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PodMed > Hallux Valgus (Surgery Unit) > Flashcards

Hallux Valgus (Surgery Unit) Flashcards

1
Q

Radiographic measurments:

1st metatarsal protrusion distance

Normal value A

What is it? Relative B

A

A: +/- 2 mm

B: Difference in radii of longitudinal bisections of 1st and 2nd metatarsals

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2
Q

Radiographic measurment

Metatarsus Primus Adductus Angle

normal A

B is associated with HV development in rectus feet

C in metatarsus adductus feet

A

A: 8 degrees

B: 12 degrees

C: > 8 degrees

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3
Q

Hallux abductus angle

HAA normal A

A

A: 10-20 degrees

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4
Q

Tibial sesamoid position

Normal : A

Relative position of B in relation to the C of 1st metatarsal

A

A: 4

B: medial sesamoid

C: bisection

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5
Q

1st metatrsophalangeal position

How does

Normal Deviated Subluxed

look like?

A
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6
Q

Surgical management for hallux valgus depends on ?

  1. Degree of A
  2. B of deformity
  3. C
  4. D mechanics
  5. Other factors
A
  1. A: deformity
  2. B: Nature
  3. C: Physiological age
  4. D: Foot
  5. General health, Co-morbidity, Home support
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7
Q

What are the different classifications for hallux valgus surgery?

  1. A
  2. B
  3. C
  4. D
  5. E
A

A: Bupectomy : medial bump, head of 1st head

B: Arthroplasty/ joint implant

C: Osteotomy of hallux

D: first metatarsal osteotomies : distal and proximal

E: Fusion procedures: 1st mtpj and 1st met-cuniform

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8
Q

“Bumpectomy”

Silver

Removal of A

Reinforcment of B

A

A: Medial exostosis

B: Medial capsule

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9
Q

‘Bumpectomy’

Silver bunionectomy

What are the indications for silver bunionectomy?

  1. A
  2. B
  3. C
  4. D
  5. E
A

Bump pain

  1. Bupm pain
  2. No sesamoid or joint pain
  3. Good ROM
  4. No pain or crepitus with ROM examination
  5. Elderly patients (Osteoprosis)
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10
Q

“Bumpectomy”

Silver bunionectomy

Advantages Disadvantages

  1. A post-op recovery 1. Weakens E
  2. B post-op oedema 2. poor F
  3. C procedure 3. Fails to correct G
  4. May be performed in pt with D
A
  1. A: Rapid 1. E: medial aspect of 1st mpj
  2. B: Minimal 2. F: long term prognosis
  3. C: Simple 3. Structural aetiology
  4. D: Osteoprosis
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11
Q

Bumpectomy

Mcbride Nubionectomy

A ostectomy

B sesamoidectomy

+/- Transfer of C tendon dorsally to D

A

A 1st metatarsal

B Lateral

C adductor hallucis D medial capsule

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12
Q

Bumpectomy-McBride bunionectomy

What are the indications for this procedure?

  1. No A
  2. Pain associated with the B
  3. Adequate C
  4. Mild D
  5. E medial eminence
  6. Deviated to F
  7. H
A
  1. A : pain or creptus with ROM 1st mpj
  2. B: lateral sesamoid
  3. C: ROM 1st mpj
  4. D: Mild axial rotation hallux
  5. E: Hypertrophy
  6. F: Subluxed 1st mpj
  7. H: TSP>4
  8. Elderly patients (osteoprosis)
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13
Q

Bumpectomy

McBride bunionectomy

What are the advantages?

  1. Relatively A
  2. More B than Silver
  3. May be performed with patients with C
A

A: Simple

B: Corrective

C: Osteoprosis

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14
Q

Bumpectomy

Mcbride bunionectomy

What are the disadvatnages of this procedure?

  1. Fails to correct A
  2. High incidence of either B
A
  1. A: structural aetiology
  2. B: Hallux valgus
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15
Q

For both Silver and Mcbride buionectomies what are the Post-op course of action?

  1. Patient wears post-op shoe for A
  2. Return to B ASAP
  3. Wise to use C for 1-2/12 to assist maintaning correction of D
  4. Minimal E compared to other bunionectomies
A
  1. A: 2-3 weeks
  2. B: normal activities
  3. C: IDW D: HAA
  4. E: morbidity
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16
Q

Arthroplasty/ Joint implant

Keller bunionectomy

Gap arthoplasty 1st MPJ

A removed which is paralled to the shaft

B fixation 2-4/52

Suture C to plantar aspect proximal phalanx

Best reserved for D patients or E

A

A: 1/3rd- 1/2 base proximal phalanx

B: 1.6 mm K-wire

C: FHL

D: geriatric patients

E: endstage hallux limitus

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17
Q

Arthroplasty

Joint implant

Advantages: Disadvantages:

  1. A 1. weakens B
  2. C recovery 2. secondary D
  3. E ROM
  4. Eliminated F
A
  1. A: simple 1. B: purchase strength of hallux
  2. C: rapid 2. D: central metatarsalgia
  3. E: Restores
  4. F: O/A pain
18
Q

What are the post-op course of action for Arthroplasty/Joint implant?

  1. wears A
  2. Relatively B
  3. May need to use C
A
  1. A: post-op shoes while k-wires are in situ (The wires might bend)
  2. B: early return to normal activity
  3. C: IDW postoperatively for a period of surgery was for HV
19
Q

Akin Bunionectomy

Distal Akin

Used to correct A

Rarely performed as B

Shortens C

Fixate with D

E procedure

* distal would have more effect on joint angulation that proximal phalanx

A

A: high DASA

B: Single procedure

C: prxoximal phalanx

D: ss wire, staple, K-wire, screw

E: Ambulatory

20
Q

Proximal Akin

Used to correct A

Minimal B present

Shortens C

D must be closed

A

A : high PASA

B: valgus rotation

C: proximal pahalnx

D: Epiphysis proximal phalanx

21
Q

Proximal Akin

Technique / Procedure :

A parallel to base

B perpendicular longitudinal axis proximal phalanx

C Fixation

A

A: Proximal cut

B: Distal cut

C: Internal

22
Q

Proximal Akin

Post-op course

osteotomy takes A to unite

Protect in B for C

Support with Coban bandage of hallux for further D

A

A: 6-8 weeks

B: Post-op shoes / C:4/52

D: 2-4/52

23
Q

What is the most commonly performed bunionectomy performed today?

A: ?

A

A: Austin bunionectomy

24
Q

What are the indications for Austin procedure?

A HV deformity

MPA angle of B

Age C

D bone density

A

A: Mild-moderate

B: 12-20 degrees

C: 14-75 years old

D: Good

25
Q

What is the first step of the Austin procedure?

A tenoctomy

Release of B

A

A: Adductor hallucis

B: lateral sesamoidal ligament

26
Q

What is the 2nd step for Austin procedure?

A

Inverted ‘L’ shaped capsulotomy

27
Q

What are the 3rd and 4th steps in Austin procedure?

3rd: Inspection of A
4th: Removal of B

A

A: metatarsal head

B: Medial eminenece

28
Q

What is the next step after removal of the medial eminence in Austin procedure?

A

“V” osteotomy and insertion of K wire at the apex of the V to hold

the bone temporarly until they put the screw in

29
Q

What is the next step after “V” osteotomy in the Austin procedure?

A

Lateral re-positioning of the 1st met head

and then the removal of prominance metatarsal neck

and fixation

30
Q

What are the advantages for Austin procedure?

A osteotomy

Good B (low incidence of C)

Can D ( reduce incidence of lesser metatarsalgia)

Technically E

A

A: Stable

B: bone to bone C: AVN

D: plantarflex/shorten

E: easy

31
Q

What are the limitations of Austin procedure?

Limitation of A possible

B patients

A

A: amount of correction possible

B: Juvenille patients

32
Q

Post-op course for the Austin procedure:

Sutures removed at A

Post-op shoes for B

C for a period

Return to normal shoes after D

Return to sedentary work E post-op

Return to active work F

Return to active exercise G

Total time to recover H

A

A: 2 weeks

B: 4 weeks

C: +/- IDW

D: 4 weeks +

E: 1-2 weeks

F: 4-6 weeks

G: 2-3 weeks

H: 1 or 2 years

33
Q

Obligue closing base wedge osteotomy

A base/shaft osteotomy from B to C

Create D hinge

Use axis guide

to E 1st ray

to F

G essential

A

A: Oblique B: medial-proximal C:lateral-distal

D: medial cortical

E: abduct

F: abduct/ plantarflex

G: internal fixation

34
Q

Oblique closing base wedge

what are the advantages? what are the disadvantages?

  1. Can reduce A 1. Technically B
  2. Can C mildly 2. Can fracture D
    1. Needs NWB BK cast for E
    1. F , reduced G
A

Oblique closing base wedge

  1. A: large MPAA 1. B: difficult
  2. C: plantarflex 2. D: medial hinge
    1. 6-8 weeks
    1. osteoprosis, mpj ROM
35
Q

Scarf osteotomy

A osteotomy

Indication B

Advantages:__Disadvantages:

  1. Good C 1. Technically D
  2. E via use axis guide 2. internal fixation with F
  3. May G by removing the dorsal wedge
  4. can perform H
A

A: Transverse Z

B: High MPAA

  1. C: reduction of IMA 1. D: difficulty
  2. E: plantarflex 2. F: 2 screws
  3. G: shorten
  4. H: bilateral surgery
36
Q

What are the complication of bunion surgery?

  1. A
  2. Displacement of B
  3. Post-op C
  4. Restricted D
  5. E removal
  6. Return of F
  7. G
  8. H
A
  1. A: Infection
  2. B: osteotomy
  3. C: oedema
  4. D: ROM
  5. E: Fixation
  6. F: deformity
  7. G: hallux varus
  8. H: avascular necrosis
    9.
37
Q

What are the causes of oedema post operation?

Some oedema is A

B

C

Excessive D

Movemenet of E

A

A: normal

B: Infection

C: hematoma

D: walking

E: osteotomy site

38
Q

What are the casues car restricted ROM?

initially A

B

Inadequate C

Failure to shorten D

Treatment: E

A

A: normal

B: Fibrosis capsule, EH capularis

C: bone resection

D: 1st metatarsal

E: Early ROM exercises, steroid injection

39
Q

What are the causes of fixation removal?

A

screw heads too B

Presnece of C

Treatment :

E

A

A: K-wires losen

B: Prominant

C: infection

E: placement and choice of fixation

E: LA

40
Q

What are the causes of the return of deformity?

A reduction

Poor B

Non C

Treatment?

No D

E

A

A: Inadequate reduction

B: Post-op management

C: Non-compliance

Treatment:

D: No treatment

E: reoperate

41
Q

What is involved in Silver procedure?

  1. Removal of ?
  2. Lateral ?
  3. ? release
  4. reinforcement of ?
A
  1. the medial eminence
  2. capsulorraphy
  3. adductor
  4. the medial capsule with V-Y capuloraphy
42
Q

What is the Mcbride procedure based on your Podiatric Medicine book?

A

Mcbride resected the adductor hallucis tendon at its insertion to the proximal phalanx and the fibular sesamoid. The tendon was then dissected free back to the level of its muscle belly. The fibular sesamoid was then excised (he emphasized that the most difficult part of removing the sesamoid was freeing the bone from the intermetatarsal ligament). He then resected the exostosis from the head of the metatarsal. If there was still capsular contracture, Mcbride made a small stab incision into the taut lateral capsule. He thaught it was absolutly necessary to have no remaining contractures that could keep the hallux in valgus position. The adductor hallucis tendon was then transplanted to the shaft of the first metatarsal and sutured into the periosteium. The purpose of this transfer, according to McBride, was that it no longer had any leverage pull on the digit, and its new location, when contracted would bring the first and second metatarsal toegther.

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