Procedures
Indications
Procedures
Pot Pourri
Name that procedure!
100
Describe the Peabody procedure.
same procedure as a Reverdin (distal cut is parallel to joint surface and proximal cut is made perpendicular to long axis of 1st met and lateral cortex is left intact) except the osteotomy is performed at metatarsal neck to avoid sesamoids.
100
What are the indications for a Reverdin procedure?
-increased PASA* -IMA: <8 deg -congruous or deviated 1st MPJ
100
Describe the Hohmann procedure.
It is a historical procedure that removes a trapezoid wedge at anatomic neck of metatarsal. the capital fragment is transposed laterally and depressed plantarly.
100
What is the major complication of the Reverdin osteotomy? (and why?) Hint: Think about what the Reverdin procedure is. Bonus 100 pts: What procedure protects against this complication? Explain how it does so.
What is seamoiditis? Bonus: Reverdin-Green creates a plantar shelf that is made parallel to WB surface to protect the sesamoids.
100
This procedure involves a distal cut on the the 1st met head parallel to the joint surface followed by a proximal cut to the long axis of the 1st metatarsal, leaving the lateral cortex intact.
What is Reverdin?
200
Describe the Reverdin-Green-Laird procedure.
Reverdin + plantar shelf (Green) + medial closing wedge osteotomy going through the lateral cortex. the capital fragment is transposed laterally to close down IMA.
200
What are the indications for a Reverdin-Laird procedure?
What is abnormal PASA and increased IMA
200
Describe the traditional scarf procedure.
a Z osteotomy in the diaphyseal and metaphyseal bone 3 cuts: primary osteotomy is longitudinal and 2 shorter arms exit distal-dorsal and proximal-plantar
200
How many times stronger is the inverted scarf procedure compared to the traditional scarf?
What is 1.6x stronger
200
Which procedure CANNOT correct for any frontal plane deformities?
What is Austin procedure?
300
What is the Wilson procedure?
oblique osteotomy on metatarsal head; slide the capital fragment laterally.
300
What are the indications for a Mitchell procedure? Bonus 100pts: Describe the Mitchell procedure.
Mitchell: transpositional, step-down osteotomy Indications: -metatarsus elevatus* -increased IMA (9-14 deg) -long 1st met
300
What is the purpose of unicorrectional, bicorrectional, and biplane Austin?
unicorrectional- reduces IMA only bicorrectional- reduces IMA and PASA biplane- reduces IMA and plantarflexes met
300
Which procedure is inherently unstable and hard to fixate due to the nature of it being a transverse osteotomy across the met head?
What is Capp procedure?
300
Name the oblique diaphyseal osteotomy that is oriented dorsal-proximal to plantar-distal.
What is Ludloff procedure?
400
Describe the Youngswick modification of Austin procedure and its significance.
(Austin: horizontal V osteotomy w/ apex in central met head; angle of apex is 60 deg traditionally) (Youngswick modification: make a chevron cut; make a second dorsal cut and remove rectangular wedge of bone to shorten the met to allow for plantarflexing and shortening of the met)
400
What are the indications for a Reverdin-Todd procedure?
-addresses PASA -increased IMA -elevated met head
400
Describe the Roux procedure.
like an angulated Mitchell; trapezoid osteotomy
400
What are the indications for a silver bunionectomy?
good in geriatric population that might not be good surgical candidates for other procedures
400
This procedure is similar to the Reverdin but instead is a dorsal wedge osteotomy out of the 1st met head that has an angulated cut to protect sesamoids but is instead used to correct hallux limitus.
What is Watermann-Green procedure
500
Describe the Kalish modification of Austin and its significance.
changed the apex of the 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.
500
What are the indications of an Austin procedure?
-increased IMA (9-15 deg) -mild to moderate HAA -variable met length -congruous to deviated 1st MPJ
500
What is the Reverdin-Todd procedure?
medial closing osteotomy + plantar shelf + resection of bone to plantarflex joint surface
500
Name and explain the 2 metatarsal head osteotomies for HAV.
1. Silver bunionectomy - partial ostectomy of the 1st met head (removes the bump) but does not correct etiology 2. McBride bunionectomy- removal of medial eminence, release/transfer of ADH tendon into medial met head, removal of fibular sesamoid
500
Explain the concept of troughing and which procedure is it mostly seen in?
One cortical edge falls into the medullary canal of the other segment Results in elevation of the capital fragment Seen more with transpositional than rotational SCARF
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