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YR3S2- anesthetics > wk 10- forefoot surgery > Flashcards

wk 10- forefoot surgery Flashcards

1
Q

arthroplasty means

A

removing part of or a whole joint

subcategories:
-implant (removed and replaced)
-resection (removing part or whole joint)

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2
Q

arthrodesis means

A

surgical fusion and fixation of bone

this is done to provide stability and reduce pain- this changes kinematics

last option typically

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3
Q

ostectomy means

A

surgical cutting and removal of bone like an exostosis

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4
Q

osteotomy means

A

surgical cutting of bone to change alignment

eg shorten and reposition bone in case of HAV

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5
Q

Tenotomy means

A

cutting of tendon

for example flexible claw toe

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6
Q

capsulotomy means

A

cutting of a joint capsule

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7
Q

ectrodactylyl is what

A

absence or malformation of digits

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8
Q

what can an ingrown mask as

A

subungual exotosis

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9
Q

digital surgery for what?

A
  1. subungal exotosis /osteochondroma
  2. recalcitrant lesions- eg heloma molle
  3. deformity- HAV, claw toe,
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10
Q

surgical procedures for heloma molle in the web space causing a deformity

A

soft tissue surgery
1. partial syndactyly- excision of corn and then skin is sutured together to remove that extra space between the webspace

osseous surgery
2. arthroplasty of the 5th proximal phalanx head (remove part of joint)
AND
(lateral) condylectomy of 4th proximal phalanx (remove part of base of prox phalanx)

by doing this it reduces the pressure thats building into a heloma molle

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11
Q

what can cause skin changes like corns

A

osseous pressure

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12
Q

can surgery be a permenant solution to recurring skin lesions?

A

yes

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13
Q

surgery options for mallet toes

A

early stage of deformity when its more flexible
1. tenotomy surgery can solve the issue

chronic deformity
2. athroplasty and flxor tenotomy combined (osseous and soft tissue surgery)

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14
Q

what forms in the joint space when an arthoplasty (removal of bone) is done

A

fibrocartliginous joint

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15
Q

what makes hammer toe a complex digital deformity

A

more planes and joints involved, more complex procedure

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16
Q

mallet toe is a simple procedure compared to

A

hammer toe

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17
Q

how is hammer toe deformity a 3 plane deformity

A

elevated in sagittal plane

internally rotated in frontal plane

adducted in transverse plane

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18
Q

surgical procedure of hammer toe

A

sequential release of soft tissue to rebalance soft tissue

stabilisation of proximal interphalangeal joint

maintenance with fixation

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19
Q

what conditions can influence complex hammertoe

A

anterior cavus

hypermobility

plantar plate pathology

these affect peak forefoot plantar pressures

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20
Q

k wires do what and stay in for how long

A

help with alignment/osseous correction post surgery which allows the formation of fibrocartilaginous bridges

stay in for 4-6 weeks

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21
Q

Minimally invasive surgery for hammer toe

A

using a small burr, remove oblique wedge and realign (osteotomy)

external bracing and taping for healing

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22
Q

what is a pan metatarsal head resection

A

resection of all 5 met heads, met heads are removed, realigned an soft tissue rebalanced

secured with kwires for 4-6 weeks

1st mTPJ arthrodesis fused at 15deg DF to create rocker

indicated in severe forefoot deformity- deranged forefott

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23
Q

clinical implications of metatarsus adductus

A

HAV
unstable medial column
shoe discomfort
in toe gait

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24
Q

hallux rigidus is a what?

A

young persons disease and should be considered a post traumatic condition

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25
Q

if someone has HAV and deformity of digits 2/3 also what order would you fix deformities

A

need to realign 1st then treat the lesser toe deformities

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26
Q

hallux rigidus complications

A

risk of falls
pain
altered gait
shoe fit
loss of function
cosemetics
ulceration

27
Q

types of 1st metatarsal operations

A
  1. joint salvage- preserve joint - osteotomy
  2. joint destructive- removal or fusion of joint - athroplasty/anthrodesis
  3. palliative - make more comfortable - bumpectomy, ostectomy
  4. reconstructive - recreate joint - interpositionla arthoplasty
28
Q

why are radiographs so important for surgical decision making?

A

determines what procedure to use

provides information on

arthritis/osteoporosis activity
severity of deformity (through angles)
sesamoid positions
joint congruency (sublax? deviated?)
shape of articulation
met length

29
Q

at what sesamoid position is it associated with osteoarthritis of the metatarsal

A

tibial sesamoid position:
1-3 is normal
4-7 can erode cartilage and have poor gliding function, fibula sesamoid moves into intermet space

30
Q

normal metatarsus angle is

A

through the 2nd met

31
Q

what is normal for intermetatarsal angle

A

8deg

32
Q

normal hallux valgus angle?

A

<15 deg

bisection of 1st met and 1st proximal phalanx

33
Q

DASA normal angle

A

0-6deg

34
Q

PASA normal angle

A

0-8deg

35
Q

PASA /DASA what is it

A

proximal articular set angle and
distale articular set angle

refers to the joint articulation of the base of the MTJ and base of proximal phalanx

36
Q

what type of shapes of heads make articulation unstable, stable

A

unstable- round

stable- flattened head,

most stable- ridge

37
Q

what mets should be longest - smallest

A

2, 1, 3, 4, 5

38
Q

what difference is there in mm between 1st and 2nd met length for there to be pain, pressure, malfunction?

A

more than 2mm (2mm is normal)

39
Q

why treat hallux valgus and ridigius ?

A
  1. progressive deformity
  2. medial column instability
  3. secondary deformity
  4. joint erosion
  5. quality of life
40
Q

radiographic findings of Hallux rigidus

A

osteophytes
sclerosis
joint space narrowing

41
Q

hallux rigidus surgical options

A
  1. ostectomy- remove bony proliferation (osteophytes)
  2. arthroplasty- resect the joint
    i) keller- remove base of proximal phalanx to shorten the toe
    ii) implant- silicon for older patients
    iii) interposition - recreate joint using patients capsule over the met head
  3. arthrodesis- fusion, removal of met head and add plate screws to stabilise
  4. decompression- osteotomy, met incision to open joint space
42
Q

keller procedure

A

-remove up to 30% of proximal phalangeal base

-attach FHL to remaining part of proximal phalanx

-soft tissue interposition

-maintain position with kwires

43
Q

keller arthroplasty complications post suregry

A

shortens hallux which creates a floppy toe by:

  1. reduced muscle strength
  2. shortened medial column
  3. hallux extensors not as functional
  4. trasnfer pain
  5. recurrence of deformity

not as used in modern day

44
Q

implant arthroplasty complications

A

breaks down, movement limited, doesnt last long and parts can distribute into the body

45
Q

interposition arthroplasty

A

patients own joint capsule is used to recreate the joint and cover/interpose over the met head

salvage procedure

46
Q

interposition arthroplasty indicated with who?

A

good long term solution and fixing range of motion

47
Q

indications of a joint arthrodesis

A
  1. severe arthritis
  2. failure of other procedures (last line)
48
Q

what angle is arthrodesis done in

A

15 deg valgus, 15-20 deg extension- to help with propulsion

49
Q

what is an issue with the dorsiflexion angle of an arthrodesis

A

falls risk

50
Q

what is decompression osteotomy and when to use it/not use it

A

creates space within joint preventing jamming

can use in:
1. long or normal mets
2. early stage or moderate OA/limitus

cant use in:
1. short mets- will cause transfer metatarsalgia and poor biomechanics
2. rigidus
3. osteoporosis- may not heal

51
Q

how do you determine procedure for hallux rigidus?

A

stage

stage 1- chelectomy and chondroplasty (removal of spurs, drill subcondrally to stimulate fibrocartilage)

stage 2/3- interpositional arthroplasty or decompression osteotomy

failed treatment- arthrodesis but rule out recurring deformity and not with osteoporosis

52
Q

HAV procedures (3) and when are they performed

A
  1. chevron/austin: for less severe deformity (osteotomy)
  2. scarf: for more moderate deformity (osteotomy)
  3. lapidus: for larger deformity (arthrodesis)

4.bunionectomy: temporary fix for pain, will recur (palliative)

53
Q

lapidus procedure for HAV

A

1st met and cuneiform fusion

rarely used, for severe deformity

54
Q

scarf/akin procedure for HAV

A

for moderate deformity

scarf: met is cut in half and realigned

akin: closing base wedge osteotomy (cut) with staple to reduce abduction of proximal phalanx

55
Q

chevron procedure for HAV

A

cut capital fragment of met head and relocate it

56
Q

difference between scarf and chevron osteotomy

A

scarf - mid shift correction

chevron- distal met correction

57
Q

what soft tissue balancing is also done for HAV surgeries?

A

staged lateral release of soft tissue

58
Q

what is the most common phalangeal osteotomy

A

akin
-closing base wedge osteomy of proximal phalans
(transverse osteotomy)

this causes a reduction in HAV angle and interphalangeal angle

59
Q

Complications of HAV surgery

A

overcorrection- varus
non/malunion
AVN
joint degeneration
transfer metatarsalgia

60
Q

what is transfer metatarsalgia

A

transferring load to other mets

occurs in short mets

61
Q

do sesamoids have good blood supply?

A

no

62
Q

what procedures can you do for hallux varus

A
  1. androdesis (gold standard)
  2. keller arthroplasty
  3. reverse akin- shift proximal phalanx laterally
  4. reverse chevron- shift met head laterally
63
Q

how does hallux varus usually occur

A

caused by surgery of hallux valgus

YR3S2- anesthetics (9 decks)

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