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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
if someone has HAV and deformity of digits 2/3 also what order would you fix deformities
need to realign 1st then treat the lesser toe deformities
26
hallux rigidus complications
risk of falls pain altered gait shoe fit loss of function cosemetics ulceration
27
types of 1st metatarsal operations
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
why are radiographs so important for surgical decision making?
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
at what sesamoid position is it associated with osteoarthritis of the metatarsal
tibial sesamoid position: 1-3 is normal 4-7 can erode cartilage and have poor gliding function, fibula sesamoid moves into intermet space
30
normal metatarsus angle is
through the 2nd met
31
what is normal for intermetatarsal angle
8deg
32
normal hallux valgus angle?
<15 deg bisection of 1st met and 1st proximal phalanx
33
DASA normal angle
0-6deg
34
PASA normal angle
0-8deg
35
PASA /DASA what is it
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
what type of shapes of heads make articulation unstable, stable
unstable- round stable- flattened head, most stable- ridge
37
what mets should be longest - smallest
2, 1, 3, 4, 5
38
what difference is there in mm between 1st and 2nd met length for there to be pain, pressure, malfunction?
more than 2mm (2mm is normal)
39
why treat hallux valgus and ridigius ?
1. progressive deformity 2. medial column instability 3. secondary deformity 4. joint erosion 5. quality of life
40
radiographic findings of Hallux rigidus
osteophytes sclerosis joint space narrowing
41
hallux rigidus surgical options
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
keller procedure
-remove up to 30% of proximal phalangeal base -attach FHL to remaining part of proximal phalanx -soft tissue interposition -maintain position with kwires
43
keller arthroplasty complications post suregry
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
implant arthroplasty complications
breaks down, movement limited, doesnt last long and parts can distribute into the body
45
interposition arthroplasty
patients own joint capsule is used to recreate the joint and cover/interpose over the met head salvage procedure
46
interposition arthroplasty indicated with who?
good long term solution and fixing range of motion
47
indications of a joint arthrodesis
1. severe arthritis 2. failure of other procedures (last line)
48
what angle is arthrodesis done in
15 deg valgus, 15-20 deg extension- to help with propulsion
49
what is an issue with the dorsiflexion angle of an arthrodesis
falls risk
50
what is decompression osteotomy and when to use it/not use it
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
how do you determine procedure for hallux rigidus?
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
HAV procedures (3) and when are they performed
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
lapidus procedure for HAV
1st met and cuneiform fusion rarely used, for severe deformity
54
scarf/akin procedure for HAV
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
chevron procedure for HAV
cut capital fragment of met head and relocate it
56
difference between scarf and chevron osteotomy
scarf - mid shift correction chevron- distal met correction
57
what soft tissue balancing is also done for HAV surgeries?
staged lateral release of soft tissue
58
what is the most common phalangeal osteotomy
akin -closing base wedge osteomy of proximal phalans (transverse osteotomy) this causes a reduction in HAV angle and interphalangeal angle
59
Complications of HAV surgery
overcorrection- varus non/malunion AVN joint degeneration transfer metatarsalgia
60
what is transfer metatarsalgia
transferring load to other mets occurs in short mets
61
do sesamoids have good blood supply?
no
62
what procedures can you do for hallux varus
1. androdesis (gold standard) 2. keller arthroplasty 3. reverse akin- shift proximal phalanx laterally 4. reverse chevron- shift met head laterally
63
how does hallux varus usually occur
caused by surgery of hallux valgus

YR3S2- anesthetics (9 decks)

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