Practice images w/ Qs

Question 1

Name the procedure done:

Answer 1

Distal akin w/ 0.062 kwire

Question 2

Name procedure, fixation, and post op course:

Answer 2

Hallux arthrodesis w/ 4.0 cannulated screw

Question 3

What is the procedure? Fixation? Post-op?

Answer 3

Procedures: Reverdin Green

Fixation: 2.7mm cortical screw (most common), 0.062” k-wire

Post-op: surgical shoe for 4wks

Question 4

Read the pre-op xray (left). What correction would you perform, include fixation? What was performed (right)?

Answer 4

(Austin with 0.062 Kwire; could also used 2.7mm cortical or 3.0mm cannulated; 60)

Question 5

What is the post op course for this procedure?

Answer 5

Austin- surgical shoe 4wks

Question 6

What procedure and fixation? What angle are the osteotomy cuts at?

Answer 6

Kalish–> look for the 2 screws in the distal shaft w/ heads close together, two 2.7mm cortical or 3.0 cannulated; 55

Question 7

What procedure and fixation? What angle are the osteotomy cuts at?

Answer 7

Offset V–> look for the 2 screws in the distal and proximal shaft, two 2.7mm cortical or 3.0 cannulated; 35

Question 8

Name the procedure and it’s major complication. What are the special names of the screws used for this procedure?

Answer 8

Scarf; troughing; Barouk screws

Question 9

Procedure and fixation

Answer 9

Transverse Base Osteotomy; .062 kwire

Question 10

Procedure, fixation:

Answer 10

Juvara Mod of the CBWO

Compression screw- 3.5 cancellous

Anchor screw- 2.7 cortical

Question 11

Procedure, fixation:

Answer 11

2nd toe: arthodesis 0.062 kwire

Hallux: proximal akin 0.062 kwire

1st met: opening base wedge w/ pates and screws

Question 12

Procedure, fixation, post op care:

Answer 12

McKeever, tubular plate and screws with placement of an interfragmentary screw

Cast NWB 6wks, Cast WB 2wks, progress to sneaker

Question 13

Name the procedure and fixation. What would be the major indications to this procedure?

Answer 13

McKeever, 2 crossed 2.7 cortical screws

Indications: DJD/hallux limitus, inflammatory/neuromuscular/post-traumatic arthropathy, ray salvage, HAV (can get up to 10 degrees IM correction from resulting muscle balance)

Question 14

Name the procedure and fixation. What would be the major contraindications to this procedure?

Answer 14

McKeever arthrodesis, anatomic locking plate w/ 2.0 cortical screws and placement of an interfragmentary screw

Contraindications: adjacent osteoarthritis, adjacent rigid deformity, osteoporosis, **lifestyle/job that requires a lot of bending at 1st MPJ

Question 15

What position do we want the hallux to be in after fusion?

Answer 15

10 degrees abduction

10 degrees dorsiflexion/5mm off the ground

5 degrees valgus

Question 16

What procedures were done here?

Answer 16

Hallux: distal akin w/ crossed 0.062 kwires because the lateral cortex

1st met cuneiform joint: lapidus w/ 2 crossed 3.5 cortical screws (not totally sure on the size, just eyeballed it)

Question 17

Read the pre-op x-ray (left), propose correction. Describe post op (right), name procedure and fixation.

Answer 17

Austin w/ 0.062 kwire

Question 18

Name the condition:

Answer 18

Hallux limitus/rigidus

Question 19

Read the x-ray and give diagnosis. What are your three surgical correction options?

Answer 19

Hallux limitus.

Keller, McKeever, Implant

Question 20

Name the procedure. Who would you perform this on? Describe post op course.

Answer 20

Keller arthroplasty w/ 0.062 kwire

Old people with low activity levels!

Surgical shoe WB 4wks

Question 21

What are you looking at?

Answer 21

Hemi MPJ implant- metal (titanium?)

Question 22

What are you looking at?

Answer 22

Silicone total implant with gromets

Question 23

What is this complication?

Answer 23

Stress fracture from transfer metatarsalgia

Question 24

What is this complication?

Answer 24

Subchondral cysts

Question 25

What is this complication?

Answer 25

Implant fracture

Question 26

What is the pre-op diagnosis (left?) Correction? Other options for correction?

Answer 26

Pre-op: hallux varus Correction: temporary fixation with a 0.062 kwire Other options: * Soft tissue: tendon transfer (lateralize the EHL/EHB), supplemental suture, temporary fixation (pictured) * Bone: REVERSE bunion procedures--\> reverse Reverdin, Austin, usually stick with distal procedures * Hallux IPJ procedures--\> reverse Akins, hallux IPJ arthrodesis, usually following sesamoidectomy * Salvage procedures--\> implant, resection arthoplasty (Keller), 1st MPJ or IPJ arthrodesis

Question 27

Read the pre-op xray (A). What procedure was done to correct this (B)? What must be accomplished when removing the cartilage?

Answer 27

(A) Hallux varus (B) McKeever fusion with 2 crossed 4.0 partially threaded canulated screws Must pass through the subchondral plate when removing cartilage Joint prep techniques: end-to-end resection (can lead to shortening), currettage (not effective according to Johnson et al 2009), power burr/rasp

Question 28

What procedure was done here? What are some soft tissue adjuvant procedures that are done to assist muscle balance with this procedure?

Answer 28

Keller arthroplasty w/ a single 0.062 kwire through the first MPJ Muscle balance options: EHL lengthening, EHB transection, suture FHL/FHB through plantar drill holes. (This is because we lose the insertion points for EHB and FHB with the removal of the phalanx base) Dead space: purse string suture through joint capsule

Question 29

How would you maintain the space at the surgical joint? What is the post-op course of this procedure? Possible complications?

Answer 29

Interpose the capsule to use as a biological spacer, perform muscle balance procedure. WBAT in surgical shoe, 4wks; pull pin at 4wks Complications: apropulsive gait, loss of digital control/stability, overload the 2nd MPJ

Question 30

Read the xray. What procedure and fixation would you do?

Answer 30

Mild IM, \*mildly\* increased PASA--\> modified McBride w/ Reverdin-Green using a 2.7 cortical screw

Question 31

What procedure was done here?

Answer 31

Juvara modification of CBWO and Proximal Akin w/ monofilament wire

Question 32

Read the xray. What procedure(s) and fixation would you do?

Answer 32

Austin (60 degree wings) w/ 1 2.7 cortical screw

Question 33

What are the main iatrogenic causes of Hallux varus?

Answer 33

* Staking of the 1st met head (overaggressive bunionectomy) * Removal of fibular sesamoid (leads to soft tissue imbalance) * Overaggressive correction of IM angle or HAb angle (now negative) * Overaggressive lateral release/tightening of medial capsule * Overaggressive bandaging

Question 34

Read the xray. What procedure(s) and fixation would you do?

Answer 34

Severe IM angle, increased PASA and HAb angle Juvara modification of CBWO w/ a 3.5mm cancellous compression screw and 2.7mm cortical anchor screw Reverdin Green to correct PASA w/ a 2.7 cortical screw

Question 35

Read the xray.

Answer 35

1st MPJ is subluxed and hypertrophy of medial eminence. Moderate IM angle, Met adductus present, increase in PASA and HAb True IM would probably show IM at severely increased, so we would do a Juvara mod of CBWO w/ 3.5 cancellous compression screw and 2.7 cortical anchor screw

Question 36

What procedure(s) were done here?

Answer 36

OBWO, Reverdin-Green(?), and Proximal Akin