ABSTRACT
Abstract Objective The purpose of the present study is to compare the radiological results of angular correction and its maintenance in the medium term between two minimally invasive techniques for the treatment of hallux valgus (minimally invasive chevron surgery vs. Bosch technique). Methods A comparative prospective analysis of patients undergoing surgery for symptomatic hallux valgus deformity was performed. We compared two minimally invasive techniques in homogeneous groups of population. Two groups of 62 and 63 feet respectively, were constituted. We compared first ray angular corrections and consolidation as well as the correction power of both osteotomies and their maintenance over time. The postoperative complications and surgical time in both study groups were also evaluated. The minimum follow-up was 2 years. Results There were differences between both groups in the intermetatarsal angle at 24 months postsurgery. There were no differences between both groups regarding metatarsophalangeal angle, and distal metatarsal articular angle. There were no intraoperative complications in either group. The surgical time between both groups had statistically significant differences. Conclusions Both screw-stabilized, Bosch surgery and minimally invasive chevron (hybrid when associated with percutaneous Akin osteotomy) present adequate correction of moderate hallux valgus. However, patients treated with Bosch percutaneous surgery had a greater correction power of the intermetatarsal angle in the medium term, as well as a shorter surgical time, when compared with those who were treated with chevron osteotomy. Both techniques had a similar evolution over time regarding loss of correction and postoperative complications.
Resumo Objetivo O objetivo deste estudo é comparar os resultados radiológicos da correção angular e sua manutenção no médio prazo entre duas técnicas minimamente invasivas para o tratamento de hálux valgo (cirurgia minimamente invasiva em chevron vs. técnica de Bosch). Métodos Foi realizada uma análise prospectiva comparativa de pacientes submetidos à cirurgia para deformidade sintomática de hálux valgo. Comparamos duas técnicas minimamente invasivas em grupos homogêneos de população. Dois grupos de 62 e 63 pés, respectivamente, foram constituídos. Comparamos correções angulares de primeiro raio e consolidação, bem como o poder de correção tanto das osteotomias quanto de sua manutenção ao longo do tempo. As complicações pós-operatórias e o tempo cirúrgico em ambos os grupos de estudo também foram avaliados. O seguimento mínimo foi de 2 anos. Resultados Houve diferenças entre ambos os grupos no ângulo intermetatarsal aos 24 meses após a cirurgia. Não houve diferenças entre ambos os grupos em relação ao ângulo metatarsofalângico e ao ângulo articular metatarso-distal. Não houve complicações intraoperatórias em nenhum dos grupos. O tempo cirúrgico entre ambos os grupos apresentou diferenças estatisticamente significativas. Conclusões Sendo as duas técnicas estabilizadas por parafusos, tanto a osteotomia de Bosch quanto a cirurgia minimamente invasiva em chevron (híbrida quando associada à osteotomia percutânea de Akin) apresentam correção adequada de hálux valgo moderado. No entanto, os pacientes tratados com a osteotomia percutânea Bosch apresentaram maior poder de correção do ângulo intermetatarsal no médio prazo, bem como e menor tempo cirúrgico, em relação aos que foram tratados com osteotomia em chevron. Ambas as técnicas apresentaram evolução semelhante ao longo do tempo no que se refere à perda de correção e complicações pós-operatórias.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Bone Plates , Clavicle/surgery , Clavicle/diagnostic imaging , Minimally Invasive Surgical Procedures , Fractures, Bone/surgery , Fracture Fixation, InternalABSTRACT
Introducción: Existen múltiples tratamientos quirúrgicos del hallux valgus. El propósito de este estudio fue comparar los resultados radiográficos de corrección angular y su mantenimiento a mediano plazo, entre dos técnicas percutáneas: MICA y Bösch. Materiales y Métodos: Análisis prospectivo comparativo de pacientes sometidos a cirugía de hallux valgus mediante dos técnicas percutáneas (grupo Bösch: 42 pies, grupo MICA: 36 pies). Se compararon las correcciones de los ángulos IM, MTF y AMD, y el poder de corrección de ambas osteotomías y su mantenimiento a mediano plazo. Se registraron las complicaciones posoperatorias. Seguimiento mínimo: 6 meses. Resultados: La corrección promedio de los ángulos IM, MTF y AMD fue: 20,22°; 7,74°; 8,26° a los 6 meses en el grupo Bösch; y de 15,8°; 1,6° y 1,98° en el grupo MICA. El potencial de corrección IM fue mayor en el grupo Bösch. No hubo diferencias significativas entre ambos grupos en cuanto a la pérdida de corrección entre las 6 semanas y los 6 meses, salvo el ángulo MTF en el grupo MICA. La corrección del ángulo AMD fue mejor en el tiempo con la técnica MICA. Hubo 4 complicaciones con la técnica MICA y 8 con la técnica de Bösch. Conclusiones: Ambas técnicas logran una corrección adecuada del hallux valgus moderado. Sin embargo, el poder de corrección del ángulo IM a mediano plazo fue mayor con la técnica de Bösch. En el otro grupo, aunque se perdió la corrección del ángulo MTF entre las 6 semanas y los 6 meses, los valores se mantuvieron dentro de los 20° de valgo MTF. Nivel de Evidencia: II
Introduction: Multiple surgical treatments for the hallux valgus have been described. The purpose of this study is to compare the radiological results for the angular correction and its stability on the middle term between two percutaneous techniques (MICA versus BOSCH technique). Materials and methods: Prospective comparative analysis of surgically treated patients with hallux valgus by two percutaneous techniques (BOSCH group: 42 feet; MICA group: 36 feet) in homogenous groups. Intermetatarsal, metatarsophalangeal and distal metatarsal articular angle corrections were compared, as well as the correction power of both osteotomies and its stability in the middle term. Postoperative complications were recorded. Minimum follow-up: 6 months. Results: Average angle correction of MTP, IM y DMAA 6 months after surgery in Bosch group: 20,22°; 7,74°; 8,26°; MICA: 15,8°; 1,6° and 1,98° respectively. BOSCH group had a higher IM correction power. There were no significant statistical differences between both groups in the loss of correction by 6 weeks to 6 months; except for the MTP angle in the MICA group. MICA presented a better correction of the DMAA in time. Postoperatively, MICA had 4 complications, while BOSCH 8. Conclusions: We obtained good results with both techniques in the treatment of moderate hallux valgus. However, patients undergoing the Bosch technique had greater correction on the intermetatarsal angle in the mid-term follow-up. Although the MTP angle correction decreased between 6 weeksand 6 months in MICA technique, the values remained within normal 20° of valgus MTP. Level of Evidence: II
Subject(s)
Osteotomy , Hallux Valgus , Treatment Outcome , Minimally Invasive Surgical ProceduresABSTRACT
Introducción: La artroscopia se ha convertido en una importante herramienta para tratar diversas afecciones del tobillo. El uso de portales anteriores y posteriores, asociados o no a distracción mecánica, permite una completa exploración de esta articulación. Como toda técnica quirúrgica, no está exenta de complicaciones. Objetivos: Evaluar las complicaciones tempranas de la artroscopia anterior de tobillo, sin distracción articular, y compararlas con las descritas en la bibliografía internacional. Materiales y Métodos: Estudio retrospectivo que evaluó a 198 pacientes sometidos a artroscopia anterior de tobillo por diversas patologías. Todos fueron operados por un único cirujano, en dos instituciones de salud, durante un período de 6 años, con un seguimiento posquirúrgico mínimo de 12 meses. Los pacientes fueron evaluados mediante el puntaje de la AOFAS y se consignaron las complicaciones intra y posoperatorias tempranas. Resultados: Se evaluó a 34 mujeres y 164 hombres (edad promedio 37.5 años). Hubo 23 complicaciones (11,61%): celulitis local (6 casos), parestesias transitorias del nervio peroneo superficial (4 casos), parestesia permanente del nervio peroneo superficial (1 caso), dolor residual en los portales (4 casos), artritis séptica (2 casos) y un caso de otras complicaciones. Conclusiones: Un conocimiento preciso de la anatomía, una asepsia y una técnica quirúrgica correctas, y los cuidados de manejo intraquirúrgico del instrumental permiten evitar la mayoría de las complicaciones. La artroscopia anterior de tobillo sin distracción por medio de los clásicos portales antero-lateral y antero-medial es una técnica segura, con un bajo índice de complicaciones y una muy baja morbilidad para el paciente. Nivel de Evidencia: IV
Introduction: Arthroscopy has become an important tool to treat various conditions of the ankle. The use of anterior and posterior portals, with or without mechanical distraction, allows for a complete exploration of this joint. Like all surgical techniques, it is not without complications. Objectives: To evaluate the early complications of anterior ankle arthroscopy with or without joint distraction, and to compare them with those described in the international literature. Materials and Methods: A retrospective study that evaluated 198 patients undergoing anterior ankle arthroscopy for various pathologies. All were operated on by a single surgeon, in two health centers, during a period of 6 years, with a postoperative follow-up of at least 12 months. Patients were evaluated by AOFAS score and early and postoperative complications were recorded. Results: 34 women and 164 men were evaluated (average age 37.5 years). There were 23 complications (11.61%): local cellulitis (6 cases), transient paresthesia of the superficial peroneal nerve (4 cases), permanent paresthesia of the superficial peroneal nerve (1 case), residual pain in the portals (4 cases), septic arthritis (2 cases) and one case of other complications. Conclusions: Most complications can be avoided by a precise knowledge of the anatomy and the aseptic techniques, as well as an adequate surgical approach and intra-operative management of the instrumentation. Anterior ankle arthroscopy without joint distraction through standard antero-lateral and antero-medial portals is a safe technique, having a low rate of complications and a very low morbidity for the patient. Level of Evidence: IV