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#2 BOARDS > Tendon Transfers and Bunions > Flashcards

Tendon Transfers and Bunions Flashcards

1
Q

Adductor tendon transfer

A
  • Adductor tendon is transected at its attachment to the lateral sesamoid and lateral base of the proximal phalanx and re-routed over the metatarsal head and attached to the medial capsule
  • Performed with HAV surgery to help realign the sesamoid apparatus under the metatarsal head
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2
Q

Flexor tendon transfer

A
  • FDL is transected near its insertion on the distal phalanx, split longitudinally to the base of the proximal phalanx and wrapped around the proximal phalanx and sutured together
  • AKA Girdlestone procedure
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3
Q

Jones tenosuspension

A
  • EHL tendon is transected and rerouted medial to lateral through the head of the 1st metatarsal and sewed back on itself
  • Kirk modification is to pass the tendon from top to bottom (dorsal to plantar) which requires less tendon
  • The distal stump of EHL is then attached to the EHB to maintain some extensor function of the hallux
  • Arthrodesis of the 1st IPJ to prevent overpowering of the EHL and hammering
  • Performed for pressure problems under the 1st met head
  • Indications: flexible cavus foot, flexible plantarflexed 1st ray
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4
Q

Hibbs tenosuspension

A
  • EDL tendon slips are detached from their insertion, combined together, then reattached to the lateral cuneiform or the base of the 3rd metatarsal
  • EDB tendons are transected and reattached to the stump of the corresponding EDL tendon
  • 4th and 5th longus slips are both attached to the 4th EDB slip
  • Releases buckling force at the MPJs and elevates the forefoot
  • Indications: equinus with or without clawtoes
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5
Q

Split tibialis anterior tendon transfer (STATT)

A
  • Tibialis anterior is split from its insertion just proximal to the superior extensor retinaculum
  • The lateral fibers are passed through the peroneus tertius sheath and sutured to the tendon or attached to the cuboid
  • This increases dorsiflexion of the foot and balances the foot laterally
  • Indications: flexible rearfoot varus, excessive supination, dorsiflexory weakness
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6
Q

Peroneus longus tendon transfer

A
  • Peroneus longus is released at the level of the cuboid and transferred through the intermuscular septum down the EDL sheath and inserted into the lateral cuneiform or base of 3rd metatarsal
  • Peroneus longus may also be split and half anastomosed to the tibialis anterior at its insertion and the other half anastomosed to the peroneus tertius
  • Indication: drop foot, pes cavus
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7
Q

Heyman procedure

A
  • Transfer of all long extensor tendons to their respective metatarsal heads
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8
Q

Tibialis anterior tendon transfer (TATT)

A
  • Tibialis anterior tendon is transferred to the 3rd cuneiform through the EDL tendon sheath
  • Acts to reduce supination and increase dorsiflexion
  • Indications: drop foot, recurrent clubfoot, flexible forefoot equinus
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9
Q

Tibialis posterior tendon transfer

A
  • Tibialis posterior tendon is transferred through the interosseous membrane and fixated to the 3rd cuneiform
  • This is an out of phase tendon transfer
  • Indication: drop foot, recurrent clubfoot
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10
Q

Austin

A
  • Head procedure
  • Corrects IM
  • Chevron osteotomy with 60 degree angle
  • Can incorporate wedge (bicorrectional) to correct PASA
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11
Q

Youngswick modification

A
  • Takes a “candle wick” out dorsally
  • Shortens and plantarflexes
  • Indicated in metatarsus elevatus
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12
Q

Reverdin

A
  • Medial closing wedge of metatarsal head
  • Corrects PASA
  • Lateral cortex remains intact
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13
Q

Reverdin-Green

A
  • Medial closing wedge of metatarsal head
  • Corrects PASA
  • L shaped cut preserves the integrity of sesamoid articulation
  • Lateral cortex remains intact

Green - “save the sesamoids”

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14
Q

Reverdin-Laird

A
  • Corrects PASA and IM

- Same as Reverdin-Green with completion of osteotomy through the lateral cortex to allow IM correction

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15
Q

Reverdin-Todd

A
  • Corrects PASA, IM and allows plantarflexion of the metatarsal head
  • Same as Reverdin-Laird with penetration of the plantar cortex to allow sagittal plane correction
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16
Q

Watermann

A
  • Dorsal closing wedge of metatarsal head
  • Indicated in hallux limitus
  • Plantar cortex is left intact
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17
Q

Green-Watermann

A
  • Dorsal wafer of bone is taken out, but cut is angled proximal midway in order to preserve the sesamoid articulation
  • Dorsal flag (exostosis) is removed
  • Indicated in hallux limitus

Green: “save the sesamoids”

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18
Q

Peabody

A
  • Neck procedure
  • Same as Reverdin (medial closing wedge with lateral cortex intact) except osteotomy is made more proximal to avoid the sesamoids

The “peabody” connects the head to the neck

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19
Q

Hohmann

A
  • Same as Peabody except lateral cortex is not preserved in order to shift capital fragment laterally
  • Able to also correct IM (lateral shift)
  • Able to correct PASA (medial wedge resection)
  • Corrects metatarsus elevatus because capital fragment can be plantarflexed
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20
Q

Wilson

A
  • Neck osteotomy
  • Distal medial to proximal lateral
  • Shortens and laterally displaces the head
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21
Q

DRATO

A

Derotational abductory transpositional osteotomy (DRATO)

  • Metatarsal head can be manipulated at any angle in any plane
  • Wedge resection can be incorporated
  • Very unstable osteotomy
22
Q

Mitchell

A
  • Wafer of bone is taken out medially
  • Proximal cut of osteotomy is complete through lateral cortex
  • Distal cut is not complete but is squared off near lateral cortex allowing a lateral head shift and a shelf for stability
  • Procedure shortens metatarsal so metatarsal head is plantarflexed to compensate
23
Q

Kalish

A
  • Shaft procedure
  • Modified long arm Austin
  • Long arm is dorsal
  • Angle is 55 degrees
24
Q

Scarf

A
  • Shaft procedure
  • Corrects IM angle
  • Distal cut extends dorsal
  • Proximal cut extends plantar
25
Q

Ludloff

A
  • Shaft procedure
  • Cut from distal plantar to proximal dorsal
  • Straight cut
  • Able to correct IM
26
Q

Mau

A
  • Shaft proceudre
  • Opposite of Ludloff
  • Straight cut from dorsal distal to plantar proximal
  • Able to correct IM
27
Q

Labrinudi

A
  • Shaft procedure
  • Plantar closing wedge
  • Dorsal cortex remains intact
  • Corrects metatarsus primus elevatus
28
Q

Crescentic

A
  • Base proceudre
  • Curvilinear cut from distal medial to proximal lateral
  • Corrects IM angle
  • May be fixated slightly dorsiflexed or plantarflexed
  • Advantage is that it does not shorted the metatarsal
29
Q

Juvara

A
  • Base procedure
  • Several types (A, B, B1, B2, C, C1, C2)
  • Cut from proximal medial to distal lateral
  • Lateral closing wedge is removed
30
Q

Juvara A

A
  • Wedge is removed from lateral cortex
  • Medial cortex is preserved
  • Transverse plane correction only
31
Q

Juvara B

A
  • Wedge is removed from lateral cortex

- Medial cortex is NOT preserved

32
Q

Juvara B1

A

Transverse and sagittal correction

33
Q

Juvara B2

A
  • Transverse and sagittal correction

- Corrects for long or short metatarsal

34
Q

Juvara C

A
  • No wedge is resected
35
Q

Juvara C1

A
  • Sagittal correction only
36
Q

Juvara C2

A
  • Sagittal correction

- Corrects for long or short metatarsal

37
Q

Loison-Balacescu

A
  • Base procedure
  • Lateral closing wedge
  • Corrects IM only
38
Q

Logroscino

A
  • Reverdin plus a Loison-Balascu
  • Corrects IM and PASA
  • An opening Logroscino may be performed by taking the wedge from the Reverdin and inserting it into an opening abductory wedge at the base of the 1st metatarsal
39
Q

Arthroplasties

A
  • Indicated in older patients with hallux rigidus/limitus and severe DJD
  • Capsular tissue is sutured across the joint space (purse string) to prevent bone contact
  • Usually performed with an extensor hallucis longus lengthening
40
Q

Keller

A
  • Resection of base of proximal phalanx

- Bumpectomy

41
Q

Mayo

A
  • Resection of 1st metatarsal head
42
Q

Stone

A
  • Metatarsal head resection, taking more dorsal than plantar in order to leave the sesamoids intact
43
Q

Lapidus

A
  • Fusion of the first TMTJ

- Indicated for increased IM and pain at the first TMTJ

44
Q

McKeever

A
  • Fusion of first MPJ

- 15-20 degrees of extension

45
Q

Silver

A

Medial bumpectomy of 1st met head and medial proximal phalanx

46
Q

Cheilectomy

A
  • Dorsal bumpectomy

- Indicated in hallux limitus

47
Q

Kessell-Bonney

A
  • Osteotomy of proximal phalanx

- Dorsal closing wedge of proximal phalanx

48
Q

McBride

A

Similar to silver but may be performed with an adductor tendon transfer and a fibular sesamoid excision

49
Q

Akin

A
  • Proximal Akin corrects DASA
  • Distal Akin corrects IPJ
  • Medial wedge taken from proximal phalanx
50
Q

Hiss

A
  • Same as McBride with dorsal transfer and advancement of abductor hallucis tendon
  • Performed in an attempt to re-establish joint medial balance
51
Q

Regnauld

A

Mexican hat trick

  • Similar to peg-in-hole procedure
  • Shortens proximal phalanx
  • Indicated in hallux limitus
52
Q

Cotton

A
  • Opening wedge of medial cuneiform
  • Medial eminence and/or autogenous bone graft can be inserted into medial aspect of cuneiform

Can also do a dorsal cotton for flat foot recon

#2 BOARDS (14 decks)

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