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PodMed > Lapidus and Proximal metatarsal osteotomies (Surgery) > Flashcards

Lapidus and Proximal metatarsal osteotomies (Surgery) Flashcards

1
Q

What are the indications for Proximal metatarsal osteotomies?

A
  1. Large intermetatarsal angle
  2. Juvenile HAV
  3. Hypermobility of the first ray
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2
Q

What are different procedure for Proximal metatarsal osteotomies?

A
  1. Closing base wedge osteotomy (CBWO)
  2. Opening base wedge osteotomy (OBWO)
  3. Crescentic osteotomy
  4. Proximal Chevron ostetomy
  5. Lapidus osteotomy
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3
Q

What’s the technique involved in closed base wedged osteotomy?

A
  1. Axis guide placement
  2. Osteotomy
  3. Internal fixation
  4. Lateral release
  5. Medial eminence resection
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4
Q

Entry point:

  1. what is the distance of entry point from the medical cortex?
  2. what is the distance of entry point from the MCJ?
A
  1. 5 mm
  2. 1.5 cm
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5
Q

It is best to try to keep the osteotomy 1? to the weightbearing surface when performing CBW osteotomy

But if dorsiflexion of the distal segment is desired, then a 2? is created

If plantarlfexion of the distal segment is desired, then a 3? is created

A
  1. perpendicular
  2. plantar medial corticol hinge
  3. dorsal medial corticol hinge
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6
Q

What are some of the complications with CBW osteotomy?

1?

a

b

2?

a

b

A
  1. Osteotomy Entering 1st MCJ
    (a) Osteotomy too oblique
    (b) Apex too lateral
  2. Osteotomy too Distal (midshaft)
    (a) Delayed Healing
    (b) Less IMA correction
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7
Q

What fixation would you use for the CBW osteotomy?

Two screws

1?

2?

Anchor screw placed 3?

Lag screw placed perpendicular to

A
  1. One cortical screw as an anchor
  2. One cancellous as a lag screw
  3. perpendicular to shaft
  • Upper right quadrant from lateral view
  • Protects cortical hinge
  1. osteotomy
  • Lower left quadrant from lateral view
  • Provides compression
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8
Q

What do you do for Lateral release/Medial eminence of CBW osteotomy?

  1. Perform ?
  2. Perform?
  3. Resect?

Less aggressive than with distal osteotomies

Usually parallel to the shaft

A
  1. lateral release first, prior to osteotomy
  2. osteotomy
  3. medial eminence last
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9
Q

Some facts about CWBO:

  1. IMA angle

Learning Curve

NWB postop 2?

Anatomically 3? correction

A
  1. Higher IMA’s and juvenile HAV
  2. 6-8 weeks
  3. better
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10
Q

Crescentic osteotomy:

using: 1?

Main complication: 2?

What kind of osteotomy 3?

A
  1. Crescentic saw
  2. Dorsiflexion of the distal fragment
  3. Curved osteotomy of the base of the met head
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11
Q

Crescentic Osteotomy

Proximal crescentic osteotomy. Diagram of the osteotomy

site. The surgeon’s hand is pushing the metatarsal shaft in a

lateral direction. The Freer elevator is pushing the metatarsal

base in a medial direction. Note the 2–3 mm overhang on the

lateral aspect of the osteotomy site (From Mann and Mann.8

Used with permission)

A
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12
Q

What are the Advantages/Disadvantages of Cresentic procedure?

1?

2?

3?

4?

A
  1. Good if first ray relatively short
  2. Good IM correction Level 2 studies
  3. Dorsiflexion malunions
  4. Hallux varus
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13
Q

Proximal Austin

Apex 2 cm 1?

Relatively 2?

Fixated with

A
  1. from the TMT
  2. stable/ large contact area
  3. 2 screws/ plate
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14
Q

What are the advantages of proximal Autsin procedure?

1?

2?

3?

A
  1. Maintain length
  2. less chance of dorsiflexion of the distal fragment
  3. Faster healing comparing to other procedures at the base
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15
Q

what is the Applications of Lapidus Procedure?

1?

2?

3?

A
  1. Moderate to severe hallux valgus deformity
  2. Hypermobile first ray
  3. Adjunct to other pes valgus procedures
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16
Q

Some facts about metatarsal cuniform joint:

1?

2?

3?

A
  1. Flat joint
  2. Inherently stable
  3. Minimal motion (“non-essential joint”)
17
Q

What is the Lapidus procedure?

A

Removal of the metatarsal-cuniform joint. as little as possible

Important: the 1st metatarsal should be positioned in 15-20 degrees of plantarflexion otherwise the first metatarsal would be elevated.

18
Q

What are the indications for Lapidus procedure:

based on lecture notes:

1?

2?

3?

4?

5?

based on the book:

6?

7?

8?

9?

10?

A
  1. Moderate to severe HAV
  2. Ligamentous laxity
  3. Hypermobile 1st ray
  4. Elevated metatarsal
  5. Intercuneiform instability
  6. Severe hallux valgus
  7. intermetatarsal angle>18
  8. hypermobility of the 1st metatarsocuniform joint
  9. HAA >25 degrees
  10. degenerative disease of the metatarsocuniform articulation
19
Q

What is Lapidus procedure?

A

Basically Arthrodesis of the first metatarsocuniform joint

20
Q

What are the contraindications for Lapidus procedure?

1?

2?

3?

A
  1. Short 1st metatarsal
  2. Poor bone stock
  3. Patient factors
21
Q

Where do you incise for the Lapidus procedure?

1?

2?

A
  1. Direct medial
  2. Dorsal medial
22
Q

Where do yo position for fusion?

1?

2?

A
  1. Plantarflexion of joint motion
  2. Plantar translocation of metatarsal
23
Q

What are the considerations for Lapidus procedure?

1?

2?

3?

4?

5?

A
  1. Intermetatarsal angle
  2. First metatarsal-cuneiform joint architecture
  3. 1st metatarsal length
  4. Bone quality
  5. Pt. factors
24
Q

What are the post-operative management for Lapidus?

1?

2?

3?

4?

A
  1. Jones dressing 1 week
  2. Non-weight bearing SLC x 6-8 weeks
  3. Removable cast brace x 4 weeks with progressive increase in weight
  4. Return to regular shoes 10-12 weeks
25
Q

What are the benefits of Lapidus?

1?

2?

3?

4?

A
  1. Correction of large deformities
  2. Decreased risk of recurrence
  3. Increased medial column stability
  4. Decreased risk of complications

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