Name that Surgery! Flashcards
Akin
Medially based wedge osteotomy of the proximal phalanx.
Best for enlarged DASA angle.
Can be modified for central or distal osteotomies depending on Hallux abductus angle and how long the proximal phalanx is.
Austin osteotomy.
Indicated for Mild HAV (12-14 degrees)
V shaped osteotomy with apex in center of met head.
ARMS FORM 60 DEGREE ANGLE.
Cheilectomy
Indicated for Stage 1-2 hallux limitus, joint sparing procedure..
Removal of the dorsal bone spur and dorsal 1/3 of the 1st metatarsal head.
Optional: Removal of the bony prominence from the proximal phalanx base as well.
Closing base wedge osteotomy
Indicated for severe HAV
Is a closing wedge osteotomy straight across the base of the first met.
This is difficult to fixate.
What is the DRATO?
Indicated for a large 1st IMA + Abnormal PASA + Valgus rotation of the first met.
This is a derotational osteotomy of the frst met head (Vertically cut through the met head, cartilage is rotated for realignment, very unstable!)
What is the Hohmann?
Indicated for HAV
It is a through and through transverse osteotomy of the metatarsal neck and considered unstable.
It can be used in either the first met or the fifth met.
What is a Juvara?
Indicated for HAV >15 degrees
An oblique CBWO with the apex medially, wedge laterally with the base ending in mid 1/3 of the metatarsal, direction allows for better fixation.
What is a Kalish?
Indicated for HAV >15 degrees
Procedure is similar to an Austin but it has a long dorsal screw for fixation.
Angle reduced to 55 degrees (instead of the 60 degree austin angle)
What is the Keller?
This is indicated for patients aged >50-55 with HAV IMA 16 degrees or less + Hallux limitus/rigidus!!
Resection of the proximal 1/4 to 1/3 the base of the proximal phalanx with a chielectomy.
The capsular tissue is then sewn into the first MPJ space.
What is the Kessel-Bonney?
Indicated for hallux limitus
Removal of a pie shaped dorsiflexory wedge of bone from the proximal phalanx.
joint sparing procedure
What is the Lambrinudi?
Indicated for hallux limitus (Joint sparing)
Plantarflexory wedge osteotomy of the first met base.
What is the Lapidus?
HAV + 1st ray hypermobility
Fusion of 1st met base to medial cuneiform
What is the Logroscino?
HAV IMA >15 in rectus foot >13 with adductus + Abnormal PASA.
CBWO or crescentic to correct HAV
Reverdin (or Peabody) to correct for cartilage orientation
What is the Loison?
An osteotomy for HAV
Transverse CBWO
What is the Ludloff?
HAV
An osteotomy oriented from proximal dorsal to distal plantar. Transpositional osteotomy.
This is opposite the orientation of MAU.
What is the Mau?
HAV
Oblique cut diagonally (Dorsal distal to Plantar proximal) through the first met.
Considered a rotational osteotomy
What is the McBride?
Mild HAV (Doesnt truly correct the deformity)
This is a Silver plus soft tissue/ capsular release/tightening
What is the McKeever?
First MPJ Arthrodesis/Fusion
Indications: HAV or dislocation, Hallux limitus/rigidus, Polio, CP, previous joint injury.
Procedure: Removal of cartilage on 1st met head and base of proximal phalanx. Remodel the opposing sides to be a matching cone-in-cup shape.
Hallux position: Abducted 5-10 degrees with 5-10 degrees of dorsiflexion from the WB surface.
What is the Mitchell?
HAV
Distal metaphyseal osteotomy with rectangular block of bone removed and preservation of the lateral cortical spur.
Width of the spur is varied depending on the amount of correction needed.
What is the Trethowan?
HAV opening base wedge osteotomy
Opening base wedge osteotomy
What is the Peabody?
Abnormal PASA osteotomy.
Its just a reverdin that is done at the first met neck.
What is the Reverdin?
Mild HAV and Abnormal PASA
Medially based wedge (Proximal cut perpendicular to the long axis of the first met and distal cut parallel to articular cartilage surface)
Resection of the first met head.
What is the Scarf procedure?
HAV IMA 12-18
Z-type osteotomy through the shaft of the first metatarsal
What is the silver procedure?
Medial 1st MPJ pain
Mild HAV
Procedure: Isolated resection of medial eminence of the first met head.
What is the Stamm procedure?
HAV
OBWO in the medial cuneiform
What is the Valenti procedure?
Hallux limitus
removal of 45 degree dorsal wedge from the first met and proximal phalanx to increase ROM
What is the Vogler procedure?
HAV
Offset V osteotomy made in the neck of the first met (similar to Kalish but more proximal)
What is the Watermann procedure?
Hallux limitus
Removal of closing wedge of bone from the first met head to dorsiflex the DF capital fragment.
Green modification protects the sesamoids.
What is the Wilson procedure?
Reverse wilson can be done for the Tailors bunion.
HAV IMA 12-14
HAV + Long 1st met
Oblique (Distal med to Proximal Lat) through and through osteotomy at the first met neck, capital fragment slides laterally on the shaft (unstable and slow to heal)
What is the Youngswick procedure?
HAV + DF 1st met
HAV + Hallux limitus
Austin but with an extra slice taken out of the dorsal arm to allow the head to drop plantarly and decompress the first MTPJ
What is the Bankart procedure?
Indicated in cases of met adductus + >8 years old
Congenital absence of the medial cuneiform.
Removal of the cuboid to balance out lack of medial cuneiform.
What is the Brown procedure?
Used for met adductus in young 2-6 y/o children.
Procedure: Transfer TP into navicular
Medial capsulotomy of nav-cun joint
What is the Berman and Gartland procedure?
The most popular osseous procedure for met adductus!!
Indications: Met adductus + Age 6 or older
Procedure: Pan met base wedge dome shaped/crescent shaped osteotomy.
Manipulate the foot into the correct position, use pin fixation in all metatarsals and cast for 6 weeks.
What is the Heyman, Herndon, and Strong procedure?
Also known as the tarsometatarsal soft tissue release.
Indicated for met adductus + Ages 2-6 years old.
Procedure: 3 dorsal incisions
Capsulotomies and ligament releases of all TMTJ.
Keep plantar lateral ligaments and joint capsules intact to prevent dorsal dislocation
Manipulate the mets and foot into a rectus position and cast for three months.
What is the baker procedure?
Achilles tendon lengthening.
Tongue and groove cut in the aponeurosis with the tongue distal, facing upward.
the aponeurotic bands are then sutured together.
What is the Sliding Z lenghtening procedure of the achilles?
Achilles tendon lengthening
Cuts most commonly done in the frontal plane but can be in the sagittal plane
Usually percutaneous, recommended open in McGlams
DF the foot after cutting
What is the Vulpius and Stoffel procedure?
Gastroc equinus procedure
Distal resection of gastroc aponeurosis using an inverted V.
THERE IS NO SUTURE OF THE GASTROC TO THE SOLEUS HERE.
What is the cotton procedure?
For pes planus, PTTD, and medial column repair.
Medial and sometimes intermediate cuneiform osteotomy dorsal to plantar.
Triangular shaped bone graft (measuring 4-7 mm) is inserted into the osteotomy no fixation is necessary.
Hoke arthrodesis
Not to be confused with the Hoke achilles procedure.
Pes planus, medial column repair.
Usually done in conjunction with ankle equinus correction and calcaneal osteotomies or arthroeresis.
Procedure: TAL with fusion of navicular to medial and intermediate cuneiforms.
What is the Kidner procedure?
For pes planus, kidner foot type (Acessory navicular), medial column repair.
Detach the TP from navicular
Resect the acessory navicular
Reattach the TP to the navicular more plantarly with tendon bone anchors.
Koutsgiannis
For PTTD
Medial sliding osteotomy, shifts the function of the achilles medially and restores heel valgum.
What is the Miller procedure?
For Pes Planus TAL Medial column fusion (NCM) Resect hypertrophy of navicular Advance medial soft tissues.
When is STJ arthroereisis indicated?
Indicated for flexible pes valgus + patient not yet at skeletal maturity (Or if arthrodesis is not appropriate for an older patient)
youngs tenosuspension
For pes planus + Age over 10
Patients with navicular cuneiform fault but no DJD yet
Helps to PF first ray by taking away TA antagonistic action against the PL.
Procedures: TAL, Rerout TA through keyhole in navicular (Dont detatch TA from insertion)
TP reattachment beneath the navicular creates a powerful plantar navicular cuneiform ligament.
Brohstrom-Gould
Evert the foot and tighten the ATFL and the CFL in a pants over vest fashion.
Augment with incorporation of the inferior extensor retinaculum.
Christman and Snook
Lateral ankle instability repair to reinforce the aTFL and CFL.
Detach half of the PB from its insertion.
Reroute it through a drill hole in the talar neck and distal lateral malleolus (through the widest part, anterior to posterior)
Suture graft tendon to periosteal flap at the level of the CFL.
Distal half of PB then sutured to proximal half.
What is the Hoffman procedure?
The resection of met heads 2-5 commonly done with a keller first MPJ arthroplasty as well.
This is indicated in rheumatoid arthritis with fibular deviation and fat pad atrophy.
What is the Hoffman-Clayton?
Used to treat fibular deviation due to rheumatoid arthritis and fat pad atrophy.
Resection of met heads 2-5 and the bases of the proximal phalanx (thats the clayton portion)
What is a Jones procedure?
A tenosuspension in which the EHL is detached and insterted into the first met head
the IPJ of the hallux is fused
Stump of the EHL is attached to EHB possible
Used to treat a weak TA.
Describe the split tibialis anterior tendon transfer (STATT)
Tibialis anterior is split and inserted into peroneus tertius or cuboid to increase true ankle DF and decrease long extensor swing phase.
Also helps to decrease an adductovarus forefoot.
