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Flashcards in Hallux Limitus (Surgery) Deck (36):
1

 

What's the value for normal 

1st MPJ dorsiflexion?

1st MPJ plantarflexion?

 

Dorsiflexion: 65 degrees

Plantarflexion: 20 degrees

 

2

Frequency of Hallux limitus?

1?

In bilateral 2?

Women ratio 3?

 

 

 

1. 2nd most common after HV

2. 98% of pts had a family history 

3. 62%

3

 

What are the syptoms for Hallux limitus?

1?

2?

3?

4?

5?

 

 

 

 

1. Pain from impingment of dorsal osteophyte

2. ROM pain due to irregularity of the articular artilage surface

3. Pain from inflammation 

4. Pain from shoe related pressure on prominant oteophytes

5. Pain form irritation of dorsal cutaneous nerves

 

 

4

 

What are some of the Aiteologies for Hallux limitus?

1?

2?

3?

4?

5?

6?

 

 

1. Pes Valgus-Hypermobility of 1st ray 

2. Metatarsus primus elevatus: Hallux equinus 

3. Long 1st metatarsal/ Short 1st metatarsal 

4. Varus deformity: Forefoot/ Rearfoot

5. Trauma- micro/macro

6. Immobalisation

5

 

What aresome of the Sytemic Aetiology for Hallux limitus?

1?

2?

3?

4?

5?

 

 

1. Gouty Arthritis

2. Osteoarthritis

3. Rheumatoid arthritis

4. Neuromuscular disorders

5. Iatrogenic causes

 

6

Metatarsus Primus Elevatus 

Primary MPE 

1?

2?

 

 

 

1. Secondary to proximal varus deformity 

2. Hallux equinus subsequently develops to afford medial 

7

Secondary MPE

results from 1?

 

1. retrograde effects of hallux equinus on 1st met head in pes valgus

2. Hypermobility 1st ray 

 

8

 

How do you differentiate between primary and secondary primus elevatus?

1?

2?

 

 

 

 

1. Evaluation of weight bearing and non weight bearing

2. Compare standard lateral to lateral using "forefoot block" test with digits suspended off weight bearing surface 

9

 

Radiographic measurment for Metatarsus Primus Elevatus

Normally, dorsal cortex of 1st and 2nd metatarsal shaft are 1?

Measure 2?

 

 

 

 

1. Parallel 

2. Angular divergence between 1st and 2nd metatarsals

10

 

Osteochondritis Dissecans

Osteochondral 1?

2 erosion?

Main cause 3?

4?

5 x-rays?

 

 

1. fracture

2. 1st MPJ central and dorsal articular artilage erosion 1st MH

3. Cause

4. Fragmentation with cleavage lesion 

5. x-rays may not demonstrate lesion 

 

11

 

What are the consequences for progressive osteoarthritis?

Gradual 1.?

2.? Proliferation

3? narrowing

4.? flattening

5.? lesion 

6? findings more extensive

 

 

 

 

1. Joint destruction 

2. Osteophyte 

3. Joint space narrowing

4. Articular surface 

5. Cystic subchondral 

6. Intra-operative 

 

12

Subchondral cyst 

Common feature of 1?

Resulting from 2?

Chracateristics 3?

Accompanying features 4?

 

 

 

 

1. OA

2. Stress/Pressure 

3. Multiple and Radiolucent with a surrounding sclerotic margin 

4. Joint space narrowing and bone sclerosis 

 

13

 

1. Where is the axis of rotation for hallux?

2. What motion does this axis allow for?

 

 

1. located centrally within the 1st metatarsal head 

2. Allows for sagittal plane gliding motion of stabalised hallux on rotating metatarsal head

 

14

 

In hallux limitus, where is the axis transferred to 1?

what does this lead to 2?

 

1. Axis of rotation converted to plantar hinge which is at the level of the sesamoidphalangeal ligament

2. Leads to dorsal impingment and osteophytic formation

 

 

15

Radiographic Grading

What are the characteristics for Grade I of Hallux limitus?

1?

2?

3?

4?

 

 

1. Functional limitation of dorsiflexion 

2. Mild dorsal spurring 

3. Pain from dorsal hypertrophy 

4. No structural sesamoid disease

 

16

Radiographic Grading

What are the charachteristics of Grade II hallux limitus?

1?

2?

3?

4?

5?

 

 

1. Broadening and flattening of 1st met head and base of proximal phalanx

2.  Joint space narrowing

3.  Structural 1st ray elevatus

4.  Osteochondral defect

5.  Sesamoid hypertrophy

17

Radiographic Grading

What are the characteristics of Grade III?

1?

2?

3?

4?

5?

 

1.  Severe loss of joint space

2.  Extensive spurring

3. Osteochondral defects of

4. metatarsal head +/-proximal

5. phalanx +/- joint mice

6. Extensive sesamoid hypertrophy and loss of joint space

7. Near ankylosis

18

 

What are the surgical procedures for Hallux limitus:

1.?

2.?

3.?

 

 

 

1. Cheilectomy

2. Joint destructive

3. Osteotomies

 

19

 

What are the different methods for the joint dstructive surgical procedure for hallux limitus?

1?

2?

3?

 

 

 

1. Keller

2. 1st mpj arthrodesis

3. Joint implant

20

 

What is an stepwise surgical approach for hallux limitus?

1. Addresses ?

2. Aim to create ?

 

1. soft tissue as well as osseous pathology

2. pain free improved ROM 1st mpj

21

 

Some facts about Cheiectomy:

 Important 1? 

 Need to carefully inspetc 2?

 Removal of 3?

 Abrasion arthroplasty or subcondral drilling to encourage 4?

 Good long term success rate with grade 5?

 

1. first step in increasing ROM

2. articular cartilage

3.loose cartilage

4. encourage formation of pseudocartilage

5. Grade I and II

22

 

More facts about Cheilectomy:

Remove and smooth 1?

 Limited application as 2?


 Combine with 3?

 

1. first met head and base proximal phalanx

2. Sole procedure

3. Capsular inter-positional graft

23

Joint Destructive Procedures:

 Keller arthroplasty: 

 Good procedure for 1?

 Arthrodesis of 1st mpj: 

 Provides predictable 2?

 Implant arthroplasty: 

 Single or two component

 

 

 

1.  end stage HL deformity

2.  Stability to 1st mpj and hallux complex

3. implants

24

 

1st MPJ Arthrodesis 

1? treatment

 Obliterates 2?

 Ideal for stage 3?

 Can yield consistently to 4?

 

 

 

1.  End stage

2.  motion

3.  III HL

4. good results

25

 

What's does the 1st MPJ arthrodesis procedure involve?

 Removal of all 1?

Devices 2?            

Fenestrate 3?

to

encourage 4?

 

 

1. cartilage from 1st metatarsal head and base proximal phalanx

2. Sagittal saw, Ronguer/bone curette, Conical reamer system

3. subchondral bone with 1.6mm K-wire

4. bleeding

26

 

What is the alternative fixation technique:

 

Stable internal fixation

 Crossed K-wires

 Parallel K-wires

 Single A-O screw

 Crossed A-O screws

27

1st MPJ Arthrodesis 

 After care 1?

 Limitations 2?

 Complications 3?

 

1.  BK cast or post-op shoe for 4-6/52

2. No more high heeled footwear

3. Delayed healing, Non-union, Improper position

28

 

Some facts about joint implants:

 Better in 1?

 Hemi or double

 Complications 2?

 Hallux malleus

 

 

 

1. Theory than in practice:  Lifespan of implants

2.  Infection, Implant failure, Need for removal

29

 

What is the technique involved for Joint implant surgery?

 Removal of 1?

 Creation of 2?

 Selection of 3?

 Suturing of 4?

 Insertion of 5?

 

 

1. bone

2. Holes

3.  trial implant

4.  flexor plate to base prox phalanx

5. implant

 

30

Moberg osteotomy

1? osteotomy

 Cheilectomy 2?

  Decompression anddorsiflexion 3?

 

1. phalangeal osteotomy

2. 1st  MH

3. Osteotomy proximal phalanx

 

31

Moberg osteotomy

1? skin incision 

2? exposed 

 

1. Medial 

2. Capsule inside joint 

 

32

Moberg Osteotomy

Make 1? first, then 2? why?

Drill holes with 3?

Thread 4?

 

 

1. proximal osteotomy

2. distal osteotomy

3. 1.4 mm K-wire

4. stainless steel wire

 

 

33

Moberg procedure

After-care

 Post-op sandal 1?

 Co-plus wrap 2?

Possible complications: 

 Avoid 3?

4?

5?

6?

 

 

1.  4-6/52

2.  4/52

3.  Over tightening wire sutures

4. Fracture plantar hinge

5. Delayed/non-union

6. AVN base proximal phalanx

 

 

 

34

1st Metatarsal Osteotomies 

 Distal osteotomies:

 Useful in 1?

 Obtain 2?

 Youngswick- modification of 3?

 Plantarflexory basal osteotomies: 

 Lambrinudi

 Sagittal Z

 Waterman

 

 

1.  Mild-moderate metatarsus primus elevatus

2.  shortening and plantar flexion of capital fragment

3. Austin (1982)

 

35

Youngswick Osteotomy/Modified Watermann

Modification 1?

2? 1st ray

 Fixated with 3?

 Ambulatory procedure

 Stage 4?

 5? loss of joint cartilage

Indications 6?  7?

 

 

1. Austin osteotomy

2.  Plantar-flexes and shortens

3.  screw or Kwire/s

4. I or II HL

5. < 50%

6. Age < 75 years

7.  Good bone density

 

36

Proximal osteotomies:

 After care:

 Non-weight bearing for 1?

 B-K cast

 Careful 2?

 Less surgery at MPJ level - less surgical scarring around joint

 Complications 3?

 

1. 6-8 weeks

2.  ROM exercises

3. Need for nwb

immobilisation

 MPE

 Delayed/non-union

 Reduced ROM 1st mpj