First MTP Fusion :Coughlin reamer preparation and Orthosolutions Cannulated 4mm screws. surgical technique
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A 1st MTP (metatarsophalangeal ) joint fusion is a highly versatile operation both in terms of the conditions which can be treated as well as in terms of the function possible after successful fusion.
A union rate of 90% plus is recorded in most series using current techniques. Success defined in terms of patient satisfaction rates though can be slightly lower than those of radiographic union of the fusion .
The keys to operative success are careful joint preparation, positioning and appropriate fixation.
Successful union of requires adequate preparation of the articular surfaces to expose subchondral bone, and rigid internal fixation. The technique described uses reciprocal dome shaped reamers to provide a congruent ‘ball and socket’ interface for fusion, this allows more versatility in aligning the toe optimally than flat cuts, provides a large surface area for fusion, and can be used to correct concomitant hallux interphalangeus.
There are various ways of fixing the fusion, most commonly a single axial compressive screw combined with a dorsal neutralising or compression plate . The technique detailed in this operation is a “crossed-screws” technique which differs only in the final mode of fixation.
Author : Mr Nick Cullen FRCS (Tr & Orth)
Institution :The Royal National Orthopaedic Hospital ,Stanmore ,UK.
- Each operation and the questions associated become a named course in the CPD section
- The operative technique itself is read as a lesson as is any company implant information if this is being assessed.
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- The vast majority of operations have a 10-15 MCQ quiz covering all aspects of the decision making and the technique
- There are four possible answers of which one is correct (or on occasion more correct) than the others.
- There are additional quiz modules on the surgical steps, the implants and problem cases being added continually
- The course is completed once all the lessons are read and quizzes submitted and passed.
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- The timer suspends after 5 minutes though if there is no activity.
- When you restart you will resume at the same point in the module.
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The pass mark is 75%.
- If you fall below this level you will be directed back to re-read the slides where you’ve tripped up.
- Once these have been read you can re-do just the questions you failed on.
- Once you have passed the quiz you can return at a future stage & resit .
- Operation Quiz – 1 CPD point
- Surgical steps Quiz – 1/4 CPD point
- Implants Quiz – 1/4 CPD point
- Problem case Quiz – 1/2 CPD point
One CPD point equates to one hour of academic activity
Welcome to the Professional Development question section. The objective of taking these tests is to demonstrate that you have understood all aspects of the assessment and management of patients requiring surgical intevention. On successful completion you will receive a certificate accredited by both the Royal College of Surgeons of both England and Edinburgh as well as the British Orthopaedic Association.
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