Melody 5th met base fracture case

Question 1

What is the classification system for 5th met base fracture?

Answer 1

Stewart, type 1-5
1. extra articular
2. intra articular
3. avulsion
4. comminution
5. avulsion without fracture, seen in kids

Question 2

What is the smallest screw size you can use to fixate a jones fracture while maintaining purchase?

Answer 2

4.5 mm

Question 3

What does literature say about a jones fracture without surgery?

Answer 3

50% re-fracture or non-union without surgery

Question 4

Why are jones fracture hard to heal?

Answer 4

They are at the level of the metaphyseal diaphyseal junction in which nutrient arteries nor metaphyseal arteries usually reach.

Question 5

Which screw head strips the most? Use it for which size screw?

Answer 5

Cruciate strips most, so use for small screws.

Question 6

3 k wire sizes

Answer 6

0.45” = 1.1 mm
0.54” = 1.4 mm
0.62” = 1.6 mm

Question 7

Normal ROM for 1st MPTJ dorsiflexion. less than __ degrees is hallux rigidus

Answer 7

45-65 degrees
< 20 = hallux rigidus

Question 8

4th IMA normal

Answer 8

6.2-6.4 is normal
> 8.6 is tailors bunion

Question 9

5th met bowing

Answer 9

Normal is 2.5-7.5
> 8 is tailors bunion

Question 10

5 types of melanoma

Answer 10

nodular, lentigious, acral, amelinotic, superficial spreading

Question 11

Steps to lateral release

Answer 11

DIMTL
Adductor hallucis
fibular sesamoidal suspensory ligament
lateral head of the FHB
removal of the fibular sesamoid

Question 12

What are the lateral structures that remain in lateral release?

Answer 12

lateral collateral ligament & associated joint capsule

Question 13

If you do a lateral release and the sesamoid position is not fixed, what does that mean?

Answer 13

Rotation of the metatarsal is the primary reason for for malposition of the sesamoids meaning a lapidus is necessary.

Question 14

Axbx for necrotizing fasciitis

Answer 14

Primaxin