Nelson Case III

Question 1

What do we want the A1C to be around for diabetics to do elective surgery?

Answer 1

Less than 8

Question 2

Can you still use betadine if patient has shellfish allergy?

Answer 2

Yes

Question 3

Average thigh tourniquet?

Answer 3

300 - 350mmhg

Question 4

Complication with Type I

Answer 4

More prone to hyper and hypoglycemia

Question 5

Elevatus is more common in which osteotomies

Answer 5

Closing base wedge

Question 6

What are other techniques for joint resection?

Answer 6

Osteotome
Saggital Saw/oscillating saw
Curettage

Question 7

Treatments for stage I hallux limitus

Answer 7

Reverse Mortons Extension

Question 8

Treatment for Stage III and IV

Answer 8

Mortons Extension

Question 9

Oloff and Jacobs- Grade I Hallux Limitus

Answer 9

Minimal Adaptive changes

• Pain on end ROM
• Rearfoot pronation
• Metatasus primus elevatus

Question 10

Oloff and Jacobs- Grade II Hallux Limitus

Answer 10

• flattening of 1st metatarsal head with possible osteochondral defect
• Small dorsal exostosis
• Pain on end ROM

Question 11

Oloff and Jacobs - Grade III Hallux Limitus

Answer 11

• More severe flattening of 1st metatarsal head
• osteophytes
• Asymmetrical joint narrowing
• Eburnation
• Crepitus

Question 12

Oloff and Jacobs - Grade IV Hallux Limitus

Answer 12

• Total obliteration of joint space
• Loose bodies
• ## < 10 degrees of motion

Question 13

What is the difference of structural and functional hallux limitus?

Answer 13

Structural- limits dorsiflexion of first ray when loaded and unloaded

Question 14

Non-joint destructive Osteotomy

Answer 14

Exostectomy
Proximal Phalanx Osteotomy
1st metatarsal Osteotomy

Question 15

NJD procedures - Exostectomy - Stage 2 procedure

Answer 15

Cheilectomy

Question 16

NJD procedures - Proximal phalanx - Kessel Bonney

Answer 16

Dorsal base wedge removal of proximal phalanx

Question 17

NJD procedures - Proximal phalanx - Regnauld

Answer 17

Mexican hat - peg and hole - shortens the proximal phalanx

Question 18

NJD procedures - Proximal phalanx - Watermann

Answer 18

Dorsal wedge osteotomy out o the first metatarsal head

Question 19

NJD procedures - Proximal phalanx - Watermann- Green

Answer 19

Preserves the sesamoid articulation by providing angulated cut with removal of the dorsal half of the metatarsal head

Question 20

NJD procedures - Proximal phalanx - Youngswick

Answer 20

Austin with two parrallel cuts dorsally to allow for plantarflexion

Question 21

NJD procedures - Proximal phalanx - Dorsal V

Answer 21

Chevorn cut made dorsal to plantar through metatarsal neck

Question 22

NJD procedures - Proximal phalanx - Saggital Z

Answer 22

Saggital Z through metatarsal shaft with proximal arm exiting medially and distal arm laterally

Question 23

NJD procedures - Proximal phalanx - Lambrinudi

Answer 23

Closing plantarflexory base wedge

Question 24

What is the distraction rate for a arthrodiastasis?

Answer 24

.5mm/day for 1 week ( max 14 days )

Question 25

What is a keller?

Answer 25

Removal of the base of the proximal phlalanx with a possible chielectomy

• may insert implant if failed

Question 26

Causes of Hallux Limitus

Answer 26

• OCD
  Long First Met
• Elevatus
• Hypermobility of 1st ray

Question 27

Arthrodesis fixation

Answer 27

• 10-15 abduction fixation

- 10 - 20 degrees of dorsiflexion for fixation

Question 28

With implants, why do you use grommets ?

Answer 28

Helps to decrease shearing forces on the silicon implant