Firecracker HAV Procedures

Question 1

What is the most likely name of a procedure performed in the proximal phalanx?

Answer 1

some sort of Akin

Question 2

Describe the Distal Akin.

Answer 2

medial closing wedge osteotomy at the distal aspect of the proximal phalanx

Question 3

What are the indications for a distal Akin?

Answer 3

abnormal HIA

long proximal phalanx

Question 4

What are the indications for a proximal Akin?

Answer 4

increased DASA

Question 5

Describe the proximal Akin.

Answer 5

medial closing wedge osteotomy in metaphyseal bone of the proximal phalanx

Question 6

Name some procedures that are used to shorten a long proximal phalanx.

Answer 6

Cylindrical Akin
Chevron (2 V-osteotomies)
Z-osteotomy
Regnauld

Question 7

What is the advantage of the oblique Akin?

Answer 7

can use cortical lag screw fixation because of orientation of osteotomy

Question 8

Describe the Keller procedure.

Answer 8

is a resection arthroplasty of the base of the proximal phalanx used for end stage HL and geriatric bunions

Question 9

Describe the Kessel-Bonney procedure.

Answer 9

resection of a dorsally based wedge from the base of the proximal phalanx used to correct early stages of HL

Question 10

Describe the McBride bunionectomy.

Answer 10

1. removal of medial eminence of 1st met
2. transfer of ADH into medial met head
3. removal of fibular sesamoid

Question 11

Describe the Silver bunionectomy.

Answer 11

partial ostectomy of the medial eminence on the 1st metatarsal head

Question 12

Describe the Reverdin procedure.

Answer 12

medial closing wedge osteotomy in the 1st met head for correction of abnormal PASA

Question 13

Describe the Peabody procedure.

Answer 13

medial closing wedge osteotomy (similar to the Reverdin) but done in the metatarsal neck to avoid sesamoids

Question 14

Describe the Reverdin-Green procedure.

Answer 14

Reverdin + plantar shelf to protect the sesamoids

Question 15

Describe the Reverdin-Laird procedure.

Answer 15

medial closing wedge osteotomy of 1st met head that is through the lateral cortex with a plantar shelf

Question 16

Name the historical procedures.

Answer 16

Peabody
Hohmann
DRATO

Question 17

Describe the Hohmann procedure.

Answer 17

trapezoid wedge removed from anatomic neck of metatarsal

Question 18

Describe the Mitchell procedure.

Answer 18

transpositional, step-down osteotomy in the 1st met that corrects IMA and plantarflexes met head

Question 19

Describe the Capp procedure.

Answer 19

transverse osteotomy across the 1st met head

Question 20

Describe the Wilson procedure.

Answer 20

oblique osteotomy in 1st met directed proximal-lateral to distal-medial

Question 21

Describe teh Austin procedure.

Answer 21

horizontal V osteotomy with 60 deg apex in the central met head

Question 22

What is the kalish modification to the Austin.

Answer 22

decreasing the apex angle to 55 deg to create a longer dorsal arm to allow for dorsal fixation with screws

Question 23

What is the Youngswick modification to the Austin?

Answer 23

chevron cut + second dorsal cut to remove rectangular wedge of bone to shroten the met

Question 24

Describe the Traditional scarf osteotomy.

Answer 24

Z osteotomy with shorter arms oriented proximal-plantar and distal-dorsal

Question 25

How many times stronger is the inverted scarf osteotomy/

Answer 25

1.6x stronger (bc troughing plantarflexes the met head which is more desirable than dorsiflexing the head which is seen if troughing occurs in the traditional scarf)

Question 26

Describe the Inverted scarf osteotomy

Answer 26

Z osteotomy with shorter arms oriented proximal-dorsal to distal-plantar.

Question 27

Name two diaphyseal osteotomies.

Answer 27

Ludloff | mau

Question 28

Describe the Ludloff osteotomy.

Answer 28

oblique diaphysesal osteotomy that runs dorsal-proximal to plantar-distal

Question 29

Describe the Mau osteotomy.

Answer 29

oblique diaphyseal osteotomy that runs plantar-proximal to dorsal-distal

Question 30

Name the proximal hallux osteotomies.

Answer 30

``` Loison-balacesu Juvara crescentic Trethowan` Logroscino ```

Question 31

what are the iatrogenic causes of hallux varus?

Answer 31

1. removal of fibular sesamoid 2. staking of the 1st met head 3. over-correction of IMA 4. over-zealous capsulorraphy 5. aggressive post-op bandaging 6. over-extensive lateral release 7. over-correction of PASA

Question 32

What is the normal Hallux-abductus angle?

Answer 32

10-15 deg

Question 33

What is the normal Hallux -interphalangeal angle?

Answer 33

0-10 deg

Question 34

What are the possible 1st metatarsal diaphyseal osteotomies?

Answer 34

SCARF or Z-osteotomy Ludloff Mau

Question 35

What are some proximal 1st metatarsal osteotomies?

Answer 35

``` Loison-bbalacescu Juvara Crescentic Trethowan Logroscino ```

Question 36

Describe the Logroscino procedure?

Answer 36

(double 1st met osteotomy) CBWO + Reverdin

Question 37

Describe the Trethowan procedure.

Answer 37

opening abductory wedge osteotomy used to correct abnormally high IMA on short metatarsals *BONUS: Where does the opening wedge graft come from?

Question 38

The Trethowan procedure is often combined with a bone graft. What is the harvesting procedure called?

Answer 38

Stamm procedure- taking a resected base of the proximal phalanx and using it as teh bone graft in the Trethowan

Question 39

Where does the opening wedge bone graft in the Trethowan procedure come from?

Answer 39

medial eminence of 1st met head | OR resected base of proximal phalanx

Question 40

Describe the Juvara osteotomy.

Answer 40

oblique medial closing wedge (CBWO) osteotomy of the metatarsal base