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Bunionectomy

Orthopedic Procedures Operative Sequence. Bunionectomy. Foot - Anatomy -. Foot - Anatomy -. Bunionectomy. Overall Purpose of Procedure :

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Bunionectomy

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  1. Orthopedic ProceduresOperative Sequence Bunionectomy

  2. Foot- Anatomy -

  3. Foot- Anatomy -

  4. Bunionectomy • Overall Purpose of Procedure: • The common bunion is a localized area of enlargement of the inner portion of the joint at the base of the big toe. The enlargement actually represents additional bone formation, often in combination with a misalignment of the big toe. The normal position of the big toe (straight forward) becomes outward-directed toward the smaller toes (HalluxValgus.) The enlarged joint at the base of the big toe (the first metatarsophalangeal joint) can become inflamed with redness, tenderness, and pain. A small fluid-filled sac (bursa) adjacent to the joint can also become inflamed (bursitis) leading to additional swelling, redness, and pain.

  5. Bunionectomy • Bunions are most often caused by an inherited faulty mechanical structure of the foot. It is not the bunion itself that is inherited, but certain foot types that make a person prone to developing a bunion. • Although wearing shoes that crowd the toes won't actually cause bunions in the first place, it sometimes makes the deformity get progressively worse.

  6. Bunionectomy- Anatomy -

  7. Bunionectomy- Anatomy -

  8. Bunionectomy - Approaches • Austin Bunionectomy: This is the most common type of bunionectomy involving cutting the first metatarsal bone at the "head" and fixing the cut with a screw. There are other names for this type of bunionectomy including tricorrectional, chevron, etc. Typically, patients are able to put some weight on the heel of the operated foot immediately post-operatively. • Lapidus Fusion: This procedure is typically reserved for the more severe bunions and involves fusing the first metatarsal bone to the medial cuneiform bone. Recovery from this surgery is much more prolonged, requiring strict non-weight bearing with a cast for 6-8 weeks after surgery. • http://www.youtube.com/watch?v=aW17Eda291U • Fusion (arthrodesis) of big toe joint: Fusion of the bunion joint is for severe osteoarthritis.

  9. Bunionectomy - Approaches • McBride Bunionectomy: removal of bone and repositioning of tendons. • Keller Bunionectomy: Removal of part of the big toe joint. This procedure is performed mostly in older patients. • Silver Bunionectomy: Simple shaving of the bunion "bump." This procedure can only be done in minor bunion cases.

  10. Bunionectomy • A less common bunion is located at the joint at the base of the smallest (fifth) toe. This bunion is sometimes referred to as a tailor's bunion.

  11. Bunionectomy • Define the procedure: • A dorsal incision is made from the proximal phalanx to beyond the neck of the metatarsal. • Removal of excess bone and realign the great toe.

  12. Bunionectomy • Wound Classification: 1

  13. Operative Sequence • 1- Incision • 2- Hemostasis • 3- Dissection • 4- Exposure • 5- Procedure (Specimen Collection possible) • 6- Hemostasis • 7- Irrigation • 8- Closure • 9- Dressing Application

  14. Bunionectomy • Instrumentation: Minor Bone tray • Positioning: The patient is in supine position, arms on arm boards. Foot, Ankle or Calf on bump. • Prepping: Surgeon preference. Duraprep, Hibiclense or a Betadine Prep Kit. Prep from tourniquet to distal metatarsals, circumferentially. • Draping: Some surgeon like a sterile towel around the tourniquet, held in place with a towel clip. U-drape and an extremity drape.

  15. BunionectomyBegin your Operative Sequence • Incision: • 15 kb on #3 handle for incision. • Some surgeons like multiple 15 kb’s for this procedure. Be prepared for this.

  16. Bunionectomycont. Operative Sequence • Hemostasis: Handheld Bovie and hemostats.

  17. Bunionectomycont. Operative Sequence • Dissection and Exposure: • Metz, Adsons. • Small Weitlander • Senn Rakes

  18. Bunionectomycont. Operative Sequence • Exploration and Isolation: • Apply plantar pressure to provide flexion of great toe.

  19. Bunionectomycont. Operative Sequence • Surgical Repair/Removal/Specimen Collection: • Depend on type of approach. • Bone can be shaved off with small drill. • Metarsal can be cut with TPS saw and held in straight position with small screws. • Ligaments can be lengthened (Z lengthening) • Have rasp available to smooth bone. • May have to make multiple incisions. • Bunion Vid

  20. Bunionectomycont. Operative Sequence • Hemostasis and Irrigation: • All bleeding is controlled with cautery. • Use of warm Saline to irrigate. • Take emeses pan with you.

  21. Bunionectomycont. Operative Sequence • Closure: • Small subcuticular stitch – 4-0 Vicryl • Skin is closed with surgeons choice of suture or staples.

  22. Bunionectomy • Major Arteries: • Ant. Tibial Artery

  23. Bunionectomy • Major Veins: • Greater Saphenous vein • Major Nerves: • Plantar

  24. Orthopedic ProceduresOperative Sequence Hammer Toe

  25. Hammer Toe • Overall Purpose of Procedure: • A hammer toe is a deformity of the second, third, or fourth toe causing it to be permanently bent at the proximal interphalangeal joint, resembling a hammer. Mallet toe is another name for this condition when affecting the distal interphalangeal joint.

  26. Hammer Toe- Anatomy - • A Flexible Joint • You can straighten a flexible hammer toe with your fingers. Although they look painful, flexible hammer toes may not hurt. • A Rigid Joint • A rigid hammer toe cannot be moved, even with the fingers. Rigid joints may cause pain and distort foot movement. This may put extra stress on the ball of the foot, causing a callus (a corn on the bottom of the foot).

  27. Hammer Toe

  28. Mallet Toe

  29. Claw Toe

  30. Hammer Toe • Define the procedure: • Resect the joint, release the soft tissue (ligaments) and place K-wire through joint.

  31. Hammer Toe • Wound Classification: 1

  32. Operative Sequence • 1- Incision • 2- Hemostasis • 3- Dissection • 4- Exposure • 5- Procedure (Specimen Collection possible) • 6- Hemostasis • 7- Irrigation • 8- Closure • 9- Dressing Application

  33. Hammer Toe • Instrumentation: Minor Bone tray • Positioning: The patient is in supine position, arms on arm boards. Foot, Ankle or Calf on bump. • Prepping: Surgeon preference. Duraprep, Hibiclense or a Betadine Prep Kit. Prep from tourniquet to distal metatarsals, circumferentially. • Draping: Some surgeon like a sterile towel around the tourniquet, held in place with a towel clip. U-drape and an extremity drape.

  34. Hammer ToeBegin your Operative Sequence • Incision: 15 kb on #3 handle for incision. • Some surgeons like multiple 15 kb’s for this procedure. Be prepared for this.

  35. Hammer Toecont. Operative Sequence • Hemostasis: Handheld Bovie and hemostats.

  36. Hammer Toecont. Operative Sequence • Dissection and Exposure: • Metz, Adsons. • Small Weitlander • Senn Rakes

  37. Hammer Toecont. Operative Sequence • Exploration and Isolation: • Apply plantar pressure. • Senns or single tooth skin hooks.

  38. Hammer Toecont. Operative Sequence • Surgical Repair • The long extensor muscle, called the extensor digitorumlongus (EDL), originates in the anterior leg. The EDL descends the leg crossing the ankle and continuing on to the tips of the toes. The EDL extends or lift the toes. • Excision of the EDL. • Resection of the articulating joint with a small saw. • The edges of the joint are lined up and a k-wire is run through the end of the toe, fusing the joint. • Reattachment of the EDL with suture like Supramid.

  39. The procedure: • http://video.google.com/videoplay?docid=6877045315990173103&ei=qtK3San_OZ-G_AGhnN2EBA&hl=en • Post Op Vid: http://www.youtube.com/watch?v=VfCj_KX6h3w

  40. Hammer Toecont. Operative Sequence • Hemostasis and Irrigation: • All bleeding is controlled with cautery. • Use of warm Saline to irrigate. • Take emeses pan with you.

  41. Hammer Toecont. Operative Sequence • Closure: • Small subcuticular stitch – 4-0 Vicryl • K-caps. • Skin is closed with surgeons choice of suture or staples.

  42. Orthopedic ProceduresOperative Sequence ORIF Ankle

  43. ORIF Ankle- Anatomy -

  44. ORIF Ankle- Anatomy - • The leg bones form a scooped pocket around the top of the anklebone. This lets the foot bend up and down. • Right below the ankle joint is another joint (subtalar), where the anklebone connects to the heel bone (calcaneus). This joint enables the foot to rock from side to side. Three sets of fibrous tissues connect the bones and provide stability to both joints. The knobby bumps you can feel on either side of your ankle are the very ends of the lower leg bones. The bump on the outside of the ankle (lateral malleolus) is part of the fibula; the smaller bump on the inside of the ankle (medial malleolus) is part of the tibia.

  45. ORIF Ankle • Overall Purpose of Procedure: • To stabilize the ankle so the patient can regain function of their foot.

  46. ORIF Ankle - Before

  47. ORIF Ankle - Before

  48. ORIF Ankle – How it happens • Skate Boarding • Ankle break

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