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Surgical Boards > McG 32: Juvenile HAV > Flashcards

McG 32: Juvenile HAV Flashcards

1
Q

what is the incidence of HAV in adolescence

A

22-36%

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2
Q

is juvenile HAV more common in M or F

A

F

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3
Q

what percent of HAV occur b/l in females

A

75%

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4
Q

extrinsic factors

A
  • tight or pointed shoes

- higher in the shod population than barefoot

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5
Q

intrinsic factors

A

-family hx (58-50%)

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6
Q

who is 5x more likely to develop HAV

A

black children

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7
Q

types of juvenile HAV

A
  • congenital
  • neurogenic
  • idiopathic
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8
Q

what is Roots theory for causes of HAV

A
  • the causative factor for all hallux HAV deformity is mechanical malfunction of the 1st MTPJ
  • ex. factors that increase STJ pronation and instability of the 1st ray will enhance the progression of the hallux valgus deformity
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9
Q

what did Lapidus believe was the cause of HAV deformity

A

-instability of the medial column

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10
Q

what percent of adolescents with HAV had an abnormally high MAA

A

75%

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11
Q

what does an increase in PASA indicate

A

an increase in PASA indicates functional adaptation of the 1st MT due to chronic malpositioning of and abnormal faces on the great toe

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12
Q

how do you measure PASA

A

relationship between a line connecting the medial and lateral articular margins of the 1st MT head and the longitudinal axis of the 1st MT

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13
Q

normal PASA

A

0-8 degrees

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14
Q

how do you measure MAA on DP projection

A

angle formed between the line bisecting the 2nd MT and the longitudinal line bisection of the lesser tarsus

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15
Q

normal MAA

A

5-17; patological ~20

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16
Q

how do you calculate the true/effective IMA

A

IMA + (MAA-15)

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17
Q

what neurological disorder can lead to HAV

A

cerebral palsy - produce spasticity or contractors of the AT

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18
Q

what other factors can contribute to HAV in adolescence

A
  • LLD
  • torsional abnormalities
  • neuromuscular disease
  • MAA
  • pes planovalgus
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19
Q

track bound joint indicates a deviation of the 1st MTPJ which is associated with what increased angle

A

PASA

20
Q

relative contraindication to surgery

A
  • ligamentous laxity
  • hyper-elasticity
  • neuromuscular disorders
21
Q

goals of surgery

A

relieve pain, restore proper jt function, prevent progression of the deformity improve cosmesis

22
Q

factors to consider

A
  • age of pt
  • growth plate status (open or close)
  • presence of coexisting etiologies
  • age of onset and progression of the deformity
  • family hx
  • degree of symptomatology - psychological and physical
  • pt and parent expectations
23
Q

what age should sx be performed

A

11-15

24
Q

surgical options

A
  • base of head osteotomies
  • soft tissue procedures
  • hallux osteotomies
  • epiphysiodesis
25
Q

List type 1 HAV characteristics

A
  • earlier onset
  • greater familial hx
  • MA
  • severe deforming forces such as pes planovalgus/equinus
26
Q

T or F: Type 1 HAV individuals would benefit from early surgical intervention

A

T

27
Q

list type 2 HAV characteristics

A
  • pts w/ moderate deformity (IM, HAA)
  • rectus foot type
  • controllable deforming forces
28
Q

when should sx be performed in type 2 HAV

A

when skeletal maturity has been achieved

29
Q

goal of ST procedures

A

relocate the sesamoid apparatus beneath the 1st MT by aligning the FHL tendon allowing proper sagittal plane motion of the hallux

30
Q

name additional ST procedures

A

lateral capsulotomy
medial capsulorrhaphy
transfer of the adductor tendon

31
Q

name distal MT osteotomies for juvenile HAV

A

-autin, offset V, reversion, mitchell, wilson, peabody

32
Q

MT head osteotomies can reduce the IMA by how much

A

13.3

33
Q

complications of Mitchell and Wilson osteotomies

A

shortening
transfer lesions
elevates
metatarsalgia

34
Q

when are transpositional osteotomies performed

A

when pts have a rectus foot and moderate IMA

35
Q

name proximal osteotomies

A

closing or opening base wedge osteotomy
crescentic procedures
Lapidus

36
Q

when are proximal osteotomies performed

A

IMA 15 degrees or greater

37
Q

what percent of pts had good outcomes with the Lapidus

A

91%

38
Q

indications for a Lapidus

A
  • instability of the 1st ray
  • long 1st MT
  • IMA >25
  • underlying neuromuscular disease
  • genetic conditions such as Down syndrome
39
Q

what is epiphysiodesis

A

arresting the lateral physic of the 1st MT base and allowing the medial physic to continue to grow

40
Q

advantage of epiphysiodesis

A

less surgery

less post-op disability (WB immediately)

41
Q

what is the golden period for epiphysiodesis

A

btw ages 9-14
F: 10-12
M: 11-14

42
Q

where should the staple be placed for epiphysiodesis

A

dorsal to plantar in the lateral 25% of the MT base across the physis

43
Q

what procedure is done in conjunction with epiphysiodesis

A

McBride bunionectomy

44
Q

what ancillary procedures are performed with juvenile HAV

A
  • MA correction
  • cuneiform osteotomies
  • pes valgus reconstruction
  • ATL
45
Q

complications

A
  • residual pain
  • jt stiffness
  • recurrence
  • hypertrophic scar formation
46
Q

T or F: adolescents are more likely to develop hypertrophic scars

A

T - they have a longer inflammatory phase in wound healing

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