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McGlamry Part II

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ajkim1's version from 2015-05-02 20:49

Section 1

Question Answer
What is an Austin bunionectomy (in broad terms)?V-shaped osteotomy placed medial to lateral in the head of the 1st MT
Where is the apical axis guide placed in an Austin bunionectomy?Centrally in the MT head
What dictates a strong construct in an Austin bunionectomy?Fixating the plantar arm of the osteotomy with screw fixation
What size K-wire do we use in an Austin bunionectomy?0.045 in
How do we lengthen the capital fragment?Direct the K-wire proximally
How do we maintain the length of the capital fragment?Direct the K-wire perpendicular to the long axis of the 1st MT
How do we shorten the capital fragment?Direct the K-wire distally
What's the purpose of a gentle distraction force on the hallux?Easy lateral translocation of the capital fragment
What patient factors are dependent in fixation?Bone quality, metal allergy, and surgeon preference
What size K-wire for the initial path of the screw?0.062 in
How do we direct the K-wire?Perpendicular to the plantar arm of the osteotomy on the lateral view and aimed toward the crust between the sesamoid articular surfaces in the dorsoplantar orientation (proximal-dorsal to distal-plantar)
How do we drill after screw placement?Pilot hole is establish with under" drill or lesser drill bit
What's the purpose of a countersink?Creates a space for seating the land of the screw head, weakens the dorsal cortex preventing stress riser formation and increasing the compressive surface area for the screw upon engagement
Why do we use a depth gauge?Measure the screw length to ensure that the screw wasn't long enough to enter the joint and irritate the sesamoids
What's the purpose of a longer dorsal arm?Corrects larger IM angles, increases axial and transverse plane stability of the osteotomy
Where is the axis guide placed in a longer dorsal arm?Below the midpoint of the MT head to afford a firm site for screw fixation
What's the order of execution in longer dorsal arm?Dorsal osteotomy then the plantar arm
What type of patients do we perform the longer plantar arm?Larger, heavier patients who will have difficulty off-loading the operative site during the recovery period
Where is the axis guide placed in a longer plantar arm?Superior to the midpoint of the MT head
What is notable about the long dorsal and plantar arm procedures?Fixation is allowed with 2 or more screws
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Section 2