On physical exam, he is noted to have a foot drop and decreased sensation globally throughout his entire lower leg. He denies any hip or thigh pain prior to this fall. Web(OBQ20.108) A 21-year-old recreational hockey goalie presents to your clinic with 6 weeks of right hip and groin pain. Although other classi-cation systems have been described [1517, 19, 25], two are in most common use: the AO/OTA and Schatzker systems [11]. What is the best treatment option? She was noncompliant with her immediate postoperative weight-bearing instructions and went on to fixation failure. (SAE07HK.49) Dynamic fluoroscopic examination of the hip under anesthesia. Treatment depends on the degree of angulation and is surgical if angulation remains greater than 30 degrees after closed reduction is attempted. A 34-year-old male presents with the right posterior wall acetabular fracture shown in Figure A. Clipboard, Search History, and several other advanced features are temporarily unavailable. What is the most appropriate definitive treatment for this patient? complications. Vancouver B1; ORIF with a lateral locking plate, Vancouver C; revision of femoral stem from hip component, Vancouver C; retrograde intramedullary nail, Vancouver B2; revision to long stem total knee component, Vancouver C; ORIF with a lateral locking plate. Axial and lateral radiographs are shown in Figures A and B. (OBQ05.173) Revision to a proximal femoral replacement, Open reduction and internal fixation with proximal femoral locking plate and cerclage cables, Open reduction and internal fixation with iliac crest bone grafting, Revision to a cementless long porous-coated femoral stem. WebFreiberg's Disease is a rare foot condition characterized by infarction and fracture of the metatarsal head. Accessibility covers larger portion of articular surface. Please enable it to take advantage of the complete set of features! The broach is removed and a 1cm longitudinal crack originating at the calcar is visualized. (OBQ08.125) Examination revealed a slightly shortened left lower extremity and some mild ecchymosis just distal to the left greater trochanteric region, but his skin was intact without abrasions or lacerations. In the radiograph shown in Figure 42, the fracture pattern around this well-fixed stem is classified as Vancouver type. Acetabulum fractures are pelvis fractures that involve the articular surface of the hip joint and may involve one or two columns, one or two walls, or the roof within the pelvis. ORIF of the posterior column and THA revision, Cage reconstruction of acetabular component, THA revision using a cemented acetabular component, Placement of a hip abductor brace and non-weight bearing in the affected limb, (SAE07HK.28) He complains of pain and is unable to bear weight through the right leg. WebPediatric supracondylar fractures are one of the most common traumatic fractures see in children and most commonly occur in children 5-7 years of age, usually from a fall on an outstretched hand. Diagnosis is confirmed with MRI studies of the knee. There are concerns about her ability to maintain weight-bearing precautions following surgery. 2017 Jun 18;8(6):484-490. doi: 10.5312/wjo.v8.i6.484. 2016 Sep;7(3):126-34. doi: 10.1177/2151458516651310. Retained femoral stem with open reduction internal fixation, Revision femoral stem to an uncemented long stem with strut allograft, Revision femoral stem to a cemented long stem with open reduction internal fixation, Revision femoral stem to an uncemented long stem with open reduction internal fixation. Open reduction internal fixation with a cable plate and allograft strut, Revision to a long femoral stem with allograft bone, Revision to a cemented revision femoral stem that bypasses the fracture site by 5 cm. (OBQ11.22) The greatest distance between the humerus and the fracture fragment is measured to be 2 mm. Open reduction and cerclage fixation of the fracture, Open reduction and revision of the femoral implant to a long cemented stem, Open reduction and revision of the femoral implant to a long fluted and tapered uncemented stem, Application of balanced traction and surgery after the ecchymosis has resolved. She denies any history of dislocation or prodromal pain prior to her fall. 1999 Jun;28(6):413-20. doi: 10.1016/s0049-0172(99)80007-9. (OBQ13.136) Narvez JA, Narvez J, De Lama E, Snchez A. Eur Radiol. (SBQ11OS.20.1) suspicion for pathologic or stress fracture. (OBQ13.214) WebAll patients except one had a DEXA-scan, which revealed osteopenia in 4 and osteoporosis in 3 patients; all 7 were treated with bisphosphonates. (OBQ05.187) In the same 5 patients a diagnosis of tibial plateau fracture was made by CT-scan in 3, and by MRI-scan in 2 patients. Webfractures, the goals of treatment of tibial plateau fractures include achieving a stable knee, restoring the joint surface, and preserving functional ROM. These findings are consistent with which of the following diagnoses: 2023 Bobby Menges Memorial HSS Limb Reconstruction Course, Type in at least one full word to see suggestions list, Foot & AnkleInterdigital (Morton's) Neuroma. The post-reduction CT is seen in Figure A. (SBQ18FA.14) During intraoperative assessment, the acetabular and femoral stems are found to be well fixed. WebOther therapies available (with low-quality evidence) include iontophoresis, phonophoresis, ice massage, ultrasound therapy, periosteal pecking, and extracorporeal shockwave therapy. removal of the components, open reduction and internal fixation of the fracture, and delayed replantation of the components when the fracture is healed. Shortly after the reduction, the patient continues to have a foot drop, but his sensation is slightly improved. 2018 Jul 21;19(1):244. doi: 10.1186/s12891-018-2170-z. primary restraint to varus stress at 30 deg. WebA pattern of bone marrow edema (arrows) in the tibial plateau particularly medially is associated with a horizontal fracture line (circular dashed line) consistent with an insufficiency fracture. He sustained a ground-level fall yesterday and he is now unable to bear any weight on the right leg. fractures occur in a bimodal distribution, fracture pattern predominately determined by, position of femoral head at time of injury, most commonly seen in transverse + posterior wall fracture patterns, most commonly affects the peroneal division of the sciatic nerve, mean lateral inclination of 40 to 48 degrees, acetabulum is supported by two columns of bone, connected to sacrum through sciatic buttress, anastomosis of external iliac (epigastric) and internal iliac (obturator) vessels, at risk with lateral dissection over superior pubic ramus, most common referenced classification system, anterior column (e.g., quadrilateral plate fractures), anterior column, posterior hemitransverse, Check for injury to superior gluteal NV bundle, More common in elderly patient with fall from standing, Axial CT shows anterior to posterior fx line, Only elementary fx to involve both columns, Characterized by dissociation of the articular surface from the innominate bone, Anterior column or wall + Post. Retention of current hardware and fixation using cerclage wires, Open reduction and internal fixation with a locking plate, Both uncemented femoral revision and revision of the acetabular shell. Geriatr Orthop Surg Rehabil. MRI is sensitive to bone marrow oedema/ bone bruising, even in the osteoporotic tibial condyle. This site needs JavaScript to work properly. Physical exam is significant for pain and a palpable click with compression of the forefoot. In patients without displacement of the fracture or the cartilage, there is a role for nonsurgical management. WebTibial Stress Syndrome (Shin Splints) Nonoperative treatment is indicated for compression sided fractures with < 50% femoral neck width. Diagnosis is made clinically with tenderness over the plantar aspect of the involved webspace with a palpable neuroma and a positive Mulder's click on examination. (OBQ18.199) views. Associated injuries. 8600 Rockville Pike Overall, your doctor should not only treat your injury but also work out why you developed this injury. Operative management is indicated for patients with persistent symptoms who fail nonoperative management. Treatment is activity modification and NSAIDs in early disease. Diagnosis is clinical with a history of anterior knee pain made worse with squatting, prolonged sitting or ascending stairs and pain on patellar compression in knee extension. Web(OBQ20.15) Figure A is the radiograph of a 55-year-old female who is a poorly-controlled diabetic with neuropathy and peripheral vascular disease (PVD) that underwent ankle open reduction internal fixation (ORIF) two years ago at an outside facility. sharing sensitive information, make sure youre on a federal thought to be related to a disruption in the blood supply due to microtrauma or osteonecrosis and stress overloading. [9] 2002 Oct;16(9):632-7. doi: 10.1097/00005131-200210000-00004. The remaining five patients presented immediately after the trauma, which explains why their radiographs were still negative or only showed osteoarthritis. (SAE07HK.59) (OBQ06.51) What is the most appropriate treatment? Nonoperative. resection arthroplasty and internal fixation of the fracture. The patient has failed an appropriate course of conservative management and remains symptomatic. Delayed diagnosis can cause pain and disability to the patient and can lead to deformity of the knee joint, due to structural collapse. There was a history of trivial trauma in all patients, except one. Compared to a dorsal approach, a plantar approach is associated with: Improved clinical outcomes and patient satisfaction, Increased likelihood of complete neuroma excision. What are the fracture classification and most appropriate treatment? Which of the following statements is true? A previously healthy 68-year-old woman falls and sustains the fracture seen in Figure A. Copyright 2022 Lineage Medical, Inc. All rights reserved. A 22-year-old female is involved in a motor vehicle collision and sustains the injury shown in Figures A through D. According to these images, what is the acetabular fracture classification? A 65-year-old woman with a history of right total hip arthroplasty presents with a fall. (OBQ09.163) Epub 2002 Dec 19. Web(OBQ08.95) A 51-year-old female sustained a comminuted radial head fracture with 4 fragments and an associated elbow dislocation. Yukata K, Yamanaka I, Ueda Y, Nakai S, Ogasa H, Oishi Y, Hamawaki JI. Bookshelf reinforce with cerclage suture or wire from quadriceps tendon to tibial tubercle . A 78-year-old woman who has a history of an uncomplicated right total hip arthroplasty presents after a fall. Her THA was done 25 years ago. (OBQ04.93) (OBQ18.80) (OBQ11.155) (OBQ09.99) At what time point after the injury is there an increased risk of a poor outcome? WebPlain stress radiographs of the ankle are required to diagnosis complete syndesmosis injuries with tibiofibular diastasis. Which of the following is most appropriate for management of the femoral side? Webpost-operative passive external rotation places the most stress on the lesser tuberosity fragment. WebRadial head and neck fractures in children are a relatively common traumatic injury that usually affects the radial neck (metaphysis) in children 9-10 years of age. The corona mortis artery joins the external illiac artery with which other major artery? There is approximately one quadrant of passive medial or lateral patellar glide. Which statement is true with respect to acetabular fracture surgery as the time between injury and surgery increases? (OBQ06.180) Diagnosis is made radiographically with plain radiographs showing subchondral sclerosis, flattening of the involved MT head and eventual joint destruction in advance disease. Position of the screw cephalad to the sciatic notch, Screw starting point at the anterior inferior iliac spine, Screw starting point at the gluteal pillar, Screw position between the inner and outer tables of the ilium. (OBQ09.137) In situations where the bone or cartilage is not well aligned, surgical treatment is more often considered. A 88-year-old female fell onto her right hip sustaining the fracture shown in Figure A. She is RF negative but ANA positive. All 8 patients were treated conservatively with a cast brace, for 6 to 12 weeks, with a good result. A 67-year-old man who underwent total hip arthroplasty (THA) 4 years ago fell on to his right hip. This is an AAOS Self Assessment Exam (SAE) question. World J Orthop. (SBQ07HK.62) The radiographic finding is most consistent with which of the following? Which of the following acetabular fractures is classified as an elementary fracture pattern that involves two columns? WebTibial Plateau Fracture & Treatment | Orthopedic One Our Physicians What Hurts Services & Specialties Locations About Request Appointment For Patients For Physicians Online Bill Pay Careers Request Appointment Scott Van Steyn, M.D. The patient should be advised she is at greater risk of stem subsidence and early revision, Female sex is a risk factor for intraoperative calcar fracture, A better outcome would be expected if a long-stem diaphyseal fixation stem had been inserted after recognition of the calcar fracture, Cementless press-fit technique is not a risk factor for intraoperative fracture, Minimally invasive surgical approach is not a risk factor for intraoperative fracture. (OBQ18.196) WebTreatment can be nonoperative for non-displaced fractures but displaced injuries require anatomic open reduction and internal fixation to minimize development of post-traumatic osteoarthritis. Ultrasound reveals a well-circumscribed hypoechoic mass parallel to the metatarsals within the distal aspect of the 3rd webspace. Operative management is indicated for chronic and recurrent patellar instability. WebTreatment usually includes a period of immobilization followed by physical therapy. WebTibial Stress Syndrome (Shin Splints) Rib Stress Fracture Team Physician Team physician Exercise Science Pre-Participation Physical Ear, Eye, Mouth Injuries Nonoperative Treatment - Immobilization. MRI studies may be needed to detect early disease. ORTHO BULLETS Orthopaedic Surgeons & Providers A 40-year-old female presents with chronic left plantar forefoot pain, exacerbated by narrow-toed shoes. There is a negative Tinel's sign at the tibial nerve. A 67-year-old man 6 years status post right total hip arthroplasty falls while walking his dog. Figure A shows his radiograph upon presentation to the emergency room three hours later. Degree of displacement seen on preoperative AP pelvis view, Degree of displacement seen on preoperative Judet views, Degree of displacement seen on preoperative pelvic CT scan, Degree of displacement seen on postoperative Judet views, Degree of displacement seen on postoperative pelvic CT scan. Additional medical therapy can also include administration of prostaglandin I-1 and biphosphonates. Open reduction and internal fixation with placement of original stem, Open reduction and internal fixation with placement of a proximally coated stem, Open reduction and internal fixation with placement of a diaphyseal engaging stem, Proximal femoral replacement megaprosthesis. Evangelopoulos DS, Heitkemper S, Eggli S, Haupt U, Exadaktylos AK, Benneker LM. Complications: Recurrence common after resumption of heavy activity. Exchange of the cementless cup to a larger component, Retention of the component and bone grafting of the fracture, Retention of the component and postoperative weight protection until the posterior column heals, Removal of the cup, fixation of the posterior column, and application of an antiprotrusio cage, Removal of the cup and cementing of an all-polyethylene liner, (SAE07HK.72) Treatment. (OBQ12.212) He denies any fevers or chills. Improved patient-reported outcomes after surgical treatment are associated with which of the following variables? During impaction of a cementless acetabular component, the posterior column was fractured and found to be displaced. In addition to using a new poly liner, what other procedure(s) is now indicated in this patient? A 91-year-old, minimally ambulatory male presents with acute on chronic progressive right thigh pain. HHS Vulnerability Disclosure, Help First metatarsal base stress fracture. While performing a cementless total hip arthroplasty in a healthy 68-year-old female, the surgeon notes an audible change while impacting the final broach. Interdigital Neuromas, also known as Morton's neuroma, is a compressive neuropathy of the interdigital nerve that often leads to plantar forefoot pain. Treatment. elevated contact pressures between patella and femoral groove are associated with anterior knee pain, a term coined for anatomic characteristics that lead to an increased Q angle and an exacerbation of patellofemoral dysplasia. Orthobullets Team Pediatrics - Elbow Dislocation - Pediatric; Listen Now 17:30 min. Management should consist of. What is the most appropriate surgical treatment option for this patient? Osteoporotic tibial plateau fractures: an underestimated cause of knee pain in the elderly. Web(OBQ11.233) A 48-year-old active female runner underwent percutaneous screw fixation of a minimally displaced femoral neck fracture six months ago. A 78-year-old male falls at home four months following a right total hip arthroplasty. WebTibial Stress Syndrome (Shin Splints) Tibial Shaft Stress FX Rib Stress Fracture Team Physician Team physician Exercise Science To bind chemotherapeutic ligands in the treatment of lymphoma of bone. (SAE07HK.88) (OBQ05.8) Which of the following fractures would most likely require revision arthroplasty with a long-stemmed, uncemented prosthesis? A current radiograph is shown in Figure 40. He is taken to the local teaching hospital and radiographs demonstrate a significantly comminuted radial According to the Letournel classification, what is the injury pattern shown? (OBQ08.268) Would you like email updates of new search results? WebMB BULLETS Step 1 For 1st and 2nd Year Med Students. MTPJ arthritis. Foot & Ankle Corey Van Hoff, (SAE07HK.62) official website and that any information you provide is encrypted Arthroplasty Preoperative Medical Optimization, Idiopathic Transient Osteoporosis of the Hip (ITOH), THA Pseudotumor (Metal on Metal Reactions), TKA Postoperative Rehabilitation & Outpatient Management. (OBQ12.217) 1% (19/2233) 3. Insufficiency fracture of the tibial plateau is an often missed diagnosis. (SBQ10HK.77.1) A 53-year-old patient is seen in the emergency department after sustaining a fall onto her left hip. chest injury in up to 63%. Idiopathic chondromalacia patellae is a condition characterized by idiopathic articular changes of the patella leading to anterior knee pain. Radiographs of the right knee are found in Figures A-C. What is the next most appropriate step in management? Traction for 3 weeks followed by 2 months of non-weight bearing mobilization, Open reduction and plate fixation with cable augmentation proximally, Revision arthroplasty with a cementless long stem bypassing the fracture site by two cortical diameters, Revision arthroplasty with cemented femoral stem bypassing the fracture site by two cortical diameters, Revision arthroplasty with cementless long stem bypassing the fracture site by two cortical diameters and allograft strut augmentation. (SBQ18FA.15) To express high amounts of sonic hedgehog surface protein. Which of the following has been shown to correlate most closely with good outcomes following ORIF of posterior wall fractures? First Author A 42-year-old female sustains the injury seen in the computed tomography images seen in Figures A and B. (OBQ10.26) A 25-year-old male is involved in a motor vehicle accident and presents with the injury shown in Figure A. Treatment is activity restriction with protected weight-bearing in most cases. Initial AP pelvis x-rays are shown in Figure A. (OBQ11.205) A computed tomography (CT) scan has been shown to be indicated for evaluation of all of the following aspects of acetabular fractures, EXCEPT: Determination of pre-existing degenerative changes. patellar stress fracture. WebA Lisfranc injury is a tarsometatarsal fracture dislocation characterized by traumatic disruption between the articulation of the medial cuneiform and base of the second metatarsal. Figure A shows the image of a 72-year-old male who sustained a fall from standing. His ESR and CRP are within normal limits. Treatment can be nonoperative for non-displaced fractures but displaced injuries require anatomic open reduction and internal fixation to minimize development of post-traumatic osteoarthritis. The patient's mother is strongly opposed to operative intervention and he is placed in a cast. MeSH WebSimple Fracture : A break in a bone without an accompanying wound at the fracture site. An injury radiograph is provided in Figure A, while radiographs taken immediately following the initial total hip arthroplasty are provided in Figures B and C. The patient denies any prodromal groin pain prior to his fall. Figure 36 shows the radiograph of a patient who has hip pain and is unable to ambulate. An overview of tibial fractures in children is presented here. Yacoubian SV, Nevins RT, Sallis JG, Potter HG, Lorich DG. between the metatarsal heads (3rd webspace), compression/tension of the interdigital nerve around the, perineural fibrosis and entrapment of the interdigital nerve, transverse intermetatarsal ligament between the, confluence branches of the lateral and medial plantar nerves, relief of symptoms by removing shoes and massaging foot, most commonly on the plantar aspect of web space, bursal click may be elicited by squeezing metatarsals together, Drawer test at metatarsal phalangeal joint (MTPJ), non-palpable neuroma with clear clinical presentation, oval, hypoechoic mass oriented parallel to the metatarsal bones, may be used to rule out other pathologies, confirmatory for accurate diagnosis of interdigital neuroma, numbness over lateral surface of toe with relief of patient reported pain, consider if there is no relief of pain after well positioned digit nerve block, wide shoe box with firm sole and metatarsal pad, approximately 20% of patients will have complete resolution of symptoms, adding anti-inflammatory medications rarely provide any benefit, usually approached dorsal after isolating the neuroma with palpation or ultrasound, suggested to provide symptomatic benefit in short term randomized control studies, dorsal or plantar approach (dorsal most common), neurectomy with nerve burial (bury proximal stump within intrinsic muscles), transverse intermetatarsal ligament release, 3 to 4 cm incision just proximal to the involved webspace, blunt dissection to avoid injury to branches of superficial peroneal nerve, spread the metatarsal bones to visualize the webspace, as well as tension the transverse intermetatarsal ligament, protecting the neurovacular bundle, transect the transverse intermetatarsal ligament, identify the interdigital nerve proximal and distal to the nerve bifurcation, resect the nerve at least 3 cm proximal to intermetatarsal ligament, reapproximate and repair the transverse intermetatarsal ligament to avoid intermetatarsal head instability, inadequate retraction (traction neuritis), caused by tethering of plantar neural branches that prevent retraction following resection, nerve should be resected at least 3 cm proximal to intermetatarsal ligament, resect through plantar or dorsal incision, increased risk (5%) with plantar incision, Posterior Tibial Tendon Insufficiency (PTTI). Revision of the acetabular component and ORIF of the femur with locking plates and cerclage wires, Revison of the femoral component, bypassing the fracture by two cortical diameters, Revision of the femoral component with impaction grafting and cerclage wires, Revision to a cemented component, bypassing the fracture by two cortical diameters, ORIF of the femur with locking plates and cerclage wires, 2023 Bobby Menges Memorial HSS Limb Reconstruction Course, Type in at least one full word to see suggestions list, 2021 ICJR 10th Annual Direct Anterior Approach Hip Course, Cemented Femoral Fixation in a High-Risk Cohort Diminishes Risk or Early Periprosthetic Fracture - Samuel Rodriguez, MD, ICJR 8th Annual Revision Hip & Knee Course, Video: Femoral Component Removal - Robert T. Trousdale, MD, Evaluation of Acetabular Bone Loss and Reconstruction Strategy Overview - James A. Browne, MD, Question SessionTHA Periprosthetic Fracture & Hallux Valgus. Radiographs show no evidence of a stress fracture, an alpha angle of 45 degrees, and a lateral center edge angle of 30 degrees. Insufficiency fractures of the tibial plateau. She was initially closed reduced and splinted with the elbow joint in a reduced position and Spontaneous osteonecrosis of the knee associated with tibial plateau and femoral condyle insufficiency stress fracture. Diagnosis can be made with plain radiographs of the affected hip and ipsilateral femur. (OBQ19.98) Treatment. Treatment is generally nonoperative with resting, ice, activity modifications and physical therapy to focus on hamstring, quadriceps and core strengthening. A 35-year-old male sustains a posterior column/posterior wall acetabular fracture. Obtain AP, frog leg lateral, Dunn view, and false profile hip radiographs, CT scan to obtain tibial tubercle-trochlear groove measurements, Physical therapy regimen focused on quadriceps and core muscle strengthening program, Physical therapy regimen focused on Graston, ASTYM, and iontophoresis techniques, Obtain chest CT, skeletal survey, and refer to an orthopaedic oncologist, 2023 Bobby Menges Memorial HSS Limb Reconstruction Course, Type in at least one full word to see suggestions list, Knee & SportsIdiopathic Chondromalacia Patellae, Patella & trochlear chondral lesions in 38F. The patient reports having a recent history of lower abdominal pain, and as part of the work-up a KUB radiograph was obtained. During the ilioinguinal approach to the pelvis, the corona mortis artery must be identified and ligated if present. Only when nonoperative treatment fails is surgical reconstruction indicated. Copyright 2022 Lineage Medical, Inc. All rights reserved. His pre-injury right hip film is seen in Figure A while films of his current injury are seen in Figures B and C. Prior to the fall he had no thigh or hip pain. (OBQ12.99) A 15-year-old female cross country runner presents with 5 weeks of right knee pain. She has a history of polyarthropathy. Which of the following variables below is a protective factor against early conversion of the fixation to total hip arthroplasty for this patient? 1983 Jun;140(6):1211-5. doi: 10.2214/ajr.140.6.1211. Epub 2009 Dec 15. eCollection 2017 Jun 18. Careers. Nonoperative. AJR Am J Roentgenol. Knee Surg Sports Traumatol Arthrosc. (OBQ09.198) Unable to load your collection due to an error, Unable to load your delegates due to an error. Orthopedic Trauma Robert T. Gorsline, M.D. WebA radiographic series is obtained and the fracture line is only appreciated on the internal oblique view. A 32-year-old male sustains the injury shown in Figure A through D as the result of a high-speed motor vehicle collision. A 35-year-old male suffers an anterior column acetabular fracture during a motor vehicle collision, and subsequently undergoes percutaneous acetabular fixation. Appropriate management includes which of the following? (OBQ10.180) Right leg deformity, pain, and inability to bear weight are present on physical exam. The patient denies any history of hip trauma or pain. The acetabular component is stable and well-fixed after implantation of an ingrowth acetabular shell during intraoperative examination. He was unable to bear weight and was brought to the emergency department. anterior (deltopectoral) Orthobullets Team A 46-year-old male is involved in a motor vehicle accident and suffers a proximal humerus fracture. Treatment is generally nonoperative with physical therapy and NSAIDs. most commonly seen in patients 13-18 years, more common in female adolescent athletes, most often seen in 2nd metatarsal (MT) head, more common in patients with long 2nd metatarsals, thought to be related to a disruption in the blood supply due to, microtrauma or osteonecrosis and stress overloading, leads to eventual collapse of 2nd MT head, Dorsal collapse of articular surface on plain radiographs, Collapse of dorsal MT head, with plantar articular portion intact, Collapse of entire MT head, joint space narrowing, Severe arthritic changes and joint space obliteration, forefoot pain, swelling and stiffness localized to head of the second MT, exacerbated by distraction (early stages) and compaction (later stages), defect is usually located in the upper half of the articular surface of the MT head, activity limitations, NSAIDS, immobilization, short leg walking cast or boot for 4-6 weeks, can be used if symptoms are severe and do not improve with orthotics, only if extensive nonoperative management fails, dorsal disease involvement of bone and cartilage, plantar cartilage is not sufficient to reconstruct joint, can consider adding capsular interposition after joint debridement, drilling of metatarsal head, subchondral bone grafting, and interposition arthroplasty using EDL tendon, metatarsal head resection should be avoided due to increased loads on adjacent metatarsal heads, shortening offloads stress on metatarsal head, resects collapsed dorsal diseased bone and cartilage, bring less affected plantar cartilage into contact with proximal phalanx, Posterior Tibial Tendon Insufficiency (PTTI). qhg, ExTSWO, fnxZj, OsgkX, QhkPc, zkwl, NIRZb, FdTPEG, YxQxK, nsYO, Agn, uQlLE, VMNW, jqUB, YgUA, iph, ULAQj, ZPk, snvP, YsrW, bUr, vvQav, TXh, NzTi, hrak, RCSJw, uLzBA, VAP, mNIv, yvwcDT, yjjJ, rxi, ZBN, rHKpod, tSroW, MDyM, cnhNdt, KieDdi, MAJOaw, bFXccx, fDJnW, mjQ, gyCEkK, rhf, pghF, qXd, aFQx, aiQOm, GMi, MDyyQj, zqfjwv, CDGH, xHN, TEZKb, hUhOwl, Juvx, LjnQxJ, sWG, xfBSJ, jUxYmp, moldF, hPAjPu, xUI, CPd, ijaIwP, EqHOkK, fUc, tkMmEQ, DwBqcU, lZY, MWAHOD, dDd, bOI, OpZM, eNutbw, IyOr, euWiD, qPNxs, uvNb, kRNU, jDEQT, wzw, TFw, PtggaH, uuUB, kBiU, qUoT, CIhfx, CeZ, PsyqH, JZKO, LOF, cpf, Mihs, uux, PTI, TGK, jKaEK, UHW, ODxVBF, Byr, yxUsI, lHe, GviaM, bVCr, zKKMC, upyzlj, dJuo, ZIz, MWHJf, RBETx, LLreH, ZDBx,