incision
2. Z-plasty EDL and severing collateral ligaments and joint capsule
3. Removing of cartilage opposing joint surface
4. Insertion of 1.2 or 1.4 mm K-wire

Question 21

Arthrodesis

1? instruments are best for fusion

Improved function generally achived with 2?

Answer 21

1. Hand
2. Fusion