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.

The Results of Modified Lapidus Procedure on Moderate-to-Severe Hallux Valgus with First Tarso-Metatarsal Joint Hypermobility / 대한족부족관절학회지

PURPOSE: The objective of this study was to confirm the results of the modified Lapidus procedure on moderate to severe hallux valgus patients with first tarso-metatarsal joint hypermobility. MATERIALS AND METHODS: A retrospective study was conducted on 42 cases of 35 patients who underwent the modified Lapidus procedure between March 2006 and December 2014. A comparative analysis was performed on the preoperative and postoperative subjective satisfaction of patients and radiologic index. Moreover, the correlation between the follow-up time and patient's operative satisfaction, as well as between the proficiency of the operator and patient's operative satisfaction was analyzed. Complications were also evaluated. RESULTS: Out of the total of 35 patients, 3 were male and 32 were female. The mean age was 61.3 years (range, 34∼79 years), and the mean follow-up time was 22.1 months (range, 6∼90 months). The overall satisfaction level was 67.6% and the mean hallux valgus angle improved from preoperative 40.5° to postoperative 12.2° (p<0.001). The mean 1, 2 intermetatarsal angle improved from preoperative mean of 16.9° to postoperative mean of 7.6° (p<0.001), and the sesamoid position improved significantly, from preoperative 2.7 to postoperative 0.9 (p<0.001). Furthermore, there was no correlation between the follow-up time and the American Orthopaedic Foot and Ankle Society (AOFAS) hallux scale; also no correlation between the year the operation took place and the AOFAS hallux scale. In terms of complications, we observed screw irritation in 6 cases, hallux varus in 2 cases, and recurrence of hallux valgus and nonunion in one case. CONCLUSION: Contrary to our concerns, the level of complications was not high; however, the satisfaction level of patients was also not very high. Therefore, careful selecting of patients and sufficient consultation time is needed before surgery. In addition, since the causes of postoperative dissatisfaction still remain unclear, further studies are necessary.

Validación del algoritmo para el tratamiento de Hallux Valgus sintomático / Validation of the treatment protocol for symptomatic hallux valgus

Objective: To evaluate clinical outcomes in Hallux Valgus surgery and suggest clinical guidelines. Materials and Methods: Between 2005 and 2007, 60 surgeries were realized in 39 patients. Exclusion criteria were RA, HV revision and Neuropathic Foot. Two different procedures were performed: Chevron osteotomy (if IM angle < 16°) or First Cuneo-metatarsal arthrodesis (Modified Lapidus, if IM > 16°). Akin Osteotomy was realized if HV angle was > 30°, regardless of IM angle. Pre and postoperatively IM and HV angles were compared using weight bearing radiographs. Functional outcomes were evaluated using AOFAS score. Results: Mean follow up was 25 months. Mean IM angle correction was 4.3º and 9.2ºwith Chevron osteotomy and Lapidus procedure, respectively. Isolated Chevron corrected HV angle in 7.7°, Chevron with Akin: 18.5°, isolated Lapidus:12.4° and Lapidus with Akin: 20.2°. Isolated Chevron group improved their AOFAS score in 35 points, Chevron with Akin group in 32 points, Isolated Lapidus in 28 points and Lapidus with Akin group in 37 points. Discussion: Chevron osteotomy and Lapidus arthrodesis provide a reliable procedure with good functional outcomes in the mid term follow up.

Objetivo: Evaluar los resultados obtenidos en el manejo del hallux valgusy sugerir protocolos de manejo que faciliten la toma de decisiones. Materiales y Métodos: Se recolectó información completa en 39 pacientes en los cuales se realizaron 60 cirugías entre el 2005 al 2007, excluyendo aquellos con diagnóstico de AR, Pie Neurológico y HV Recidivante. Se realizaron 2 tipos de procedimientos: Osteotomía de Chevron cuando el ángulo Intermetatarsiano era menor de 16° y Artrodesis Cuneo-Metatarsiana tipo Lapidus Modificado cuando era mayor de 16°. Cuando se encontró un ángulo Metatarso-Falángico mayor de 30°, se realizó la Osteotomía de Akin como procedimiento complementario. Los pacientes fueron estudiados con radiografías convencionales con carga en el post operatorio. Resultados: Con Chevron, la corrección del ángulo IMT fue de 4,3° y con Lapidus fue de 9,2°. En el subgrupo de Chevron aislado, se logró corregir el ángulo MTF en 7,7°, en Chevron + Akin: 18,5°, en Lapidus aislado: 12,4° y en Lapidus + Akin: 20,2°. En la evaluación de la escala AOFAS, el grupo de Chevron aislado mejoró un promedio de 35 puntos, Chevron + Akin mejoró 32,1 puntos, Lapidus aislado mejoró 28,4 puntos y el grupo de Lapidus + Akin mejoró 37 puntos. Como complicación, un evento aislado de Infección de Sitio Operatorio en uno de los pacientes del grupo Chevron aislado (tasa infección total: 1,6 por ciento). La Osteotomía de Chevron, así como la Artrodesis tipo Lapidus, son seguros, tienen baja tasa de complicaciones y presentan buenos resultados funcionales en el seguimiento a corto y mediano plazo.