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Podiatry > Bunion Procedures > Flashcards

Bunion Procedures Flashcards

(44 cards)

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1
Q 
Pathogenesis of bunion
stage 1 → 
stage 2→ 
stage 3→ 
stage 4→
A

STAGE 1 → lateral subluxation of hallux
–unstable 1st ray→ unstable hallux→ strain trans. pedis

STAGE 2→ hallux abductus pressure against lesser toes

  • -unstable sesamoid, transverse pedis, FF adductus
  • -EHL & flexors → bow string
  • 1st MTPJ axis change

STAGE 3→ ↑ IM angle

  • -retroactive force to 1st met from hallux against 2nd digit
  • -cuneiform split
  • -*eversion throughout propulsive phase
  • -*worsening primus elevatus → ↓ hallux DF at 1st MTPJ

STAGE 4→ hallux and/or 2nd MTPJ dislocation

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2
Q

HAV angle

A

~15º

-describes deformity of hallux relative to 1st metatarsal

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3
Q

Intermetatarsal (IM) angle

A

8-12º

  • relationship b/w 1st and 2nd metatarsal
  • as IM increase the EHL is shorter
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4
Q

Interphalangeal joint (IPJ) angle

A

0-10º

-relationship of distal phalanx of hallux relative to the proximal phalanx

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5
Q

Proximal articular set angle (PASA)

A
  1. 5º
    - orientation of articular cartilage relative to 1st metatarsal
    - the more lateral the higher the PASA
    - *↑ causes the tracking
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6
Q

Distal articular set angle (DASA)

A
  1. 5º

- deviation of the proximal phalanx relative to 1st MTPJ

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7
Q

Metatarsus adductus (MA) angle

A

~15º
-relationship b.w 2nd metatarsal (represents metatarsus)
to the midfoot

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8
Q

Adjusted IM angle

A

measured IM angle + (measured MA angle - 15)

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9
Q

Tibial sesamoid position

A
  • range is 1-7 w/ 1-3 normal (4 is on midline of met)
  • looks at condition of crista
  • looks at overall severity of HAV deformity
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10
Q

Metatarsal protrusion

A

-length of 1st metatarsal relative to 2nd metatarsal

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11
Q

Positional deformity

A

HAV angle (~15º) > PASA + DASA

  • PASA and DASA are both normal (7.5º)
  • denotes soft tissue deformity
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12
Q

Structural

A

HAV angle = PASA + DASA

  • PASA and/or DASA are abnormal
  • osseous deformity
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13
Q

Combined

A

HAV angle > PASA + DASA

  • PASA and/or DASA are abnormal
  • osseous and soft tissue deformity
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14
Q

Silver

A
  • Bump ONLY
  • less than ideal bone stock
  • no effect on angles
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15
Q

McBride

A

Positional (soft tissue) correction

  • addresses bump as well
  • sufficient if ONLY abnormal value → HAV angle (15º)
  • performed w/ most of the other types of bunionectomies
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16
Q

Proximal Akin

A

Osteotomy → proximal phalanx of hallux near base

  • HIGH DASA
  • -7.5º is normal
  • crossed K-wires → best fixation
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17
Q

Distal Akin

A

Osteotomy → proximal phalanx of hallux near head

  • correct a high IPJ
  • -0-10º normal
  • crossed K-wires → best fixation
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18
Q

Cylindrical Akin

-oblique Akin

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A
  • Corrects LONG proximal phalanx
  • Corrects DASA/IPJ abnormalities

-same as akin (?) just more room to put screw

19
Q

Reverdin

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A

Osteotomy → 1st metatarsal head (metaphysis)

  • corrects high PASA (>7.5º)
  • removes tibial sesamoid
20
Q

Reverdin-Green-Laird

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A

Osteotomy → 1st metatarsal head (metaphysis)

  • corrects PASA
  • avoids tibial sesamoid
  • can correct moderate ↑ of IM angle (8-12º normal)
  • -cut through and through w/ shelf and slide head
21
Q

Austin

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A

Osteotomy → 1st metatarsal head (metaphysis)

  • corrects moderate ↑ of IM angle (8-12º normal)
  • doesn’t remove bone, just make < shaped cut & reposition
22
Q

Austin-Bicorrectional

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A

Osteotomy → 1st metatarsal head (metaphysis)

  • corrects moderate increase of IM angle
  • can correct PASA
  • chevron wedge is removed
23
Q

Austin-Modified

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A
  • offset V (superior arm is longer)
  • corrects larger IM angle than basic austin
  • can be swiveled → some PASA correction
  • allows use of 2 screws
24
Q

Peabody

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A

Junctional osteotomy

  • corrects PASA
  • -similar to Reverdin, but at NECK → poorer blood supply
  • proximal enough to avoid sesamoid
25
Mitchell
Junctional osteotomy - corrects moderate ↑ in IM angle (8-12º) - significantly shortens 1st metatarsal - -used for long 1st metatarsal - -cut out small shelf from distal segment and proximal segment slides into the new space
26
Roux
Junctional osteotomy - bi-plane Mitchell → shortens 1st met. - corrects moderate IM - corrects PASA
27
Hohmann
Junctional osteotomy - tri-plane correction → shortens 1st met. - corrects PASA - corrects moderate IM angle - can correct FRONTAL plane - EXTRA CAPSULAR - DRATO (derotational, angulational, transpositional osteotomy) ank
28
Wilson
Junctional osteotomy - corrects moderate IM angle - -through and through angled cut and slide lateral - shortens 1st met. - EXTRA CAPSULAR
29
Ludloff
Diaphyseal osteotomy - corrects *mod/high IM angle → transposition - -proximal cut is dorsal - can correct some PASA at loss of full IM correction - can shorten BUT → elevates - can lengthen BUT → plantarflexes - proper exposure → lots of dissection - good for screw fixation - poor vascularity balance by large bone to bone contact
30
Mau
Diaphyseal osteotomy - corrects mod/high IM angle → rotation - -distal cut is dorsal (DD MAU) - -much more stable to weight - can correct some PASA at loss of full IM correction - can shorten BUT → plantarflex - can lengthen BUT → elevates - -b/c but is almost parallel to ground → not much sagittal change - proper exposure → lots of dissection - good for screw fixation - poor vascularity balance by large bone to bone contact
31
Scarf
Diaphyseal osteotomy - corrects mod/high IM angle - -troughing - -very stable - can correct some PASA at loss of full IM correction - proper exposure → lots of dissection - good for screw fixation - poor vascularity balance by large bone to bone contact
32
Indications for a base procedure
- 1st IM angle >15º - previous failures or recurrent deformity - Elevatus - Rigid deformity - HAV w/ Met adductus → ↑ IM angle - Juvenile HAV
33
Loison-Balacescu
Standard transverse base osteotomy - IM angle >15º - shorten mildly long 1st met (possible disadvantage) - minimal DF or PF w/ axis concept - no bone graft - cancellous bone → good blood supply/heals well - can combine w/ a head procedure for greater deformity - -always perform head osteotomy FIRST Disadvantages - 6 weeks NWB - difficult to fixate → very close to joint space
34
Juvara
Oblique base osteotomy - IM angle > 15º - better screw fixation/earler ROM - can correct multiple planes - can correct short or long (Juvara C) Disadvantages - more *shortening & *dissection - longer NWB → *diaphysial bone → doesn't heal as well b/c cortex is thicker
35
Juvara A Juvara B
Oblique base osteotomy → transverse correction Type A + sagittal correction
36
Juvara C1 Juvara C2
oblique bone cut → sagittal correction C1 + length correction
37
Proximal Austin
- techically difficult | - relatively minimal shortening of 1st met
38
Crescentic osteotomy
Advantages - can correct in all 3 planes - less bone shortening → no wedge removed - cancellous bone → better healing Disadvantages - less stable & difficult to fixate - special instrumentation required - NWB 6-8 weeks
39
Opening base wedge osteotomy
- reserved for HAV w/ high IM angle & SHORT metatarsal - difficult post-op management - possible jamming 1st MPJ - requires bone graft → longer NWB
40
Lapidus
- Fusion of the 1st MC joint (and 2nd met bases) - stable, versatile, and predictable - addresses deformity AND etiology - stabilizes medial column Indicated for: - -hypermobile 1st ray → 5º at 1st MC & 12.3 at 1st NC - -large IM angle - -elevated or PF 1st ray - -flatfoot/over pronated - -recurrent deformity - -ligamentous laxity
41
Medial Cuneiform Osteotomy (Cotton)
Indications: - associated metatarsus adducts - flatfoot procedures - avoids growth plates → good for children - long radius arm → more correction - technically difficult
42
Factors influencing rate of HAV development
- severity of pronation - degree of FF adductus - extent of calcaneal eversion - extent of STJ & MTJ subluxation - declination of STJ axis → ↑ frontal plane motion - angle & base of gait - length of stride - ↓ propulsive phase → ↓ development - -need propulsive gait to develop HAV - severity of inflammation - obesity - hard flat terrain → ↑ GFR - shoe gear
43
Predisposing factors for HAV
- genetics - arthritis (RA) - trauma - neuromuscular conditions (CMT) - shoe gear - BIOMECHANICAL → excess pronation in midstance of gait - -hypermobile 1st ray & fixed soft tissue due to shoes - -FF valgus compensation → exacerbates HAV - -FF varus → less force on HAV development
44
Iatrogenic causes of Hallux Varus
- excision of Fibular sesamoid - Over-correcting → IM angle or PASA - Overzealous: - resection of medial eminence - -stalking the head → disrupts sagittal groove - lateral release - medial capsulorrhaphy/plication - tendon transfer - post-op dressings ↑ → ↓

Podiatry (1 decks)

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