Nelson Case I

Question 1

Conservative Management of Hallux Abductovarus

Answer 1

Avoid tight fitting shoes

Orthotics: Bunion Shields, toe spacers. night splints

Question 2

Normal HVA and IM

Answer 2

HVA: < 15 and IM < 9

Question 3

Mild HVA and IMA

Answer 3

HVA: < 20 and IM<= 11

Question 4

Moderate HVA and IMA

Answer 4

HVA 20 -40 and IM< 16

Question 5

Severe HAV and IMA

Answer 5

> 40 and IMA >= 16

Question 6

Normal metarsus adductus angle: bisection of the 2nd met and right angle of the medial and lateral sides of foot

Answer 6

Normal 15 degrees ( less is rectus)

- Birth Metarsus angle can be 30 degrees

Question 7

Normal PASA

Answer 7

0-8 degrees

Question 8

DASA

Answer 8

0-8 degrees

Question 9

Hallux Abductus Interphalngeus Angle

Answer 9

10 degrees

Question 10

Metatarsal protrusion distance

Answer 10

Normal + or - 2 mm

Question 11

Normal Tibial sesamoid position

Answer 11

1-3

Question 12

Reverdin Green - laird

Answer 12

Corrects PASA and IM ( protects sesamoids)

Question 13

Allergic to PCN what should you do?

Answer 13

If the patient just had a rash it is okay to move forward with ANCEF

Question 14

Abnormal DASA

Answer 14

Akin –> first proximal phalanges osteotomy

Question 15

Normal DASA and abnormal Inter phylangeal angle

Answer 15

Distal Ankin

Question 16

PASA + DASA = HAA
PASA =- DASA abnormal
Congruent

Answer 16

Structural Deformity

Question 17

PASA + DASA not = HAA
PASA and DASA normal
Deviated / Subluxed

Answer 17

Positional Deformity

Question 18

PASA + DASA not = HAA
PASA and DASA abnormal
Deviated or subluxed

Answer 18

Combined deformity

Question 19

Structures to release in bunion

Answer 19

Extensor Capsule 
Adductor Hallucis Tendon 
Fibular sesamoid legament 
Lateral collateral ligament 
FHB tendon ( if not released already)

Question 20

Angle for an Austin

Answer 20

60 degrees

Question 21

Angle for Kalish

Answer 21

55 degrees

Question 22

Reasonable screw sizes for bunionectomy

Answer 22

2.7mm -3.0mm

Question 23

Coumadin takes how many days to take affect and what should you bridge with?

Answer 23

3-5 days and bridge with lovenox

- Lovenox 3-4 days with target INR 2-3

Question 24

Post op fever

Answer 24

Wind - 1-2 days
Water - 3-5 days
Wound - 5-7 days
Walk - > 7 days
Wonder Drugs - Anytime

Question 25

Crescentric has the least amount of what?

Answer 25

Least amount of shortening

Question 26

Ludloff osteotomy

Answer 26

Osteotomy orientation is Dorsal Proximal to Distal Plantar

Question 27

Logroscino

Answer 27

Reverdin + Loison-Balacescu ( closing base wedge on lateral aspect of first metatarsal)