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23 Cards in this Set
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- Back
- 3rd side (hint)
Generally speaking, when performing SX on a mild bunion, you ONLY perform a ______________ procedure without a metatarsal osteotomy.
However, if you are doing a metatarsal osteotomy, you would use a MODIFIED McBride procedure. |
Generally speaking, when performing SX on a mild bunion, you ONLY perform a ___Soft Tissue___ procedure without a metatarsal osteotomy.
However, if you are doing a metatarsal osteotomy, you would use a MODIFIED McBride procedure. |
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Pre-operative symptoms that would indicate a need for a Soft tissue procedure would include>>
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Bump pain
Medial pain with shoe gear Medial skin & soft tissue irritation over the 1st metatarsal head NO sesamoid or deep pain |
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Pre-Op radiographic signs for Soft tissue procedures are:
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The angles should be WNL
IM angle should be 9-10* |
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Describe the operative technique for the soft tissue procedure, the Silver:
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Incision (dorso medial?)
Capsulotomy Resection of bump Closure |
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Post operative course for all soft tissue procedures:
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2 weeks in a SX shoe
Sutures off in 14 days Sneaker 2-4 weeks Post-op x ray on 1st visit ROM exercises |
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What is the major disadvatanges to doing a Silver?
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-Doesn't correct etiology of HAV
-Weakening medial structures (hallux abductus) -Recurrence (COMPLICATION) -Joint stiffness (COMPLICATION) |
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A true McBride bunionectomy includes:
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REMOVING FIBULAR SESAMOID (gives you more aggressive lateral release)
-Possible Adductor Transfer (lateral release will include release of conjoined adductor tendon, capsulotomy, fibular sesamoid ligament) |
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Lateral release will include release of what 3 structures:
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conjoined adductor tendon
capsulotomy fibular sesamoid ligament |
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A modified McBride does not include what steps:
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Removal of fibular sesamoids
Adductor transfer |
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What are the steps to a McBride (full)
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Incision
Capsulotomy Resection of bump Lateral Release Excision of fibular sesamoids Adductor transfer Medial capsulotomy Closure |
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What is staking in relation to this radiograph?
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Taking too much of the bump off, where the medial facet becomes compromised.
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For a Modified McBride the IM angle should be?
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Up to 10*
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For a Silver, the IM angle should be?
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NORMAL 8*
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Describe the Hiss Procedure
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Dorsal transfer and advancement of the abductor hallucis tendon.
Attach the tendon to the base of the prox phalanx to hold the toe straight. |
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What are the skin incisions for bunionectomies?
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Longitudinal (curved to straight): gives ADEQUATE exposure to joint, and allows you follow everything in the same plane
Medial incision (problem is it takes longer to get back into shoe) |
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The medial elliptical incision is not a good idea b/c:
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All the vascular structures are located there!
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Describe the mini tightrope procedure.
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Relocates the 1st and 2nd met to a normal IM angle without the use of an osteotomy using a drill hole technique
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Usually uses a C arm. mark the medial aspect of the 2nd met, where u want to make your accessory incision.
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What is the suture used in the Mini Tight Rope procedure?
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Fiberwire-- which is a polyester suture with a polyethylene core.
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The complications seen w/ the Mini Tight rope are:
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Splaying b/c the fiberwire stretches
Continuing pain Bone fx (2nd met) |
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Name some capsulotomies (specifically medial types)
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Vertical Incision
H incision U shaped I shaped L shaped (dorsomedial inverted) |
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What kind of dorsolinear capsulotomy is this?
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Washington monument.
Strongest capsulotomy. |
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The exostectomy is also referred to as:
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The Schede procedure (1980)
It removes the bump & Assists in tightening the medial capsule. |
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What is the difference between capsuolotomy & capsulorrhaphy?
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capsulorrhaphy is actually removing a piece of the capsule in order to aid in tightening.
Uses osteome and mallets. Power equipment. |
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