HAV Surgery

Question 1

Name the metatarsal head osteotomies.

Answer 1

1. Reverdin
2. Reverdin-Green
3. Reverdin-Laird
4. Reverdin-Todd
5. Peabody
6. Roux
7. Drato
8. Hohmann
9. Mitchell
10. Austin
11. offset-V
12. Capp
13. Wilson
14. Scarf
15. Ludloff
16. Mau

Question 2

What does the Reverdin procedure correct for?

Answer 2

abnormal increases in PASA

Question 3

describe the reverdin procedure.

Answer 3

medially based incomplete wedge resection of 1st met head

• distal cut is made first, parallel to joint surface
• proximal cut is made second perpendicular to long axis of 1st met
• lateral cortex is left intact

Question 4

what is the complication associated with Reverdin?

Answer 4

sesamoiditis

Question 5

name the contraindications to Reverdin procedure.

Answer 5

• painful ROM
• large IMA
• short 1st met

Question 6

describe the Peabody procedure.

Answer 6

historical procedure that is similar to Reverdin except is performed at metatarsal neck to avoid sesamoids

Question 7

what is the complication associated with Peabody? (and thus why it is not used anymore)?

Answer 7

poor vascularity and is unstable bc procedure is done at metatarsal neck

Question 8

describe the Reverdin-Green procedure.

Answer 8

is a Reverdin with a plantar shelf to protect sesamoids

Question 9

what does the Reverdin-Green procedure correct for?

Answer 9

abnormally increased PASA

Question 10

Which reverdin modification utilizes a plantar shelf cut parallel to WB surface to preserve articulation with sesamoids?

Answer 10

Reverdin- Green

Question 11

which Reverdin modification addresses abnormal PASA and increased IMA?

Answer 11

Reverdin-Laird

Question 12

Describe the Reverdin-Laird procedure.

Answer 12

Reverdin + plantar shelf + medial closing wedge osteotomy going thru lateral cortex
*capital fragment is transposed laterally to close down IMA

Question 13

which Reverdin modification does not leave the lateral cortex (hinge) intact?

Answer 13

Reverdin-Laird

Question 14

Which Reverdin modification addresses increased PASA, IMA, and elevated met head?

Answer 14

Reverdin-Todd

Question 15

Describe the Reverdin-Todd procedure.

Answer 15

Reverdin + plantar shelf+ resection of bone to plantarflex joint surface

Question 16

describe the hohmann procedure.

Answer 16

historical procedure that removes a trapezoid wedge at anatomic neck of metatarsal and transposes capital fragment laterally and depresses plantarly

Question 17

describe the Mitchell procedure.

Answer 17

transpositional, step-down osteotomy that corrects IMA and plantarflexes met head

Question 18

what procedure is good if you have a long 1st met (although this is rare)?

Answer 18

Mitchell- bc it provides some shortening and plantarflexion of met head

Question 19

what is the DRATO procedure?

Answer 19

(historical purposes only)

-derotational, angulational, transpostional osteotomy performed in metatarsal neck

Question 20

Describe the Roux procedure.

Answer 20

trapezoid osteotomy –> leads to a lot of shrotening

Question 21

describe the Capp procedure.

Answer 21

transverse osteotomy across met head

Question 22

describe the wilson osteotomy.

Answer 22

oblique cut of met neck ; then slide capital fragment laterally

Question 23

Describe the Austin procedure.

Answer 23

horizontal V osteotomy with an apex of 60 deg

Question 24

what does the uni-correctional Austin correct for?

Answer 24

reduces IMA

Question 25

what does the bicorrectional Austin correct for?

Answer 25

reduces IMA and PASA

Question 26

what does the bi-plane Austin correct for?

Answer 26

reduces IMA and plantarflexes metatarsal

Question 27

true or false: austin procedures correct frontal plane deformities.

Answer 27

false- austin procedures do NOT correct frontal plane deformities.

Question 28

how much bone loss do you get with any osteotomy?

Answer 28

1mm (but by the time you add in screw fixation and bone healing, that is an additional 2mm) *= 3mm bone loss total

Question 29

What is the Kalish modification of Austin?

Answer 29

changed the apex of angle from 60 deg to 50-55 deg to create a longer arm dorsally on the met to get 2 screws to follow AO technique

Question 30

What is the Youngswick modification of Austin?

Answer 30

make a Chevron cut followed by a second dorsal cut to remove extra bone to shorten the met and allow plantarflexing and shortening

Question 31

what is the bicorrectional modification of Austin?

Answer 31

make a chevron cut then take wedge out; then rotate met out of its increased PASA

Question 32

if you lift your arm in the guide wire placement (so that superior pole is lateral), what does this do to the met?

Answer 32

plantarflexes it

Question 33

if you drop your arm in the guide wire placement (so that superior pole is medial), what does this do to the met?

Answer 33

dorsifelxes it

Question 34

if you angulate your guide wire so that it points to 2nd met head, what does this do to your 1st met/

Answer 34

lengthens it

Question 35

if you angualte your guide wire so that it points proximal on 2nd met, what does this do to your 1st met?

Answer 35

shortens it

Question 36

describe the scarf procedure.

Answer 36

Z osteotomy in diaphyseal and metaphyseal bone

Question 37

describe the orientation of the arms of the Z for a traditional scarf procedure.

Answer 37

proximal-plantar to distal-dorsal Z

Question 38

which scarf modification allows for maximum IMA reduction?

Answer 38

rotational scarf

Question 39

describe the orientation of the arms of the Z in inverted scarf.

Answer 39

proximal-dorsal to distal-plantar

Question 40

which scarf is better for a high IMA- transpositional or rotational?

Answer 40

rotational

Question 41

which scarf is stronger- inverted or traditional?

Answer 41

inverted is 1.6x stronger

Question 42

troughin affects traditional/rotational scarf how?

Answer 42

dorsiflexes head

Question 43

troughing affects inverted scarf how?

Answer 43

plantarflexes head

Question 44

what is troughing?

Answer 44

when one cortical edge falls into the medullary canal of the other segment, resulting ine elvation of capital fragment

Question 45

troughing is seen in which scarf procedure more ?

Answer 45

transpositional rather than rotational

Question 46

name the diaphyseal osteotomies.

Answer 46

ludloff | mau

Question 47

describe the orietnation of the oblique osteotomy in a ludloff.

Answer 47

proximal- dorsal to distal-plantar

Question 48

describe the orietnation of the oblique osteotomy in a mau.

Answer 48

proximal-plantar to distal-dorsal

Question 49

what are teh contraindications to scarf?

Answer 49

high PASA significant sagittal plane deformity narrow met width