Answers | Verified | Updated
Diastasis for Lisfranc = a fracture is present - Correct
Answer-2-5 mm of diastis betwen 1st and second mt base
Chronic lisfrancs--->ct=1 mm diastasis betwen 1st and 2nd
mt or an increase of more than 15 degrees in the tarso-
metatarsal joint
signs of lisfranc on xray - Correct Answer-fleck sign (1 and 2
met bases)
first ray elevated
arch flattens
MCC direction lisfranc displaces - Correct Answer-Dorsal
and Lateral
,When to sx correct lisfranc - Correct Answer->2mm
displaced
wait 14 days if too much edema
Approach to ORIF lisfranc fx - Correct Answer-middle cunii
start proximal superior medical >to the base of the 2nd mt
possibly, 3rd mt.
the first lag screw=KEY to REDUCTION. T
if needed do a few more lag screws from the the bases
metatarsals >cuni.
If cuni instability **screw across the
cunis.communition=plates.
Rules for bunions in the Juvenile pt - Correct Answer-14-16
yrs. Ideal time frame to do sx for them is near skel. Maturity
11-15 yoa.
Don't do anything joint destructive /don't remove the fib
sesamoid.
take mt adductus into consideration in a peds patient.
,Transpositional osteotomies ideal e.g. austin, kalish, offset V
for rectus foottype and mod. IMA. But if they have Mt
Adductus, really high IM or really high PASA
Distal metaphyseal peds osteotomies - Correct Answer-
Austin, offset v, reverdin, mitchell, wilson and peabody.
Mitchell and wilson SE including shortening, transfer
lesions, elevatus, metatarsalgia
How to fix bunion in a peds pt with IM >15 - Correct
Answer-Base procedure aka proximal metaphyseal
osteotomy.
-closed or open base wedge, cresentic procedure, lapidus
=goal to make first and 2nd mt parallel without damaging
the open physeal plate.
base of proximal phalanx (aka proximal akin) of hallux what
does it correct - Correct Answer-Distal Angle DASA
Fix pasa with mt head osteotomy like REVERDIN=lat
cortex intact proximal cut parallel to 1st mt and distal cut
parallel to articular surface
Fix DASA W/ proximal akin
, disadvantage of the fusion vs plasty is the - Correct Answer-
fusion has less hallux propulsion and it can shorten which
can then lead to contracture of the ehl or fhl
You can walk it immediately vs plasty you cant
cancellous vs cortical screws - Correct Answer-Cannulated
cancellous screws are used for metaphyseal fractures while
cannulated and noncannulated cortical screws are used as lag
screws for fixation of diaphyseal fractures.
The main advantage of cannulated screws is that they can be
inserted over a guide wire or guide pin. The diameter of the
guide pin is much smaller than the cannulated screw
Cannulated screws have a hollow central shaft. Both cortical
and cancellous screws can be cannulated.
1st MPJ arthrodesis position - Correct Answer-neutral
rotation of the hallux,
10-15 degrees of valgus
20-30 degrees of dorsiflexion in reference to the axis of the
first metatarsal