Practice images w/ Qs Flashcards
Name the procedure done:
Distal akin w/ 0.062 kwire
Name procedure, fixation, and post op course:
Hallux arthrodesis w/ 4.0 cannulated screw
What is the procedure? Fixation? Post-op?
Procedures: Reverdin Green
Fixation: 2.7mm cortical screw (most common), 0.062” k-wire
Post-op: surgical shoe for 4wks
Read the pre-op xray (left). What correction would you perform, include fixation? What was performed (right)?
(Austin with 0.062 Kwire; could also used 2.7mm cortical or 3.0mm cannulated; 60)
What is the post op course for this procedure?
Austin- surgical shoe 4wks
What procedure and fixation? What angle are the osteotomy cuts at?
Kalish–> look for the 2 screws in the distal shaft w/ heads close together, two 2.7mm cortical or 3.0 cannulated; 55
What procedure and fixation? What angle are the osteotomy cuts at?
Offset V–> look for the 2 screws in the distal and proximal shaft, two 2.7mm cortical or 3.0 cannulated; 35
Name the procedure and it’s major complication. What are the special names of the screws used for this procedure?
Scarf; troughing; Barouk screws
Procedure and fixation
Transverse Base Osteotomy; .062 kwire
Procedure, fixation:
Juvara Mod of the CBWO
Compression screw- 3.5 cancellous
Anchor screw- 2.7 cortical
Procedure, fixation:
2nd toe: arthodesis 0.062 kwire
Hallux: proximal akin 0.062 kwire
1st met: opening base wedge w/ pates and screws
Procedure, fixation, post op care:
McKeever, tubular plate and screws with placement of an interfragmentary screw
Cast NWB 6wks, Cast WB 2wks, progress to sneaker
Name the procedure and fixation. What would be the major indications to this procedure?
McKeever, 2 crossed 2.7 cortical screws
Indications: DJD/hallux limitus, inflammatory/neuromuscular/post-traumatic arthropathy, ray salvage, HAV (can get up to 10 degrees IM correction from resulting muscle balance)
Name the procedure and fixation. What would be the major contraindications to this procedure?
McKeever arthrodesis, anatomic locking plate w/ 2.0 cortical screws and placement of an interfragmentary screw
Contraindications: adjacent osteoarthritis, adjacent rigid deformity, osteoporosis, **lifestyle/job that requires a lot of bending at 1st MPJ
What position do we want the hallux to be in after fusion?
10 degrees abduction
10 degrees dorsiflexion/5mm off the ground
5 degrees valgus
What procedures were done here?
Hallux: distal akin w/ crossed 0.062 kwires because the lateral cortex
1st met cuneiform joint: lapidus w/ 2 crossed 3.5 cortical screws (not totally sure on the size, just eyeballed it)
Read the pre-op x-ray (left), propose correction. Describe post op (right), name procedure and fixation.
Austin w/ 0.062 kwire
Name the condition:
Hallux limitus/rigidus
Read the x-ray and give diagnosis. What are your three surgical correction options?
Hallux limitus.
Keller, McKeever, Implant
Name the procedure. Who would you perform this on? Describe post op course.
Keller arthroplasty w/ 0.062 kwire
Old people with low activity levels!
Surgical shoe WB 4wks
What are you looking at?
Hemi MPJ implant- metal (titanium?)
What are you looking at?
Silicone total implant with gromets
What is this complication?
Stress fracture from transfer metatarsalgia
What is this complication?
Subchondral cysts
What is this complication?
Implant fracture
What is the pre-op diagnosis (left?) Correction? Other options for correction?
Pre-op: hallux varus
Correction: temporary fixation with a 0.062 kwire
Other options:
- Soft tissue: tendon transfer (lateralize the EHL/EHB), supplemental suture, temporary fixation (pictured)
- Bone: REVERSE bunion procedures–> reverse Reverdin, Austin, usually stick with distal procedures
- Hallux IPJ procedures–> reverse Akins, hallux IPJ arthrodesis, usually following sesamoidectomy
- Salvage procedures–> implant, resection arthoplasty (Keller), 1st MPJ or IPJ arthrodesis
Read the pre-op xray (A). What procedure was done to correct this (B)? What must be accomplished when removing the cartilage?
(A) Hallux varus
(B) McKeever fusion with 2 crossed 4.0 partially threaded canulated screws
Must pass through the subchondral plate when removing cartilage
Joint prep techniques: end-to-end resection (can lead to shortening), currettage (not effective according to Johnson et al 2009), power burr/rasp
What procedure was done here? What are some soft tissue adjuvant procedures that are done to assist muscle balance with this procedure?
Keller arthroplasty w/ a single 0.062 kwire through the first MPJ
Muscle balance options: EHL lengthening, EHB transection, suture FHL/FHB through plantar drill holes. (This is because we lose the insertion points for EHB and FHB with the removal of the phalanx base)
Dead space: purse string suture through joint capsule
How would you maintain the space at the surgical joint? What is the post-op course of this procedure? Possible complications?
Interpose the capsule to use as a biological spacer, perform muscle balance procedure.
WBAT in surgical shoe, 4wks; pull pin at 4wks
Complications: apropulsive gait, loss of digital control/stability, overload the 2nd MPJ
Read the xray. What procedure and fixation would you do?
Mild IM, *mildly* increased PASA–> modified McBride w/ Reverdin-Green using a 2.7 cortical screw
What procedure was done here?
Juvara modification of CBWO and Proximal Akin w/ monofilament wire
Read the xray. What procedure(s) and fixation would you do?
Austin (60 degree wings) w/ 1 2.7 cortical screw
What are the main iatrogenic causes of Hallux varus?
- Staking of the 1st met head (overaggressive bunionectomy)
- Removal of fibular sesamoid (leads to soft tissue imbalance)
- Overaggressive correction of IM angle or HAb angle (now negative)
- Overaggressive lateral release/tightening of medial capsule
- Overaggressive bandaging
Read the xray. What procedure(s) and fixation would you do?
Severe IM angle, increased PASA and HAb angle
Juvara modification of CBWO w/ a 3.5mm cancellous compression screw and 2.7mm cortical anchor screw
Reverdin Green to correct PASA w/ a 2.7 cortical screw
Read the xray.
1st MPJ is subluxed and hypertrophy of medial eminence. Moderate IM angle, Met adductus present, increase in PASA and HAb
True IM would probably show IM at severely increased, so we would do a Juvara mod of CBWO w/ 3.5 cancellous compression screw and 2.7 cortical anchor screw
What procedure(s) were done here?
OBWO, Reverdin-Green(?), and Proximal Akin
