The first metatarsophalangeal joint fusion combined with lateral toe rotation Weil osteotomy for hallux valgus with severe metatarsal adduction / 中国骨伤

OBJECTIVE@#To explore clinical effect of the first metatarsophalangeal joint fusion combined with lateral toe rotation Weil osteotomy in treating hallux valgus with severe metatarsal adduction.@*METHODS@#From March 2017 to August 2021, 37 patients ( 69 feet ) with severe plantar adductor hallux valgus were treated with the first metatarsophalangeal joint fusion combined with rotational Weil osteotomy were retrospectively analyzed, including 8 males(11 feet) and 29 females (58 feet), aged from 67 to 83 years old with an average of (70.03±2.87) years old;3 cases on the left side, 2 cases on the right side and 32 cases on both sides. Visual analogue scale(VAS) was used to evaluate degree of pain relief before operation, 6 weeks after operation and at the final follow-up. American Orthopaedic Foot and Ankle Surgery (AOFAS) forefoot score was used to evaluate function of the affected foot before operation and final follow-up. Hallux valgus angle(HVA) and intermetatarsal angle(IMA) were measured before operation and at the final follow-up.@*RESULTS@#Thirty-seven patients(69 feet) were followed up from 12 to 48 months with an average of(22.8±0.6) months. Bone healing was achieved at the first metatarsophalangeal joint from 7 to 10 weeks with an average of (8.00±1.21) weeks after operation, without delay and nonunion. HVA was increased from (44.30±2.84)° before operation to (15.20±2.13) °at the final follow-up, and had statistical difference(t=65.781, P<0.05);while no difference in IMA before and after operation(P>0.05). VAS was decreased from (6.73±1.48) points to (2.78±0.71) points at 6 months after operation(t=3.279, P<0.05), and had difference compared with the latest follow-up(1.16±1.12)(t=4.859, P<0.05). AOFAS forefoot score increased from (52.14±5.78) preoperatively to (86.70±4.86) at the fonal follow-up, and 25 feet got excellent results, 40 feet good and 4 feet fair.@*CONCLUSION@#The first metatarsophalangeal joint fusion combined with lateral toe rotation Weil osteotomy in treating severe plantar adduction hallux valgus could significantly relieve pain and appearance of forefoot, stabilize the first sequence, and significantly improve walking function.

Lapidus operation combined with bone setting manipulation in treatment of hallux valgus in elderly patients / 中国骨伤

OBJECTIVE@#To investigate the clinical effect of Lapidus operation combined with bone setting manipulation of traditional Chinese medicine in treating hallux valgus in elderly patients.@*METHODS@#From March 2013 to October 2017, 53 elderly patients (87 feet) with hallux valgus were treated with Lapidus operation combined with bone-setting manipulation of traditional Chinese medicine, including 12 males (18 feet) and 41 females (69 feet), ranging in age from 65 to 92 years old, with an average of (76.3±4.8) years old. Visual analogue scale(VAS) was used to evaluate the degree of relief of foot pain before and 26 months after operation. American Orthopaedic Foot and Ankle Society(AOFAS) was used to evaluate the function of foot pain. The changes of hallux valgus angle(HVA angle), interphalangeal angle (IMA angle) and metatarsal wedge angle(MCA angle) were compared on X-ray films.@*RESULTS@#All the patients were followed up, and the duration ranged from 12 to 42 months, with an average of(26.0±2.7) months. In all patients, the first metatarsal joint reached bone fusion within 6 to 8 months, with an average of 4.7 months. The preoperative VAS score was 8.06±1.44, which was significantly different from 2.14±1.98 at 26 months(<0.05). The preoperative AOFAS score was 53.90±7.89, which was significantly different from 92.80±2.78 at 26 months(<0.05). The HVA, IMA and MCA were significantly improved from preoperative(38.60±2.72)°, (21.90±1.91)° and(20.90±2.20)° to the latest follow-up(17.80±1.94)°, (9.70±2.56)° and(11.70±0.48)°(<0.05). According AOFAS score, 74 feet got an excellent result, 11 good and 2 fair.@*CONCLUSIONS@#Lapidus operation combined with bone-setting manipulation of traditional Chinese medicine on the treatment of hallux valgus foot in elderly patients has satisfactory clinical effects, shortens the time of osteotomy and fixation, protects the soft tissue around the osteotomy end and promotes the bone fusion on the most satisfactory position.

Combined medial and lateral malleolus operative treatment for severe fracture of ankle / 中国骨伤

<p><b>OBJECTIVE</b>To explore the clinical effects of combined medial and lateral malleolus in treating severe fracture of ankle.</p><p><b>METHODS</b>From May 2007 to January 2011,89 patients with ankle fracture who underment surgical treatment and had complete follow-up, the data were retrospectively analyzed. In this study, there were 66 males and 23 females with an average age of 30.9 years (ranged, 26 to 62 years). Cause of injury included road accidents in 52 cases,sprains from fall down in 17, construction injury in 16 and other injuries in 4. According to type of Denis-Weber, type A were in 13 cases, type B in 24, type C in 52. Operative technique was as follows. Chosen two-incision of combined medial and lateral malleolus, and reduced lateral malleolus fracture firstly, fixed it with 1/3 tubular armor plate or rebuilt-titanium plate. To chose one or two hollow screws according to the size of fracture block. If fracture of fibula was syntripsis,it can be multi-segmental fixed. If fracture line of posterior malleolus was no more than 1/3 articular surface of ankle or the bone displacement was not serious, it can be disregarded. And if the lesion level was over 1/3, or shift position more than 3 mm,it can be fixed with lag screw after reduction. Either front-to-back or back-to-front fixed direction was OK. At the third day after operation, the patients were instructed to exercise with affected limb, weight training after 6 weeks.</p><p><b>RESULTS</b>Eighty-nine patients were followed up from 6 to 24 months with an average of 16 months. Healing time of the fracture was 10 to 12 months. According to standard of the Baird-Jackson scoring system, 68 cases got excellent results, 18 good and 3 fair.</p><p><b>CONCLUSION</b>Surgical treatment is quite effective for severe fracture of ankle. It should be chosen correctly according to types of the fracture and degree of ligament injury. At the same time, damage degree of the ligament around the ankle should be considered and properly treated.</p>