HAV surgeries

Question 1

1st MPJ Capsulotomies

Answer 1

Medial or dorsal approach to access jt and distract hallux creating a dimple at jt Medial approaches: Vertical, U, H, T or L shaped
Dorsal approaches: linear, T or inverted L-shaped or lenticular

Question 2

1st MPJ Capsulorraphy

Answer 2

Reefing of medial capsule and Removal of redundant capsule Meticulous dissection, too tight can cause hallux varus/stiff MPJ with jamming

Question 3

Lateral Release

Answer 3

To realign 1st met head over sesamoids & release contracture. Release of addH tendon, deep transverse intermet lig, lateral collateral lig, fibular suspensory lig Do not release fib susp lig if you want sesamoids to move with met head.

Question 4

Silver Bunionectomy

Answer 4

Partial ostectomy of 1st met head. Does NOT correct etiology, removes bump only (care to preserve sagittal groove) Good for pts that are not good sx candidates, progression of deformity continues and weakens medial structure, causing more lateral drift. For mild HAV
staking the head take more bone dorsally and preserve tibial sesamoid shelf to prevent hallux varus

Question 5

McBride Bunionectomy

Answer 5

Removal of medial eminence, release or transfer of AddH tendon to medial met head, removal of fib sesamoid In theory works but not good results, controversial to remove fib sesamoid now, cannot be used alone for structural deformity

Question 6

Adductor Tendon Transfer

Answer 6

Transfer tendon to medial aspect of 1st MPJ Requirements: Frontal plane deviation of sesamoids, normal met protrusion distance, normal sagittal plane alignment of 1st met

Question 7

Proximal Akin (Hallux Phalangeal Osteotomy)

Answer 7

Medial closing wedge in proximal aspect of proximal phalanx of hallux. Lateral hinge left intact (perpendicular to WB surface) To reduce DASA to 0. Cannot correct IM, subluxed joint or high PASA

Question 8

Distal Akin

Hallux Phalangeal Osteotomy

Answer 8

Medial closing wedge in distal aspect of proximal phalanx of hallux Indications: abnormal interphalangeal abductus angle

Question 9

Oblique Akin (Hallux Phalangeal Osteotomy)

Answer 9

Oblique wedge apex lateral Abnormal hallux interphalangeal angle, DASA

Question 10

Cylindrical Akin, Chevron and Z osteotomy

Hallux Phalangeal Osteotomy

Answer 10

Indications: Long proximal phalanx, abnormal DASA and hallux- interphalangeal angle

Question 11

Regnauld/ Sagittal Z (Hallux Phalangeal Osteotomy)

Answer 11

Correct long hallux only

Question 12

Reverdin

Answer 12

Medial wedge osteotomy of 1st met head Indication: IM<8 deg, Increase in PASA To correct PASA, distal cut parallel to joint surface, proximal cut made second and perpendicular to long axis of met

Question 13

Peabody

Answer 13

Same as Reverdin but performed in met neck. Historical only, not performed, very unstable and poor blood supply

Question 14

Reverdin-Green

Answer 14

Reverdin w plantar shelf to protect sesamoids Plantar shelf made parallel to weight bearing surface. Addresses abnormal PASA

Question 15

Reverdin-Green

Reverdin-(Green)- Laird

Answer 15

Reverdin-Green w lateral transposition of met head to close IM Indications: Increased PASA AND IM

Question 16

Reverdin-Todd

Answer 16

Reverdin-Green-Laird w resection of bone to allow PF of met head Addresses PASA, increased IM and elevated met head

Question 17

Hohmann

Answer 17

Trapezoid wedge at anatomic
neck of met Historical only, capital fragment laterally transposed and depressed plantarly Indications: IM 9-14deg, elevates, abnml PASA

Question 18

Mitchell

Answer 18

Transpositional step down;
indicated for metatarsus elevatus, IMA (9-14), long 1st met Corrects IM and PFs met head
Distal cut made 1st from medial to lateral across 2/3 width; proximal cut 2nd parallel to 1st cut angled dorsal-distal to plantar-proximal through lateral cortex

Question 19

Drato

Answer 19

De-rotational, angulation, transpositional osteotomy; complete osteotomy of met neck perpendicular to long axis. Capital fragment de-
rotated, 2nd osteotomy distal to 1st cut resecting wedge of bone with the base medial and apex lateral. 3rd osteotomy resecting wedge with base dorsal and apex plantar. Capital fragment transposed laterally (reduce IMA) Tx Abnormal PASA, mild increase in IM. Can DF capital fragment if needed. Allows frontal plane rotation of the head. Was not very common, but making a come back with the understanding of frontal plane rotation and the sesamoid position

Question 20

Roux

Answer 20

(Angulated Mitchell) Indications: Increased PASA, nml DASA, Increased IM (9-14deg)

Question 21

Capp

Answer 21

Transverse osteotomy of met head Can rotate in all planes; unstable and very difficult to fixate

Question 22

Wilson

Answer 22

Oblique cut of met Can get shortening of met

Question 23

Austin

Answer 23

Horizontal v osteotomy (Chevron)
Indications: IM 9-15 deg No fixation required Apex in central met head, angle of apex is 60 deg, Kalish is smaller angle (50-55) to increase dorsal wing for better screw placement, Youngswick is removal of dorsal rectangular wedge. Bicorrectional removes a trapezoidal wedge

Question 24

Scarf

Answer 24

Z osteotomy in diaphyseal and metaphyseal bone. Not for HIGH IMA
Contraindications: High PASA, narrow met width, significant sagittal deformity Primary cut longitudinal, two end cuts exit dorsal distally and proximal plantarly. Arms are angles 60-80 deg. Very stable. Can get troughing (one cortical edge falls into medullary canal of other segment)

Question 25

Rotational Scarf

Answer 25

Allows for max IMA reduction (Indications: High IMA) Can correct some PASA at expense of IMA correction. Can get gapping.

Question 26

Inverted Scarf

Answer 26

1.6x more stable than traditional Scarf End cuts= dorsal proximal, plantar distal

Question 27

Ludloff

Answer 27

Diaphyseal osteotomy Oblique cut mediallateral, proximal dorsaldistal plantar

Question 28

Mau

Answer 28

Diaphyseal osteotomy Oblique cut mediallateral, proximal plantardistal dorsal

Question 29

Z Scarf (Midshaft)

Answer 29

Indications: Moderate bunion (13- 20deg) Short 1st Consider bone stock, met width. (Inverted Scarf 1.6x stronger) Troughing may occur (down in inverted, up in standard)

Question 30

Offset V (metaphyseal- diaphyseal junction)

Answer 30

Modified Ludloff-long dorsal arm, divergence of 40-45 deg, apex of triangle in met head Reduce IMA up to 18deg, reduce PASA up to 40deg

Question 31

JUVARA

base

Answer 31

Oblique osteotomy that extends proximal-medialdistal-lateral Primarily a transvers plane correction
Hinge Axis Concept: PF-superior pole of axis is angled laterally. DF- superior pole is angled medially. (Example in left 1st met hinge angle: DF=\ , PF=/

Question 32

JUVARA B-1

Answer 32

Same as JUVARA A but hinge is disrupted and sagittal plane correction is obtained

Question 33

JUVARA B-2

Answer 33

Same as JUVARA B-1. Also length of met can be corrected

Question 34

JUVARA C-1

Answer 34

Only one osteotomy made and sagittal plane correction obtained No TRANSVERSE PLANE
correction with JUVARA C

Question 35

JUVARA C-2

Answer 35

Save as C-1, also length of met can be corrected No TRANSVERSE PLANE
correction with JUVARA C

Question 36

Loison/Balacescu

Answer 36

Transverse closing ABDuctory
wedge Provides less correction than
oblique osteotomy. Monofilament, K-wire or locking plate fixation

Question 37

Trethowan

Answer 37

Opening base wedge osteotomy Lengthens met slightly. Use bone graft, plate fixation. Use bone from med eminence or prox phalanx

Question 38

Logroscino

Answer 38

Double 1st met osteotomy. Base wedge ost combined w first met head procedure (Reverdin)

Question 39

Crescentic

Answer 39

Transverse cut with rotation of 1st met Good for relatively short 1st metatarsal because you are only making one cut, lose 1 mm of bone. Allows high IMA correction and frontal plane

Question 40

Crescentic Shelf

Answer 40

Dorsal crescentic with transverse plantar cuts More stable than standard Crescentic, fixation

Question 41

Epiphysiodesis

Answer 41

Arrest lateral portion of physis. Medial allowed to continue to grow. Leads to lateral mvmt of 1st met closing IMA. Timing is critical (age of pt)

Question 42

Lapidus Arthrodesis

Answer 42

Fusion at 1st met/cuneiform joint Allows correction of any IMA, PASA, sagittal plane and frontal plane (All components of the deformity)