Hallux Valgus (Surgery Unit) Flashcards
Radiographic measurments:
1st metatarsal protrusion distance
Normal value A
What is it? Relative B
A: +/- 2 mm
B: Difference in radii of longitudinal bisections of 1st and 2nd metatarsals
Radiographic measurment
Metatarsus Primus Adductus Angle
normal A
B is associated with HV development in rectus feet
C in metatarsus adductus feet
A: 8 degrees
B: 12 degrees
C: > 8 degrees
Hallux abductus angle
HAA normal A
A: 10-20 degrees
Tibial sesamoid position
Normal : A
Relative position of B in relation to the C of 1st metatarsal
A: 4
B: medial sesamoid
C: bisection
1st metatrsophalangeal position
How does
Normal Deviated Subluxed
look like?
Surgical management for hallux valgus depends on ?
- Degree of A
- B of deformity
- C
- D mechanics
- Other factors
- A: deformity
- B: Nature
- C: Physiological age
- D: Foot
- General health, Co-morbidity, Home support
What are the different classifications for hallux valgus surgery?
- A
- B
- C
- D
- E
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
“Bumpectomy”
Silver
Removal of A
Reinforcment of B
A: Medial exostosis
B: Medial capsule
‘Bumpectomy’
Silver bunionectomy
What are the indications for silver bunionectomy?
- A
- B
- C
- D
- E
Bump pain
- Bupm pain
- No sesamoid or joint pain
- Good ROM
- No pain or crepitus with ROM examination
- Elderly patients (Osteoprosis)
“Bumpectomy”
Silver bunionectomy
Advantages Disadvantages
- A post-op recovery 1. Weakens E
- B post-op oedema 2. poor F
- C procedure 3. Fails to correct G
- May be performed in pt with D
- A: Rapid 1. E: medial aspect of 1st mpj
- B: Minimal 2. F: long term prognosis
- C: Simple 3. Structural aetiology
- D: Osteoprosis
Bumpectomy
Mcbride Nubionectomy
A ostectomy
B sesamoidectomy
+/- Transfer of C tendon dorsally to D
A 1st metatarsal
B Lateral
C adductor hallucis D medial capsule
Bumpectomy-McBride bunionectomy
What are the indications for this procedure?
- No A
- Pain associated with the B
- Adequate C
- Mild D
- E medial eminence
- Deviated to F
- H
- A : pain or creptus with ROM 1st mpj
- B: lateral sesamoid
- C: ROM 1st mpj
- D: Mild axial rotation hallux
- E: Hypertrophy
- F: Subluxed 1st mpj
- H: TSP>4
- Elderly patients (osteoprosis)
Bumpectomy
McBride bunionectomy
What are the advantages?
- Relatively A
- More B than Silver
- May be performed with patients with C
A: Simple
B: Corrective
C: Osteoprosis
Bumpectomy
Mcbride bunionectomy
What are the disadvatnages of this procedure?
- Fails to correct A
- High incidence of either B
- A: structural aetiology
- B: Hallux valgus
For both Silver and Mcbride buionectomies what are the Post-op course of action?
- Patient wears post-op shoe for A
- Return to B ASAP
- Wise to use C for 1-2/12 to assist maintaning correction of D
- Minimal E compared to other bunionectomies
- A: 2-3 weeks
- B: normal activities
- C: IDW D: HAA
- E: morbidity
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: 1/3rd- 1/2 base proximal phalanx
B: 1.6 mm K-wire
C: FHL
D: geriatric patients
E: endstage hallux limitus
Arthroplasty
Joint implant
Advantages: Disadvantages:
- A 1. weakens B
- C recovery 2. secondary D
- E ROM
- Eliminated F
- A: simple 1. B: purchase strength of hallux
- C: rapid 2. D: central metatarsalgia
- E: Restores
- F: O/A pain
What are the post-op course of action for Arthroplasty/Joint implant?
- wears A
- Relatively B
- May need to use C
- A: post-op shoes while k-wires are in situ (The wires might bend)
- B: early return to normal activity
- C: IDW postoperatively for a period of surgery was for HV
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: high DASA
B: Single procedure
C: prxoximal phalanx
D: ss wire, staple, K-wire, screw
E: Ambulatory
Proximal Akin
Used to correct A
Minimal B present
Shortens C
D must be closed
A : high PASA
B: valgus rotation
C: proximal pahalnx
D: Epiphysis proximal phalanx
Proximal Akin
Technique / Procedure :
A parallel to base
B perpendicular longitudinal axis proximal phalanx
C Fixation
A: Proximal cut
B: Distal cut
C: Internal
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: 6-8 weeks
B: Post-op shoes / C:4/52
D: 2-4/52
What is the most commonly performed bunionectomy performed today?
A: ?
A: Austin bunionectomy
What are the indications for Austin procedure?
A HV deformity
MPA angle of B
Age C
D bone density
A: Mild-moderate
B: 12-20 degrees
C: 14-75 years old
D: Good
What is the first step of the Austin procedure?
A tenoctomy
Release of B
A: Adductor hallucis
B: lateral sesamoidal ligament
What is the 2nd step for Austin procedure?
Inverted ‘L’ shaped capsulotomy
What are the 3rd and 4th steps in Austin procedure?
3rd: Inspection of A
4th: Removal of B
A: metatarsal head
B: Medial eminenece
What is the next step after removal of the medial eminence in Austin procedure?
“V” osteotomy and insertion of K wire at the apex of the V to hold
the bone temporarly until they put the screw in
What is the next step after “V” osteotomy in the Austin procedure?
Lateral re-positioning of the 1st met head
and then the removal of prominance metatarsal neck
and fixation
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: Stable
B: bone to bone C: AVN
D: plantarflex/shorten
E: easy
What are the limitations of Austin procedure?
Limitation of A possible
B patients
A: amount of correction possible
B: Juvenille patients
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: 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
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: Oblique B: medial-proximal C:lateral-distal
D: medial cortical
E: abduct
F: abduct/ plantarflex
G: internal fixation
Oblique closing base wedge
what are the advantages? what are the disadvantages?
- Can reduce A 1. Technically B
- Can C mildly 2. Can fracture D
- Needs NWB BK cast for E
- F , reduced G
Oblique closing base wedge
- A: large MPAA 1. B: difficult
- C: plantarflex 2. D: medial hinge
- 6-8 weeks
- osteoprosis, mpj ROM
Scarf osteotomy
A osteotomy
Indication B
Advantages:__Disadvantages:
- Good C 1. Technically D
- E via use axis guide 2. internal fixation with F
- May G by removing the dorsal wedge
- can perform H
A: Transverse Z
B: High MPAA
- C: reduction of IMA 1. D: difficulty
- E: plantarflex 2. F: 2 screws
- G: shorten
- H: bilateral surgery
What are the complication of bunion surgery?
- A
- Displacement of B
- Post-op C
- Restricted D
- E removal
- Return of F
- G
- H
- A: Infection
- B: osteotomy
- C: oedema
- D: ROM
- E: Fixation
- F: deformity
- G: hallux varus
- H: avascular necrosis
9.
What are the causes of oedema post operation?
Some oedema is A
B
C
Excessive D
Movemenet of E
A: normal
B: Infection
C: hematoma
D: walking
E: osteotomy site
What are the casues car restricted ROM?
initially A
B
Inadequate C
Failure to shorten D
Treatment: E
A: normal
B: Fibrosis capsule, EH capularis
C: bone resection
D: 1st metatarsal
E: Early ROM exercises, steroid injection
What are the causes of fixation removal?
A
screw heads too B
Presnece of C
Treatment :
E
A: K-wires losen
B: Prominant
C: infection
E: placement and choice of fixation
E: LA
What are the causes of the return of deformity?
A reduction
Poor B
Non C
Treatment?
No D
E
A: Inadequate reduction
B: Post-op management
C: Non-compliance
Treatment:
D: No treatment
E: reoperate
What is involved in Silver procedure?
- Removal of ?
- Lateral ?
- ? release
- reinforcement of ?
- the medial eminence
- capsulorraphy
- adductor
- the medial capsule with V-Y capuloraphy
What is the Mcbride procedure based on your Podiatric Medicine book?
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.
