ABFAS FOREFOOT EXAM | QUESTIONS & ANSWERS (VERIFIED) | LATEST UPDATE | GRADED A+

1 ABFAS FOREFOOT EXAM | QUESTIONS & ANSWERS (VERIFIED) | LATEST UPDATE | GRADED A+ Kalish Vs Austin Correct Answer: Kalish 55o Austion 60 allows screws fixation Youngswick Correct Answer: shorten and plantarflexes**for met elevatus Distal metaphyseal JUVENILE osteotomies Correct Answer: Austin, offset v, reverdin, mitchell, wilson and peabody. Mitchell and wilson SE including shortening, transfer lesions, elevatus, metatarsalgia Reverdin --->do if theres a ton of lateral deviation of head cartilage=INCREASE PASA. fix with buried k wires, absorbable pins, monofil wire. You can also do the reverdin in combo with logriscino (prox osteotomy)=DOUBLE OSTEOTOMY Bunion procedures if IM is 15+ in juvenile Correct Answer: Base procedure aka proximal metaphyseal osteotomy. 2 -closed or open base wedge, cresentic procedure, lapidus =goal to make first and 2nd mt parallel without damaging the open physeal plate. Where do you fix PASA vs DASA Correct Answer: 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 FIxes PASA Correct Answer: "DROP like Atl" DRATO Reverdin Offset V with rotation Peabody Austin biocorrectional Postion of 1st MPTJ Fusion 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 3 the hallux nail should face upward with no frontal plane rotation, in alignment with the second digit transversely, and just off of the weightbearing surface of a loading plate in the sagittal plane. There are certain consequences that can occur if appropriate positioning is not performed. Too much plantar flexion can cause an increase in stress to the hallux interphalangeal joint, and too much dorsiflexion can make shoe fitting a challenge as well as cause less hallux purchase during gait until late propulsion. Incorrect positioning in the transverse plane could lead to second digit irritation laterally or shoe irritation medially, and frontal plane deviation can cause pain due to overloading of the interphalangeal joint condy Suture material Absorbable (e.g. Vicryl (polygalactin 910), chromic gut) Degraded in tissue in less than 60 days Traditionally used for closure of subcutaneous tissues Non-absorbable (e.g. Ethilon (nylon), silk, Prolene (polypropylene) Lasts longer than 60 days Traditionally used for skin closure Monofilament (e.g. Prolene (polypropylene), plain gut) Made of one strand of material Correct Answer: Abs vs nonabs sutures Multifilament (e.g. Vicryl Rapide (polygalactin 910), silk) 4 Made of multiple strands woven together in a braid More friction when pulled through tissues, however this adds greater security to knots than monofilament Greater risk for inflammation and infection than monofilament (Masini 2011) Correct Answer: monofilament vs. multifilament Natural (e.g. silk, chromic gut) Made of organic materials Traditionally more inflammatory than synthetic materials Synthetic (e.g. Ethilon (nylon), Vicryl (polyglactin 910)) Made of laboratory manufactured material Correct Answer: Synthetic vs non synthetic sutures it courses from medial mal to foot innervates medial and dorsal foot stops at: hallux Correct Answer: Saph nerve terminal branches Lat calcaneal branch lat dorsal cutaneous nerve **suppiles lateral foot Correct Answer: Sural Nerve terminal branch 5 MDCN-1,2,3(medial only) IDCN-5.4.3(lateral only) Correct Answer: Superficial Peroneal Nerve The superficial peroneal nerve or superior fibular nerve, innervates the peroneus longus and peroneus brevis muscles and the skin over the antero-lateral aspect of the leg along with the greater part of the dorsum of the foot (with the exception of the first web space, which is innervated by the deep peroneal nerve). Correct Answer: Innervation of Superficial Peroneal nerve Iv anesthetic, adrenal insuff Correct Answer: SE Etomidate HR - no motion HL decreased from N55-60 normal Correct Answer: HL vs HR a. Joint distraction of the 1st MTPJ via an external fixator. b. Joint function is restored by stretching of periarticular soft tissue structures, which increased functional ROM; intra-articular mechanical stress of the phalanx and MT head are also decreased by increasing the total joint space while the distractor is on. c. Indications: Any patient with symptomatic HL can be Correct Answer: I. Arthrodiastasis for the 1st MTPJ: 6 i. Should only have minimal erosive or degenerative changes with limited DF contraindications Deformity of the 1st metatarsal, i.e. metatarsal elevation Correct Answer: when to consider cheilectomy alone. when not to do it I. Distal Metatarsal Osteotomies: a. Primarily used to help decompress the joint and can be used if the patient has mild or minimal metatarsal primus elevatus. i. Can shorten, plantarflexion, and rotate the capital fragment if dorsal articular cartilage is absent Correct Answer: Distal Metatarsal Osteotomies: 1. mildly shortens the 1st MT. tx metatarsus elevatus 1. Decompresses joint space but does not correct structural elevation within the MT removing wedge* 7 reducing content of the capsular tissue, relaxing the periarticular soft tissue and permitting increased ROM, Correct Answer: Waterman*Dorsally based CW that derotates intact articular cartilage dorsally *Removal of trapezoidal wedge of bone from the 1st metatarsal head with its base dorsally. 1. Removes small section of bone to provide more dramatic relaxation of the flexor apparatus. Goal of procedure is to provide enough shortening tension off flexor structures +displace the 1st met head plantarly No actual rotation of cartilage occurs. Correct Answer: a. Modified Green-Waterman Osteotomy central MT head, Dorsal arm is perpendicular to the long axis of the 1st MT; second dorsal arm is parallel to the first **remove bone/ shortening. Indications: Hallux limitus with increase in IMA 8 i. Dorsal cuts must be parallel to prevent toggling of the OT site. Correct Answer: Austin and Youngswick Two parallel cuts are made dorsally to the Austin Chevron removing a segment of bone; Can also place two blades in the sagittal saw to make one pass with two parallel cuts. i. Useful because position of MT plantarflexion can be adjusted, allows additional elongation or shortening without affecting the IMA. ii. Arms of the OT exit distal laterally and proximal medially, and repositioning can be pure transposition, rotation, or a combination. Be aware of risk of troughing due to diaphyseal placement- prevent this by performing some rotation Correct Answer: a. Oblique Sagittal Base and Sagittal Z Osteotomies: Should be considered in patients with Hypermobility. Wedge resection can address metatarsal position and length2mm wedge resection at the joint level produces 1cm of PF at the MT head. 9 Complications: nonunion, shorten Correct Answer: Lapidus Arthrodesis: If take out 2mm wedge resection, how much PF at the head? Complicx? a. Kessel-Bonney Osteotomy: i. Resection of dorsally-based wedge of bone from the base of the proximal phalanx of the hallux. Hallux OTs may be most useful in adolescent patients. b. Regnauld, Vanore, and Sagittal Z Procedures: i. Regnauld: Remove base of proximal phalanx of the hallux, resecting a cylinder of bonapprox 1/3 of the proximal phalanx is removed from the base of the joint. Correct Answer: Hallux osteotomies Kessel Boney Reginald Relieve joint tension by shortening the proximal phalanx. inserts into the flexor plates of the MTPJs through digitations. Release of the medial band of the plantar fascia can provide notable increase in ROM - 10 Correct Answer: Distal insertion of the plantar fascia a. Painful arthritic joints deemed non-salvagable i. HR (stage III and IV) , HL, Post-surgical arthrosis and/or chronic joint pain, HAV with degenerative arthritis ii. Athrosis of 1st MTPJ secondary to arthritides, for example RA iii. Post-traumatic arthrosis Correct Answer: When to perform First Metatarsophalangeal Joint Arthroplasty i. Poor bone stock (i.e. RA, gout- will not retain implant) ii. Poor soft tissue coverage iii. Joint Infections/Osteomyelitis Correct Answer: Contraindications for Keller a. created biomechanical impairment of 1st MTPJ, which resulted in unfavorable outcomes in younger/active population b. Keller procedure now advocated for older population with increased 1st IM angle and poor bone stock, limited gait requirements, circulatory compromise, severe 1st MTPJ DJD, infection, or osteomyelitis, metabolic disease (gout) a. Morbidities: Hallux extensus (failure to preserve or reattach FHB),DJD, lesser metatarsalgia, apropulsive gait, dorsal hallux irritation, frontal plane deformities, shortened hallux, and cosmetic problems 11 Correct Answer: Why is Keller bad? a. Will decrease pain, improve ROM, decrease IM angle, decrease HAA and valgus rotation, decrease heloma molle formation, increase gait pattern and allow for greater variety of shoe gear Correct Answer: importance of joint arthroplasty ? does it fix IM? 1. During late stance- and toe off the FHB and PL stabilize the hallux against the 1st MT head in preparation for propulsion, if these tendons lose function, stabilization of the hallux and its ability to resist GRF will be altered. Correct Answer: How does effect of cutting tendon of FHB and PL and stability? i. Surgical shoe for 3 weeks, FWB. ROM from immediately following surgery for the next 3-6 months; Correct Answer: I. Hemimetatarsal Implant Arthroplasty: NO resection of the Base of PP (instead cheilectomy is performed here as needed). post op Postoperative Course: Ambulation immediately following surgery in surgical shoe with transition to normal shoe gear at 3 weeks. Correct Answer: I. Double Stem Hinged Silicone Implant Athroplasty Swanson Implant 12 only if IM normal 0-8 the FHB needs to be reattached to the base of the proximal phalanx. normal shoe gear at 3 weeks. ROM from day of surgery through the first 3-6 months after surgery Correct Answer: I. Total Joint Replacement Arthroplasty a. Involves resurfacing on both sides of the joint; resurfacing of the phalangeal base has been more successful. Severe or recurrent Hallux Valgus, failed Implant arthroplasty, hallux varus, primary 1st MTPJ osteoarthritis, posttraumatic arthritis, inflammatory or septic arthritis, neuromuscular conditions affecting the first ray Correct Answer: When to fuse 1st MPTJ Greater propulsive strength NoAdditional osteotomy Bone fixation and immobilization required More rigid and permanent correction 13 , no bone shortening The hallux and the MTPJ cannot migrate or drift out of position, HOWEVER, cannot adjust malalignments post-operatively Potential for painful delayed union/non-union/malunion Correct Answer: 1st FUSION**,, vs arthroplasty Weaker hallux for propulsion need first metatarsal osteotomy in conjunction with arthroplasty No immobilization necessary postoperatively (no bone healing required) More flexibility, can permit a wider selection of shoe choices Potential for progressive shortening Can lead to loss of hallux purchase, sagittal plane extensor or flexor contracture, and transverse plane hallux valgus or varus malalignments Correct Answer: 1st Athroplasty** vs Fusion 14 The sesamoids are generally not arthrodesed to the metatarsal head, but this may be considered if significant pain or deformity is noted preop Correct Answer: sesomids during 1st MPJ fusion? i. Slightly dorsiflexed away ii. Parallel but not touching the second toe in the transverse plane ** the position of the second toe should be established first if also doing 2nd HT correction Correct Answer: position of 1st MPJ fusion Weight bearing forces evert the foot laterally as the hallux prematurely contacts the ground through the later phases of gait. a. Calluses develop at the plantar hallux IPJ and head of the fifth metatarsal b. An elongated hallux relative to the lesser toes will behave in the same way as an overly plantarflexed hallux Correct Answer: Plantarflexed hallux position:in fusion results in the hallux plantarflexing at the IPJ to aid in balance** a. Painful and rigid hammered hallux combined with adductory lesser digital malalignment b. dorsiflexed hallux 15 Correct Answer: Dorsiflexed hallux position:during fusion