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Consider This Quiz Before Trying New Bunion Correction Procedures
1. In relaxed stance, the first ray in hallux abductovalgus (HAV) deformity will move into a:
a. Dorsiflexed position
b. Plantarflexed position
Answer: a1–4
2. If most patients with HAV have first ray hypermobility, based upon numerous studies that have verified the axis of motion of the first ray, which position will the first metatarsal most likely be in the frontal plane in relaxed stance?
a. Inverted
b. Everted
Answer: a5–9
3. The illusion of a “pronated position” of the first metatarsal in HAV has been documented with studies based upon:
a. Two-dimensional radiographs
b. Partial weightbearing computed tomography (CT) with the foot plantarflexed at the ankle
c. Weightbearing, multiplanar CT imaging
Answer: a and b10–12
4. Semi-weightbearing CT studies have not been thoroughly tested and verified for validity in measuring first metatarsal rotation in HAV patients while the only weightbearing CT study of HAV patients failed to show significant first metatarsal pronation. True or false?
Answer: True12–13
5. Studies have shown that the first metatarsal achieves its most stable, closed packed position when it is plantarflexed and:
a. Everted
b. Inverted
Answer: a9,14
6. Advocates of a new frontal plane Lapidus procedure, which rotates the first metatarsal into inversion, have made a claim that current bunionectomy procedures have a 73 percent recurrence rate. What is the recurrence rate with the new frontal plane Lapidus procedure after a five-year follow-up?
a. 0 percent
b. 73 percent
c. We do not know as five-year or long-term outcomes with this procedure have not been studied or measured in any valid clinical trial
Answer: c15
7. The only published studies with early and mid-term follow-up that have incorporated frontal plane correction with a Lapidus procedure actually rotated the first metatarsal in the direction of:
a. Inversion
b. Eversion
Answer: b17–19
8. After taking this quiz and performing your next HAV surgery, are you most likely to:
a. Rotate the first metatarsal into inversion
b. Rotate the first metatarsal into eversion
c. Continue doing what has worked best in your hands until more long-term outcome studies are published
Answer: I hope this is obvious!
References
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