HAV Surgery Flashcards
Name the metatarsal head osteotomies.
- Reverdin
- Reverdin-Green
- Reverdin-Laird
- Reverdin-Todd
- Peabody
- Roux
- Drato
- Hohmann
- Mitchell
- Austin
- offset-V
- Capp
- Wilson
- Scarf
- Ludloff
- Mau
What does the Reverdin procedure correct for?
abnormal increases in PASA
describe the reverdin procedure.
medially based incomplete wedge resection of 1st met head
- distal cut is made first, parallel to joint surface
- proximal cut is made second perpendicular to long axis of 1st met
- lateral cortex is left intact
what is the complication associated with Reverdin?
sesamoiditis
name the contraindications to Reverdin procedure.
- painful ROM
- large IMA
- short 1st met
describe the Peabody procedure.
historical procedure that is similar to Reverdin except is performed at metatarsal neck to avoid sesamoids
what is the complication associated with Peabody? (and thus why it is not used anymore)?
poor vascularity and is unstable bc procedure is done at metatarsal neck
describe the Reverdin-Green procedure.
is a Reverdin with a plantar shelf to protect sesamoids
what does the Reverdin-Green procedure correct for?
abnormally increased PASA
Which reverdin modification utilizes a plantar shelf cut parallel to WB surface to preserve articulation with sesamoids?
Reverdin- Green
which Reverdin modification addresses abnormal PASA and increased IMA?
Reverdin-Laird
Describe the Reverdin-Laird procedure.
Reverdin + plantar shelf + medial closing wedge osteotomy going thru lateral cortex
*capital fragment is transposed laterally to close down IMA
which Reverdin modification does not leave the lateral cortex (hinge) intact?
Reverdin-Laird
Which Reverdin modification addresses increased PASA, IMA, and elevated met head?
Reverdin-Todd
Describe the Reverdin-Todd procedure.
Reverdin + plantar shelf+ resection of bone to plantarflex joint surface
describe the hohmann procedure.
historical procedure that removes a trapezoid wedge at anatomic neck of metatarsal and transposes capital fragment laterally and depresses plantarly
describe the Mitchell procedure.
transpositional, step-down osteotomy that corrects IMA and plantarflexes met head
what procedure is good if you have a long 1st met (although this is rare)?
Mitchell- bc it provides some shortening and plantarflexion of met head
what is the DRATO procedure?
(historical purposes only)
-derotational, angulational, transpostional osteotomy performed in metatarsal neck
Describe the Roux procedure.
trapezoid osteotomy –> leads to a lot of shrotening
describe the Capp procedure.
transverse osteotomy across met head
describe the wilson osteotomy.
oblique cut of met neck ; then slide capital fragment laterally
Describe the Austin procedure.
horizontal V osteotomy with an apex of 60 deg
what does the uni-correctional Austin correct for?
reduces IMA
what does the bicorrectional Austin correct for?
reduces IMA and PASA
what does the bi-plane Austin correct for?
reduces IMA and plantarflexes metatarsal
true or false: austin procedures correct frontal plane deformities.
false- austin procedures do NOT correct frontal plane deformities.
how much bone loss do you get with any osteotomy?
1mm
(but by the time you add in screw fixation and bone healing, that is an additional 2mm)
*= 3mm bone loss total
What is the Kalish modification of Austin?
changed the apex of angle from 60 deg to 50-55 deg to create a longer arm dorsally on the met to get 2 screws to follow AO technique
What is the Youngswick modification of Austin?
make a Chevron cut followed by a second dorsal cut to remove extra bone to shorten the met and allow plantarflexing and shortening
what is the bicorrectional modification of Austin?
make a chevron cut then take wedge out; then rotate met out of its increased PASA
if you lift your arm in the guide wire placement (so that superior pole is lateral), what does this do to the met?
plantarflexes it
if you drop your arm in the guide wire placement (so that superior pole is medial), what does this do to the met?
dorsifelxes it
if you angulate your guide wire so that it points to 2nd met head, what does this do to your 1st met/
lengthens it
if you angualte your guide wire so that it points proximal on 2nd met, what does this do to your 1st met?
shortens it
describe the scarf procedure.
Z osteotomy in diaphyseal and metaphyseal bone
describe the orientation of the arms of the Z for a traditional scarf procedure.
proximal-plantar to distal-dorsal Z
which scarf modification allows for maximum IMA reduction?
rotational scarf
describe the orientation of the arms of the Z in inverted scarf.
proximal-dorsal to distal-plantar
which scarf is better for a high IMA- transpositional or rotational?
rotational
which scarf is stronger- inverted or traditional?
inverted is 1.6x stronger
troughin affects traditional/rotational scarf how?
dorsiflexes head
troughing affects inverted scarf how?
plantarflexes head
what is troughing?
when one cortical edge falls into the medullary canal of the other segment, resulting ine elvation of capital fragment
troughing is seen in which scarf procedure more ?
transpositional rather than rotational
name the diaphyseal osteotomies.
ludloff
mau
describe the orietnation of the oblique osteotomy in a ludloff.
proximal- dorsal to distal-plantar
describe the orietnation of the oblique osteotomy in a mau.
proximal-plantar to distal-dorsal
what are teh contraindications to scarf?
high PASA
significant sagittal plane deformity
narrow met width
