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Introducción: Las fracturas del metatarso son las lesiones traumáticas más comunes del pie, y las del primer metatarsiano son las cuartas en frecuencia. El tratamiento funcional de las fracturas metatarsianas consiste en el apoyo efectivo y precoz, sin inmovilización del miembro. Objetivo: Comparar la efectividad del tratamiento funcional en las fracturas del primer metatarsiano con los tratamientos convencionales Métodos: Se realizó un estudio analítico, observacional, retrospectivo, de casos y controles, en 102 fracturas del primer metatarsiano durante un período de ocho años. La muestra incluyó a pacientes de ambos sexos, entre 16 y 65 años de edad. Se comparó el tratamiento funcional con los tratamientos ortopédico y quirúrgico. Las fracturas fueron clasificadas según su localización, recomendación terapéutica y tratamiento efectuado. Los resultados fueron evaluados en función de la duración de la incapacidad temporal y las complicaciones. Resultados: 48 fracturas fueron tratadas con el método funcional y 41 mediante descarga e inmovilización. Los 13 pacientes con criterio de indicación quirúrgica fueron intervenidos mediante reducción y osteosíntesis. Se obtuvo una menor duración de la incapacidad y menos complicaciones con el tratamiento funcional que con los tratamientos convencionales. Conclusiones: En los últimos años ha aumentado la tendencia a tratar las fracturas metatarsianas de manera conservadora y muchos autores recomiendan el método funcional como tratamiento de elección. Este proporciona una curación más temprana y ocasiona menos complicaciones que los tratamientos convencionales(AU)
Introduction: Metatarsal fractures are the most common traumatic injuries of the foot, and those of the first metatarsal are the fourth in frequency. The functional treatment of metatarsal fractures consists of effective and early support, without limb immobilization. Objective: To compare the effectiveness of functional treatment in fractures of the first metatarsal with conventional treatments. Methods: An analytical, observational, retrospective, case-control study was conducted on 102 first metatarsal fractures over a period of eight years. The sample included patients of both sexes, between 16 and 65 years of age. Functional treatment was compared with orthopedic and surgical treatments. The fractures were classified according to location, therapeutic recommendation and treatment. The results were evaluated according to the duration of the temporary incapacity and the complications. Results: Forty eight fractures were treated with the functional method and 41 by offloading and immobilization. The thirteen patients with surgical indication criteria were operated by reduction and osteosynthesis. A shorter duration of disability and fewer complications were achieved with functional treatment than with conventional treatments. Conclusions: In recent years, the tendency to treat metatarsal fractures conservatively has increased and many authors recommend the functional method as the treatment of choice. This provides earlier healing and causes fewer complications than conventional treatments(AU)
Subject(s)
Humans , Adolescent , Adult , Middle Aged , Aged , Radius Fractures/therapy , Metatarsal Bones/injuries , Fractures, Bone/therapy , Case-Control Studies , Cross-Sectional Studies , Retrospective StudiesABSTRACT
Giant cell tumor is a benign but locally aggressive tumor with common recurrence. Most cases occur around the knee joint. Giant cell tumor of the foot is rare and very few cases involving the first metatarsal have been reported. Its characteristics and treatment in adult patients remain unclear. This paper reports a case of recurrent giant cell tumor at the first metatarsal that was excised surgically and subsequently reconstructed with non-vascularized fibula graft.
Subject(s)
Adult , Humans , Fibula , Foot , Giant Cell Tumors , Giant Cells , Knee Joint , Metatarsal Bones , Recurrence , TransplantsABSTRACT
Objective To explore the anatomical characteristics of mediate dorsal pedal cutaneous nerve and its nutritional vessels to provide anatomical basis of the perforator pedicle flap based on the medial dorsal pedal neurocutaneous vessels for repairing the forefoot soft-tissue defects.Methods From December,2016 to April,2017,the following contents were investigated in 30 adult feet specimens perfused with red latex:①The course,branches and distribution of the medial dorsal pedal cutaneous nerve.②The origin,course,branches and distribution of the nutrient vessels of the medial dorsal pedal neurocutaneous vessels.Mimic operation was performed on 1 fresh specimen.Results ①The mediate dorsal pedal cutaneous nerve mainly arose from the medial branch of the superficial peroneal nerve and processed forward for a distance of (2.5±0.4) cm under the surface of the inferior extensor retinaculum,and then divided into the mediate dorsal branch,the 1st and 2nd dorsal metatarsal branch over part of the dorsal pedal and digital skin.②The medial dorsal pedal neurocutaneous vessels were multiple segmental and polyphyletic,mainly include dorsalis pedis artery proximal perforator,the first metatarsal proximal perforator,the tibial proper plantar digital artery of the great toe and the perforater of the second toe web artery,of which the first metatarsal proximal perforator was most associated with operating methods.The first metatarsal proximal perforator perforate through the deep fascia to the subcutaneous area within the range of 1.0-2.0 cm near the proximal first plantar gap,the piercing point of which on deep fascia was constant,and the anatomical plane of the first metatarsal proximal perforator was higher than that of both the perforator of the toe web artery and the tibial proper plantar digital artery of the great toe.The first metatarsal proximal perforator divide into a large number of branches,which closely anastomose with adjacent perforators and other medial dorsal pedal neurocutaneous vessels.③Simulated surgery showed that the first metatarsal proximal perforation pedicle flap to meet the forefoot soft tissue defect repair.Conclusion The first metatarsal proximal perforator is constant in piercing point and reliable in blood supply,and it have a higher anatomical plane than that of both the perforator of the toe web artery and the tibial proper plantar digital artery of the great toe.The first metatarsal proximal perforator-based medial dorsal pedal neurocutaneous vascular flap can be transferred to repair the soft-tissue defects of forefoot.
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Objective To study the anatomic data of the first metatarsal dorsal artery and to provide anatomical basis for clinical tissue transplantation based on the first metatarsal dorsal artery.Methods The 16 adult cadaver specimens with 32 feet were dissected and meas-ured by vernier caliper.Then the anatomic data of the first metatarsal dorsal artery were analyzed.Results Through the examinations of 32 feet sample,the first metatarsal dorsal artery were classified into 5 types.Type Ⅰ:the first metatarsal dorsal artery runs at the surface of the first dorsal interosseous muscle (13 sides,40.6%).Type Ⅱ:the first metatarsal dorsal artery runs in the interior of the first dorsal interosse-ous muscle (11sides,34.4%).Type Ⅲ:the first metatarsal dorsal artery runs underneath the first dorsal interosseous muscle (6 sides, 18.8%).Type Ⅳ:the first metatarsal dorsal artery is slender (1 side,3.1%).TypeⅤ:the first metatarsal dorsal artery is absent (1 side, 3.1%).Distance relationship was measured between the first metatarsal bone and the first metatarsal dorsal artery:the vertical distance be-tween the origin of the posterior branch of the first metatarsal dorsal artery and base of the first metatarsal bone was (2.4 ±0.3)mm,the ver-tical distance between the origin of the posterior branch of the first metatarsal dorsal artery and head of the first metatarsal bone was (10.1 ±1.0)mm;the vertical distance between the origin of the anterior branch of the first metatarsal dorsal artery and the first metatarso-phalangeal joint was (7.6 ±2.7)mm.Conclusion The first metatarsal dorsal artery has clinical reference significance for the hands and feet’s trauma and skin flap transplantation such as thumb reconstruction.
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Objective To investigate the clinical effect of the free fibula composite tissue flap transplantation to repair the first metatarsal bone with soft tissue defect on foot.Methods From August, 2008 to August, 2013, 6 patients with the first metatarsal bone and soft tissue defect on foot were treated with transplantation of free fibula composite tissue flap.The causes: 2 cases in traffic accident injury, 4 cases in machine injury;3 cases with traumatic defect, and septic defect in 3 patients.Of the 6 cases, the fibular length with transplantation was 6 cm to 12 cm, and the flap area was 8 cm × 5 cm-18 cm × 16 cm;All the cases were followed-up in 3, 6, 12 months postoperatively to observe the fracture healing, and to assess injured limb function in 1 year postoperatively.Results All cases were followed up 12-24 months, and average of 14 months;All the flaps survived, and the metatarsal bone and fibula healing was good visibly in half a year, The surgery function were assessed according to Maryland's scale, and the excellent were 2 and the good were 4.Conclusion The transplantation of free fibula composite tissue flap to repair the first metatarsal bone with soft tissue defect on foot is a safe and effective strategy, and it has the advantages such as covering the wound at foot approvingly, one-time rebuild repair foot weight bearing area and the surrounding soft tissue defect, shorten the treatment cycle, for small area damage in donor area, and the function postoperative is good, etc.
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Objective To evaluate the clinical effects of free fibula and flap grafts on the repair of all the first metatarsal bone at one stage.Methods There were 9 cases with the first metatarsal bone defect from Janurary 2003 to December 2009 that treated with free vascularized fibular bone and free vascularized flap at one stage.In which 6 cases reconstructed at the primary stage and 3 cases reconstructed at the second stage.Seven cases reconstructed by free vascularized fibular combined with ALTPF,two cases reconstructed by free vascularized fibular combined with TAPF.The free vascularized fibular and flap restored the first metatarsal bone and the soft tissue defects respectively.Vascular anastomosis was the artery of flap anastomosis with anterior tibial artery and the vein of the flap anastomosis with great saphenous vein,the peroneal artery and accompany vein anastomosis with artery and vein of the flap.Results The grafted tissues survived smoothly in 8 cases,vein crisis happened in I case and the ALTPF necrosis after blood vessels expedition.So the TAPF was changed to cover the soft defect and survived smoothly.Followiy-up were done from 6 to 36 months in 9 cases.There were no ulcer on flaps and no fracture again,the fibulas had been bone healing.Evaluated by Maryland standards,six cases were excellent,two cases were fine,one case was good.Conclusion The fibula combined flap grafts provide a relatively better alternative to repair the first metatarsal bone compound tissue defects at one stage.In addition,the procedure decreased frequency of operations and short the course of treatment.Sensory function reconstruction of fibula flaps should be given full attention.As fine function of the reconstructed foot,it is a effective method for reconstruction the burdened area of the foot.
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PURPOSE: We wanted to analyze the results of the 1st metatarsal dorsal close wedge osteotomy (MTDW) combined with medical cuneiform plantar open wedge (MCPOW) for treating forefoot deformity of a cavus foot. MATERIALS AND METHODS: We retrospectively analyzed 30 patients. Their mean age was 21.5 years (SD 10.6 years) and the average follow-up period was 2.3 years. Thirty-four cases of thirty patients were classified as group A, as classified by the 1st MTDW combined with the MCPOW, 16 feet (14 patients) were group B by the 1st MTDW or MCPOW, 12 feet (10 patients), and group C by triple arthrodesis, 6 feet (6 patients). We evaluated the ankle dorsiflexion, plantarflexion, heel alignment, and the Maryland foot score (MFS) preoperatively and the last follow-up, and we analyzed the radiologic Hibb, Meary, calcaneal pitch and tibiotalar angles. RESULTS: The ankle dorsiflexion (p=0.01), plantar flexion (p=0.03) and heel alignment (p=0.02) of group A were significantly improved more than that of groups B and C. The MFS of group A revealed better than group B and C (p=0.01). The Meary (p=0.01), Hibb (p=0.02) and calcaneal pitch angle (p=0.02) of group A were significantly improved more than that of groups B and C. CONCLUSION: 1st MTDW combined with MCPOW osteotomy that focuses at the apex of the deformity for correction of a cavus foot can obtain better clinical and radiological results than other surgical procedures.
Subject(s)
Animals , Humans , Ankle , Arthrodesis , Congenital Abnormalities , Follow-Up Studies , Foot , Heel , Maryland , Metatarsal Bones , Osteotomy , Retrospective StudiesABSTRACT
PURPOSE: This study was performed to compare the contact area between three different correcting angles after the proximal crescentic and Ludloff osteotomies of the first metatarsal. MATERIALS AND METHODS: We used the two sawbone models. Proximal crescentic (PCO) and Ludloff osteotomies (LO) were performed and secured using K-wires under the correcting intermetatarsal angle (IMA) 5degrees, 10degrees, and 15degrees. Then each 6 osteotomized model was scanned five times and measured the contact area using the calculating program. We excluded the highest and lowest values. RESULTS: The mean area of cutting surface was 189 mm2 in PCO, 863 mm2 in LO. The mean contact area (contact ratio; contact area x100/area of cutting surface) of PCO was 149 mm2 (79%) in 5degrees, 139.5 mm2 (74%) in 10degrees, 107 mm2 (57%) in 15degrees IMA. The mean contact area (contact ratio) of LO was 711 mm2 (82%) in 5degrees, 535.5 mm2 (62%) in 10degrees, 330 mm2 (38%) in 15degrees IMA. CONCLUSION: A significant decrease in the contact area and contact ratio according to increase in correcting IMA was noticed in LO. We recommend the PCO rather than LO, when the IMA is needed to correct over 15degrees.
Subject(s)
Hallux Valgus , Metatarsal Bones , OsteotomyABSTRACT
PURPOSE: This study was performed to compare the contact area between three different correcting angles after the proximal crescentic and Ludloff osteotomies of the first metatarsal. MATERIALS AND METHODS: We used the two sawbone models. Proximal crescentic (PCO) and Ludloff osteotomies (LO) were performed and secured using K-wires under the correcting intermetatarsal angle (IMA) 5degrees, 10degrees, and 15degrees. Then each 6 osteotomized model was scanned five times and measured the contact area using the calculating program. We excluded the highest and lowest values. RESULTS: The mean area of cutting surface was 189 mm2 in PCO, 863 mm2 in LO. The mean contact area (contact ratio; contact area x100/area of cutting surface) of PCO was 149 mm2 (79%) in 5degrees, 139.5 mm2 (74%) in 10degrees, 107 mm2 (57%) in 15degrees IMA. The mean contact area (contact ratio) of LO was 711 mm2 (82%) in 5degrees, 535.5 mm2 (62%) in 10degrees, 330 mm2 (38%) in 15degrees IMA. CONCLUSION: A significant decrease in the contact area and contact ratio according to increase in correcting IMA was noticed in LO. We recommend the PCO rather than LO, when the IMA is needed to correct over 15degrees.
Subject(s)
Hallux Valgus , Metatarsal Bones , OsteotomyABSTRACT
PURPOSE: The aim of this study was to evaluate the result of combined first metatarsal and calcaneal osteotomy for static cavovarus deformity of the foot. MATERIALS AND METHODS: We performed a dorsal closing wedge 1st metatarsal osteotomy and a lateral and upward displacement calcaneal osteotomy for 9 patients, 12 feet (6 male and 3 female). The mean age at the time of operation was 37 years and the mean followup period was 27 months. The causes of deformity were 2 poliomyelitis, 1 cerebral palsy, 1 Charcot-Marie-Tooth disease and 5 idiopathic type. Five lateral ligament reconstructions of the ankle and six percutaneous Achilles tendon lengthenings were added. The surgical results in terms of pain, function and alignment of the foot were evaluated by means of AOFAS ankle-hindfoot score and talo-1st metatarsal, calcaneus-1st metatarsal and calcaneal pitch angles were checked with weight bearing radiographs in lateral projection. RESULTS: Talo-1st metatarsal and calcaneal pitch angles were reduced from the mean preoperative values of 21degrees and 25degrees to 12degrees and 19degrees, respectively, at last followup. Also, calcaneus-1st metatarsal angle was increased from the mean 114degrees to 144degrees. The mean AOFAS score was improved from 44.5 points preoperatively to 89.2 points at followup. There were 1 metatarso-cueiform joint nonunion, 1 sural nerve injury and 3 remaining symptomatic claw toes. CONCLUSION: Combined first metatarsal and calcaneal osteotomy appears to be an effective procedure for the treatment of adult static cavovarus foot.
Subject(s)
Adult , Animals , Humans , Male , Achilles Tendon , Ankle , Cerebral Palsy , Charcot-Marie-Tooth Disease , Collateral Ligaments , Congenital Abnormalities , Displacement, Psychological , Follow-Up Studies , Foot , Hoof and Claw , Joints , Metatarsal Bones , Organic Chemicals , Osteotomy , Poliomyelitis , Sural Nerve , Weight-BearingABSTRACT
Calcaneal or calcaneovalgus deformity can occur after surgical treatment of equinus or eguinovarus deformity in cerebral palsy patient. It is a serious complication and the results of many conservative and operative treatments are reported unsatisfactory. We experienced one case of both calcaneovalgus deformity following operative treatment of diplegic equinovarus deformity in a spastic cerebral palsy patient and report about the result of the treatment.
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Humans , Cerebral Palsy , Clubfoot , Congenital AbnormalitiesABSTRACT
Synovial chondromatosis is an uncommon disorder characterized by cartilaginous proliferation in the synovium. The cartilaginous nodules occur in the synovial membrane of a joint, bursa, or tendon sheath. It frequents large joints including knee, hip, and elbow. Synovial chondromatosis originating from the first metatarsal is extremely rare. We report a case of 37-year-old man with synovial chondromatosis of the first metatarsal.
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Adult , Humans , Chondromatosis, Synovial , Elbow , Hip , Joints , Knee , Metatarsal Bones , Synovial Membrane , TendonsABSTRACT
Avascular necrosis of the first metatarsal head is uncommon. It is most often seen following a distal metatarsal osteotomy for hallux valgus. Although many cases may be subclinical, it is a powerful cause of failure of bunion surgery. Avascular necrosis of the first metatarsal head results in a series of events that begins with phases of avascularity; revascularization, with or without collapse; and reossification. Collapse may result in degenerative change of the metatarsophalangeal joint. We have recently experienced a case of avascular necrosis of the first metatarsal head.
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Hallux Valgus , Hallux , Head , Metatarsal Bones , Metatarsophalangeal Joint , Necrosis , OsteotomyABSTRACT
PURPOSE: To evaluate the clinical results of lengthening in first brachymetatarsia using a distraction osteogensis with an external fixator. MATERIALS AND METHODS: Fifteen cases in nine patients, who had received firstmetatarsal distraction osteogenesis from January 1996 to December 2002, were enrolled in this study. At the final follow-up, the application time of the external fixator was measured and the percentage of lengthening, healing index, complication rate, and the patients satisfaction was analyzed. The patients satisfaction was evaluated using the American Orthopedic Foot and Ankle Society (AOFAS) scores, which were scored according to the level of stiffness, pain, function, and alignment. RESULTS: The score according to the AOFAS-Hallux Metatarsophalangeal joint and Inter-Phalangeal joint scale was excellent in 13 patients and good in 2. All patients were satisfied with the procedure. The average percentage of lengthening was 48.7%. The average healing index was 72.8 days/cm. The major complication was a cavus foot, which was noticed in four feet. All the first toes showed some decrease in motion at the metatarsophalangeal joint. The other complications were hallux valgus, angulation of the metatarsals, and a pin tract infection each in two feet. CONCLUSION: Distraction osteogenesis is an effective method for first brachymetatarsia. However, excessive lengthening can cause potential complications.
Subject(s)
Humans , Ankle , External Fixators , Follow-Up Studies , Foot , Hallux Valgus , Joints , Metatarsal Bones , Metatarsophalangeal Joint , Orthopedics , Osteogenesis, Distraction , ToesABSTRACT
[Objective]To assess the success of hallux valgus surgery of oblique and impaction osteotomy of first metatarsal neck.[Method]The outcome of 36 patients(45 feet)treated by this technique for symptomatic hallux valgus deformity was reviewed.The follow-up was two years.Lateral and AP radiographs were taken in a standing position pre-and postoperativly and hallux valgus angle(HV angle)and intermetatarsal angle(IM 1~2 angle)were measured accordingly.The efficacy of the surgery was evaluated by JOA scoring for foot disorders.[Result]The fracture healing was excellent.There was no case of delay union and nonunion.Two cases(three feet)were found to have superficial infection.The mean HV angle and IM 1~2 angle was revised by 15.6? and 4.2? respectively.JOA score was elevated for 29.6 points.[Conclusion]Hallux valgus can be corrected in three-dimension by the technique of first metatarsal neck osteotomy and inverted impaction fixation.
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Selection of the surgical procedure for Hallux Valgus is decided after variable factors including radiologic indices were considered. Among them, congruency of the first metatarsophalangeal [MTP] joint is important factor to get the better prognosis. Articular surface angle of first metatarsal head [AAMH] has been used to substituted for first MTP joint congruency. But there had been questions whatever that the value of AAMH measured radiologically equal to real angle in surgical field. The purpose of this article is to compare clinically used radiologic angle of AAMH to real anatomical angle in patients operated by. From march to october 1998, among the 75 patients operated by surgical method (Proximal Chevron), measures anatomical AAMH of 25 volunteer at random. Average age was 46.4 yrs old, ratio of the sample is Right : Left = 9 : 16. The radiologic AAMH measured by AOFAS (American Orthopedic Foot and Ankle Society) research committee method 1992 in the weight bearing foot AP film. The actual AAMH is measured directly in the operative field. After the capsular incision had done, first metatarsal head was dislocated totally. K -wire was inserted to articular dome of the metatasal head from medial to lateral, The transverse axial plane of K -wire is parallel to plantigrade foot position. Afterthen, printed image was taken using portable image intensifier. Average radiologic value of metatarsal head was 16.8 degree, real value was 23.52 degree. In general, real angle was bigger than radiologic angle. In the 20% of cases, radiologic angle was bigger than real angle. With paired t -test, there was no correlations in each angles (p>0.01). Conclusion; The average real AAMH measured in surgical field was 23.1degree. There was no statistic correlations between the angles radiologically and anatomically. therefore, We conclude that the angle of distal metatarsal articular surface measured radiologically has not the clinical significance to know articular congruency. Consequently We suggested the three dimensional study to know the real angle of articular surface of first metatarsal head clinically as alternative method.