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Biomechanics & Surgery Exam 4 > HAV Surgery > Flashcards

HAV Surgery Flashcards

1
Q

Name the metatarsal head osteotomies.

A
  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
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2
Q

What does the Reverdin procedure correct for?

A

abnormal increases in PASA

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3
Q

describe the reverdin procedure.

A

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
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4
Q

what is the complication associated with Reverdin?

A

sesamoiditis

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5
Q

name the contraindications to Reverdin procedure.

A
  • painful ROM
  • large IMA
  • short 1st met
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6
Q

describe the Peabody procedure.

A

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

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7
Q

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

A

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

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8
Q

describe the Reverdin-Green procedure.

A

is a Reverdin with a plantar shelf to protect sesamoids

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9
Q

what does the Reverdin-Green procedure correct for?

A

abnormally increased PASA

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10
Q

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

A

Reverdin- Green

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11
Q

which Reverdin modification addresses abnormal PASA and increased IMA?

A

Reverdin-Laird

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12
Q

Describe the Reverdin-Laird procedure.

A

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

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13
Q

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

A

Reverdin-Laird

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14
Q

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

A

Reverdin-Todd

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15
Q

Describe the Reverdin-Todd procedure.

A

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

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16
Q

describe the hohmann procedure.

A

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

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17
Q

describe the Mitchell procedure.

A

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

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18
Q

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

A

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

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19
Q

what is the DRATO procedure?

A

(historical purposes only)

-derotational, angulational, transpostional osteotomy performed in metatarsal neck

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20
Q

Describe the Roux procedure.

A

trapezoid osteotomy –> leads to a lot of shrotening

21
Q

describe the Capp procedure.

A

transverse osteotomy across met head

22
Q

describe the wilson osteotomy.

A

oblique cut of met neck ; then slide capital fragment laterally

23
Q

Describe the Austin procedure.

A

horizontal V osteotomy with an apex of 60 deg

24
Q

what does the uni-correctional Austin correct for?

A

reduces IMA

25
Q

what does the bicorrectional Austin correct for?

A

reduces IMA and PASA

26
Q

what does the bi-plane Austin correct for?

A

reduces IMA and plantarflexes metatarsal

27
Q

true or false: austin procedures correct frontal plane deformities.

A

false- austin procedures do NOT correct frontal plane deformities.

28
Q

how much bone loss do you get with any osteotomy?

A

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

29
Q

What is the Kalish modification of Austin?

A

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

30
Q

What is the Youngswick modification of Austin?

A

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

31
Q

what is the bicorrectional modification of Austin?

A

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

32
Q

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

A

plantarflexes it

33
Q

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

A

dorsifelxes it

34
Q

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

A

lengthens it

35
Q

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

A

shortens it

36
Q

describe the scarf procedure.

A

Z osteotomy in diaphyseal and metaphyseal bone

37
Q

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

A

proximal-plantar to distal-dorsal Z

38
Q

which scarf modification allows for maximum IMA reduction?

A

rotational scarf

39
Q

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

A

proximal-dorsal to distal-plantar

40
Q

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

A

rotational

41
Q

which scarf is stronger- inverted or traditional?

A

inverted is 1.6x stronger

42
Q

troughin affects traditional/rotational scarf how?

A

dorsiflexes head

43
Q

troughing affects inverted scarf how?

A

plantarflexes head

44
Q

what is troughing?

A

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

45
Q

troughing is seen in which scarf procedure more ?

A

transpositional rather than rotational

46
Q

name the diaphyseal osteotomies.

A

ludloff

mau

47
Q

describe the orietnation of the oblique osteotomy in a ludloff.

A

proximal- dorsal to distal-plantar

48
Q

describe the orietnation of the oblique osteotomy in a mau.

A

proximal-plantar to distal-dorsal

49
Q

what are teh contraindications to scarf?

A

high PASA
significant sagittal plane deformity
narrow met width

Biomechanics & Surgery Exam 4 (8 decks)

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