Surgical Mgmt of Hallux Limitus Flashcards
what is normal motion at 1st MPJ?
65-70 deg of dorsiflexion
what is etiology of hallux limitus?
trauma** dorsiflexed 1st met pronation arthridities long 1st met/short 2nd met previous surgery
what is characteristics of grade 1 hallux limitus by olaf and jacobs?
- pain at end ROM
- limitation of motion WB
- elevatus may be present
what are characteristics of grade 2 hallux limitus by olaf and jacobs?
- pain at end ROM
- limited ROM NWB
- small dorsal exostosis of 1st met head
- some flattening of 1st met head
what are characteristics of grade 3 hallux limitus by olaf and jacobs?
- pain and crepitation w/ ROM
- large dorsal oxostosis
- significant joint space narrowing, flattening of 1st met head, cartilage loss
what are characteristics of grade 4 hallux limitus by olaf and jacobs?
-pain and crepitation w/ ROM
-
how would you treat Grade 1 hallux limitus by olaf and jacobs?
- conservative: stretching, orthotics
- joint preservation: cheilectomy or Kessel Bonney
how would you treat Grade 2 hallux limitus by olaf and jacobs?
joint preservation: Kessel bonney or 1st met osteotomy
how would you treat grade 3 or 4 hallux limitus by olaf and jacobs?
-joint destructive procedure: Keller, implant, or arthrodesis
in which ACFAS classification do you get pain will full ROM?
ACFAS stage 3
in general, what is treatment approach for stage 1 or 2 hallux limitus?
(potentially salvagable joints) - so primarily joint reconstruction
in general, what is treatment approach for stage 3 or 4 hallux limitus?
(non-salvagable joints)- so joint destructive procedures
what are some non-joint destructive procedures?
- exostectomy- Ex. Cheilectomy
- proximal phalanx osteotomy- Ex. Kessel Bonney, Regnauld
- 1st met osteotomy= Ex. Watermann, Youngswick, Dorsal V
- arthrodiastasis
Describe the Cheilectomy procedure.
(non-joint destructive)
is a joint clean up procedure whereby you remove the dorsal exostosis of the 1st met head
Describe the Kessel Bonney procedure.
(non-joint destructive)
resection of a dorsally based wedge of bone from the base of the proximal phalanx
Describe the Regnauld procedure.
(non-joint destructive) shortening osteotomy of proximal phalanx by creating a “peg-in-hole”
describe the watermann procedure.
(non-joint destructive) dorsal wedge osteotomy out of 1st met head
what is the drawback to watermann procedure?
may irritate sesamoids
Describe the Youngswick procedure.
(non-joint destructive)
is an Austin osteotomy with a cut dosally to remove wedge to shorten met and plantarflex it
what is the dorsal V procedure?
(non-joint destructive)
-chevron cut made dorsal to plantar thru met neck to allow plantarflexion of met head (but no decompression like Youngswick allows for)
what is a sagittal Z procedure?
sagittal Z thru met shaft with proximal arm exiting medially and distal arm exiting laterally that allows you to lengthen or shorten and allows you to plantarflex
describe the lambrinudi procedure.
plantarflexory base osteotomy to correct metatarsus primus elevatus
what is the distraction protocol for an arthrodiastasis?
- intra-op distraction up to 5mm
- distraction 0.5mm/day for max. of 14 days
- leave joint static for 14 days
what is the max. distraction for 1st MPJ?
8-12 mm
what are the joint destructive techniques to be used in stages 3 and 4?
- arthroplasty: Keller and hemi-or total implant
- arthrodesis
describe the Keller procedure.
(joint destructive)
base of proximal phalanx is removed
when is the Keller procedure used?
(arthroplasty of 1st MPJ)- end-stage hallux limitus and geriatric bunions
when would you do a 1st MPJ arthrodesis?
end-stage procedure that is done in younger or highly active patients compared to arthroplasty
