HAV surgeries Flashcards
1st MPJ Capsulotomies
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
1st MPJ Capsulorraphy
Reefing of medial capsule and Removal of redundant capsule Meticulous dissection, too tight can cause hallux varus/stiff MPJ with jamming
Lateral Release
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.
Silver Bunionectomy
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
McBride Bunionectomy
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
Adductor Tendon Transfer
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
Proximal Akin (Hallux Phalangeal Osteotomy)
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
Distal Akin
Hallux Phalangeal Osteotomy
Medial closing wedge in distal aspect of proximal phalanx of hallux Indications: abnormal interphalangeal abductus angle
Oblique Akin (Hallux Phalangeal Osteotomy)
Oblique wedge apex lateral Abnormal hallux interphalangeal angle, DASA
Cylindrical Akin, Chevron and Z osteotomy
Hallux Phalangeal Osteotomy
Indications: Long proximal phalanx, abnormal DASA and hallux- interphalangeal angle
Regnauld/ Sagittal Z (Hallux Phalangeal Osteotomy)
Correct long hallux only
Reverdin
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
Peabody
Same as Reverdin but performed in met neck. Historical only, not performed, very unstable and poor blood supply
Reverdin-Green
Reverdin w plantar shelf to protect sesamoids Plantar shelf made parallel to weight bearing surface. Addresses abnormal PASA
Reverdin-Green
Reverdin-(Green)- Laird
Reverdin-Green w lateral transposition of met head to close IM Indications: Increased PASA AND IM
Reverdin-Todd
Reverdin-Green-Laird w resection of bone to allow PF of met head Addresses PASA, increased IM and elevated met head
Hohmann
Trapezoid wedge at anatomic
neck of met Historical only, capital fragment laterally transposed and depressed plantarly Indications: IM 9-14deg, elevates, abnml PASA
Mitchell
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
Drato
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
Roux
(Angulated Mitchell) Indications: Increased PASA, nml DASA, Increased IM (9-14deg)
Capp
Transverse osteotomy of met head Can rotate in all planes; unstable and very difficult to fixate
Wilson
Oblique cut of met Can get shortening of met
Austin
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
Scarf
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)
