PROCEDURES Flashcards
removes all met heads for severe contractures
-unstable 1st ray
modification of this is the hoffman clayton which is an added resection of prox phalanx bases with more instability
hoffman 1911
lesser met head resection combined with:
keller arthroplasty
1st MPJ implant arthroplasty
1st MPJ arthrodesis (most stable)
hoffman modifications
sagittal
-20-30 degrees dorsiflexion to 1st metatarsal
transverse
- 10-15 degrees abduction
- parallel to 2nd toes
coronal
-nail parallel to WB surface
1st MPJ fusion position
salvage procedure challenging demanding recovery complications permanent structural and functional consequences
modified hoffman
procedure of the modified hoffman?
fuse 1st MPJ for stability fuse 2-4 PIPJs arthroplasty 5th PIPJ remove met head/neck to desired length -parabola 2>1=3>4>5
types of incisions to reach metatarsals?
plantar incision
dorsal incision
great exposure
nodule excision
relocate fat pad
requires separate incision for digital repair
WB incision needs time off feet and can cause hypertrophic scar
what is this incision?
plantar incision
allows earlier WB
easier for K-wire placement
what is this incision?
dorsal incision
5 dorsal longitudinal vs 3 dorsal longitudinal?
positive exposure
potential for necrosis
less potential for necrosis
exposure
complications of hoffman ?
immediate? long term?
vascular compromise
wound dehiscence
blood loss
nonunion
edema
poor toe purchase
recurrence
