Reconstrucción por técnica de Chevron reverso y transferencia tendinosa con técnica no convencional en Hallux Varus Iatrogénico Severo / Reconstruction by reverse Chevron technique and tendon transfer with unconventional technique in severe iatrogenic Hallux Varus

El Hallux Varus Iatrogénico es una complicación de la cirugía correctiva del Hallux Valgus muy poco frecuente. El tratamiento incluye la intervención de los tejidos blandos, y óseos. El propósito de este trabajo es mostrar los resultados clínico-radiológicos del tratamiento quirúrgico del Hallux Varus Iatrogénico Flexible Severo empleando la combinación de técnicas de reconstrucción alternativas en una paciente femenina de 59 años de edad. Se realizó liberación medial de la capsula articular MTF y abductor, osteotomía de Chevron reverso, artrodesis interfalángica izquierda, transferencia tendinosa del extensor largo de Hallux hacia plantar con botón artesanal. De acuerdo a la Escala AOFAS aumentó de 30 a 90 puntos. Se logró la corrección estable de la deformidad en varo y la consolidación de la osteotomía. El Hallux Varus Iatrogénico es una complicación poco frecuente considerada una deformidad mal tolerada, con pocos casos reportados y pocos reportes. Se debe hacer un enfoque de tratamiento paso a paso para abordar todos los elementos involucrados en el Hallux Varus iatrogénico. La corrección quirúrgica del Hallux Varus iatrogénico severo con técnicas de reconstrucción no convencionales tipo Chevron reverso y transferencia tendinosa con botón plantar, es una excelente opción terapéutica de acuerdo a los resultados obtenidos en este caso(AU)

Iatrogenic Hallux Varus is a very rare complication of Hallux Valgus corrective surgery. The treatment includes the intervention of soft tissues and bones. The purpose of this paper is to show the clinical-radiological results of the surgical treatment of Severe Flexible Iatrogenic Hallux Varus using the combination of alternative reconstruction techniques in a 59-year-old female patient. Medial release of the MTF and abductor joint capsule, reverse Chevron osteotomy, left interphalangeal arthrodesis, tendon transfer of the long extensor of Hallux to plantar with artisanal button was performed. According to the AOFAS Scale, it increased from 30 to 90 points. Stable correction of the varus deformity and consolidation of the osteotomy were achieved. Iatrogenic Hallux Varus is a rare complication considered a poorly tolerated deformity, with few reported cases and few reports. A step-by-step treatment approach must be taken to address all the elements involved in iatrogenic Hallux Varus. Surgical correction of severe iatrogenic Hallux Varus with unconventional reconstruction techniques such as reverse Chevron and plantar button tendon transfer is an excellent therapeutic option according to the results obtained in this case(AU)

Fibrodysplasia ossificans progressiva in a 3-year-old female patient / Fibrodisplasia osificante progresiva en una paciente de 3 años

Abstract Background: Fibrodysplasia ossificans progressiva (FOP) is a rare autosomal dominant disease affecting connective tissue, primarily caused by de novo mutations of the ACVR1 gene. FOP is a disease with congenital malformations of the toes and heterotopic ossification in characteristic patterns that progresses with flare-ups and remissions. Cumulative damage results in disability and, eventually, death. This report aimed to describe a case of FOP to highlight the importance of early diagnosis of this rare condition. Case report: We describe the case of a 3-year-old female diagnosed with congenital hallux valgus, who initially presented with soft tissue tumors, predominantly in the neck and chest, with partial remission. Multiple diagnostic tests were performed, including biopsies and magnetic resonance imaging, with nonspecific results. We observed ossification of the biceps brachii muscle during evolution. The molecular genetic study found a heterozygous ACVR1 gene mutation that confirmed FOP. Conclusions: Knowledge of this rare disease by pediatricians is critical for an early diagnosis and for avoiding unnecessary invasive procedures that may promote disease progression. In case of clinical suspicion, performing an early molecular study is suggested to detect ACVR1 gene mutations. The treatment of FOP is symptomatic and focused on maintaining physical function and family support.

Resumen Introducción: La fibrodisplasia osificante progresiva (FOP) es una enfermedad autosómica dominante rara que afecta el tejido conectivo, cuya causa principal son mutaciones de novo del gen ACVR1. Se trata de una enfermedad con malformaciones congénitas de los primeros ortejos y osificación heterotópica en patrones característicos que progresa en empujes y remisiones. El daño acumulativo provoca discapacidad y, eventualmente, la muerte. El objetivo de este trabajo fue describir un caso de FOP para favorecer el diagnóstico precoz de esta enfermedad infrecuente. Caso clínico: Se describe el caso de una paciente de 3 años, portadora de hallux valgus congénito, que inicialmente presentó tumoraciones dolorosas de tejidos blandos, de predominio en cuello y tórax, con remisión parcial de las mismas. Se realizaron múltiples pruebas diagnósticas, incluyendo biopsias e imágenes de resonancia magnética con resultados inespecíficos. En la evolución se observó osificación de músculo bíceps braquial. El estudio genético molecular encontró una mutación del gen ACVR1 en heterocigosis que confirmó el diagnóstico de FOP. Conclusiones: El conocimiento de esta enfermedad por los pediatras es clave para realizar un diagnóstico precoz y evitar procedimientos invasivos innecesarios que pueden promover la progresión de la enfermedad. Ante la sospecha clínica, se sugiere realizar tempranamente el estudio molecular para detectar mutaciones del gen ACVR1. El tratamiento de la FOP es sintomático, centrado en el mantenimiento de la función física y el apoyo familiar.

Reconstruction of nail bed and fingertip defects with free nail flap / 中国医师杂志

Objective:To explore the application value of free nail flaps in reconstruction of nail bed and fingertip defect.Methods:From January 2018 to June 2020, nine patients with free nail flap transplantation to treat fingertip injuries in Lishui People′s Hospital were included in this study. According to the Allen classification, 6 patients were characterized as type Ⅱ and 3 were characterized as type Ⅲ. Evaluation was based on the patients′ medical records and follow-up, including postoperative healing of recipient and donor sites, two-point discrimination, the Chinese Medical Association Hand Surgery Society′s evaluation of the function of severed finger replantation, and Michigan Hand Outcomes Questionnaire (MHQ) and Foot Function Index (FFI).Results:All patients successfully completed the operation, the operation time was 3.0-5.0 h (average 4.1 h), the intraoperative blood loss was 100-250 ml (average 178 ml), and the follow-up time was 12-40 months (average 25 months). The nails and flaps of all patients survived with primary healing. No complications were observed after surgery. The appearance of the reconstructed finger of 9 patients was similar to that of the uninfected side; the flap two-point discrimination was 5.0-7.5 mm; the replantation score and MHQ results were satisfactory. The toenail of the donor site grew well, and no deformity or pain with walking was noted.Conclusions:The free toenail flap was used to treat fingertip defects, with satisfactory clinical results in repairing tissue defects, reconstructing nail bed and maintaining finger length.

Percutaneous minimally invasive osteotomy with 8-shaped bandage and hallux valgus splint fixation for the treatment of moderate hallux valgus / 中国骨伤

OBJECTIVE@#To observe clinical effect of percutaneous minimally invasive osteotomy with 8-shaped bandage and hallux valgus splint fixation in treating moderate hallux valgus.@*METHODS@#Totally 23 patients with moderate hallux valgus were treated with percutaneous minimally invasive osteotomy with 8-shaped bandage and hallux valgus splint fixation from August 2019 to January 2021, and 1 patient was loss to follow-up, and finally 22 patients(30 feet) were included, 4 males (6 feet) and 18 females(24 feet), aged from 27 to 66 years old with an average of(50.59±11.95) years old. Hallux valgus angle (HVA), intermetatarsal angle (IMA), metatarsal span (the distance between the first and the fifth metatarsal bones), changed of soft tissue width, American Orthopaedic Foot and Ankle Society(AOFAS) score, and Visual Analogue Scale (VAS) were collected and compared before operation and 6 months after operation.@*RESULTS@#Twenty-two patients were followed up from 5.7 to 6.4 months with an average of (6.13±0.85) months. The first metatarsal osteotomy of patients were obtained bone union, and deformity of the toes was corrected. Complications such as avascular necrosis of metatarsal head and transfer metatarsalgia were not occurred. Postoperative HVA, IMA, metatarsal span, soft tissue width, VAS, AOFAS score at 6 months were significantly improved compared with pre-operation (P<0.01). According to AOFAS score at 6 months after operation, 10 feet were excellent, 18 good and 2 poor. Two feet with poor were excellent after prolonged 8-shaped bandage and hallux valgus splint fixation time.@*CONCLUSION@#Percutaneous minimally invasive osteotomy with 8-shaped bandage and hallux valgus splint fixation for the treatment of moderate hallux valgus could better correct deformity of hallux valgus, relieve foot symptoms, good recovery of postoperative function, and has a significant clinical efficacy.

Can the percutaneous chevron and akin (peca) technique correct the pronation of the first metatarsal in hallux valgus? / A técnica percutânea de chevron e akin (peca) pode corrigir a pronação do primeiro metatarso em halux valgo?

ABSTRACT Objective Pronation of the first metatarsal in hallux valgus has recently been discussed among foot and ankle surgeons. This study aimed to evaluate the potential radiographic correction of moderate and severe hallux valgus using the percutaneous Chevron and Akin (PECA) technique. Methods We evaluated 45 feet in 38 patients (mean age 65.3 years old [36 - 83]; 4 men; 34 women; 7 bilateral) who underwent surgical correction using the PECA technique. The radiographic images evaluated were anteroposterior radiographs obtained pre- and postoperatively at least 6 months after surgery, including the metatarsophalangeal angle, the intermetatarsal angle, pronation of the first metatarsal, displacement of the distal fragment, medial sesamoid position and bone union. Results All parameters evaluated showed significant postoperative improvement, including correction of pronation of the first metatarsal (p < .05) and position of the sesamoid (p < .05). There was a union of osteotomies in all feet. No complications were observed, such as screw loosening or necrosis of the first metatarsal head. Conclusion The PECA technique can correct pronation of the first metatarsal in moderate and severe hallux valgus, and other deformity-associated parameters. Level of Evidence IV; Case Series.

RESUMO Objetivo A pronação do primeiro metatarso no hálux valgo tem sido um tema de discussão recente entre os cirurgiões de pé e tornozelo. O objetivo deste estudo foi avaliar o potencial de correção radiográfica do hálux valgo moderado e grave utilizando a técnica percutânea de Chevron e Akin (PECA). Métodos Avaliamos 45 pés em 38 pacientes (média de idade 65,3 anos [36 - 83]; 4 homens; 34 mulheres; 7 bilaterais) submetidos à correção cirúrgica pela técnica PECA. As imagens radiográficas avaliadas foram radiografias anteroposteriores obtidas no pré e pós-operatório com no mínimo 6 meses após a cirurgia, incluindo ângulo metatarsofalângico, ângulo intermetatarsal, pronação do primeiro metatarso, deslocamento do fragmento distal, posição do sesamoide medial e união óssea. Resultados Todos os parâmetros avaliados apresentaram melhora significativa no pós-operatório, incluindo correção da pronação do primeiro metatarso (p < 0,05) e posição do sesamoide (p < 0,05). Houve união de osteotomias em todos os pés. Não foram observadas complicações, como soltura do parafuso ou necrose da cabeça do primeiro metatarso. Conclusão A técnica PECA pode corrigir a pronação do primeiro metatarso no hálux valgo moderado e grave, bem como outros parâmetros associados à deformidade. Nível de Evidência IV; Série De Casos.

Investigation of the relationship between foot deformities and radiographic measurements of the talus and calcaneus / Investigación de la relación entre las deformidades del pie y las mediciones radiográficas del talo y del calcáneo

SUMMARY: The weight of the body is transmitted to the foot through the subtalar joint and talus. Considering the important location of the talus and calcaneus, the morphological structures of these bones may affect the biomechanics of the subtalar joint. At the same time, the morphological structure of these bones is important in some common foot deformities. We aimed to investigate whether the various measurements of the talus and calcaneus are associated with different foot deformities in this study. In this study, radiography images of 158 (72 male and 86 female) patients within the mean age of 44 years were retrospectively examined. Eleven different measurements of the talus and calcaneus were obtained from the lateral and antero-posterior radiographs of the patients. A total of 158 patient's routine clinic radiographs were retrospectively assessed, which have calcaneal spur (n=63), hallux valgus (n=32) and control group (n=63). We determined that the body height of the calcaneus, maximum width of the head of the talus, minimum anterior width of the calcaneus were significantly different between calcaneal spur group and control group. Maximum length fibular malleolar facet of the talus was significantly different between age groups. And we determined that the calcaneal index was significantly different between hallux valgus group and control groups. Also all measurements were significantly different between males and females. As a result, some measurements that significantly determine the morphology of the talus and calcaneus were found to be significant between deformity groups and control groups. We think that our study will contribute to the literature as it is the first study in which the measurements obtained from the radiographic images of the talus and calcaneus are associated with foot deformities.

El peso del cuerpo se transmite al pie a través de la articulación subtalar y el talo. Teniendo en cuenta la importante ubicación del talo y el calcáneo, las estructuras morfológicas de estos huesos pueden afectar la biomecánica de la articulación subtalar. Al mismo tiempo, la estructura morfológica de estos huesos es importante en algunas deformidades comunes del pie. Nuestro objetivo fue investigar si las diversas medidas del talo y el calcáneo están asociadas con diferentes deformidades del pie en este estudio. Se examinaron retrospectivamente imágenes radiográficas de 158 pacientes (72 hombres y 86 mujeres) con una edad promedio de 44 años. Se obtuvieron once medidas diferentes del talo y el calcáneo a partir de las radiografías lateral y anteroposterior de los pacientes. Se evaluaron retrospectivamente un total de 158 radiografías clínicas de rutina de los pacientes, los cuales tenían espolón de calcáneo (n=63), hallux valgus (n=32) y grupo control (n=63). Determinamos que la altura del cuerpo del calcáneo, el ancho máximo de la cabeza del talo, el ancho anterior mínimo del calcáneo fueron significativamente diferentes entre el grupo con espolón calcáneo y el grupo control. La longitud máxima de la faceta maleolar fíbular del talo era significativamente diferente entre los grupos de edad. También determinamos que el índice calcáneo fue significativamente diferente entre el grupo de hallux valgus y los grupos controles. Además, todas las medidas fueron significativamente diferentes entre hombres y mujeres. Como resultado, algunas medidas que determinan la morfología del talo y el calcáneo resultaron significativas entre los grupos de deformidad y los grupos controles. Estimamos que nuestro estudio contribuirá a la literatura debido a que es el primer reporte en el que las medidas obtenidas de las imágenes radiográficas del talo y el calcáneo se asocian con deformidades del pie.

Zapato de suela rígida versus zapato de suela invertida en la cirugía de hallux valgus: análisis clínico, funcional y radiológico / Rigid sole shoe versus inverted sole shoe in hallux valgus surgery: clinical, functional and radiological analysis

Resumen: Introducción: el calzado ortopédico suele prescribirse en el postoperatorio de cirugía de hallux valgus para proteger la osteotomía y mantener la funcionalidad al paciente. En este sentido, la superioridad del zapato de suela rígida en comparación con el zapato de suela invertida sigue siendo controvertido. El objetivo de este estudio es comparar los resultados clínicos, funcionales y radiológicos entre el uso del zapato de suela rígida (ZSR) y el zapato de suela invertida (ZSI) después de la cirugía de hallux valgus. Material y métodos: un total de 57 pacientes intervenidos de hallux valgus fueron incluidos y analizados retrospectivamente. En un grupo se incluyeron 28 pacientes que usaron el ZSR, mientras que el segundo grupo incluyó a 29 pacientes que usaron el ZSI. El zapato ortopédico se usó durante seis semanas tras la cirugía. Se recogieron datos clínicos (dolor lumbar y articular de las extremidades inferiores, necesidad de muletas y problemas para subir y bajar escaleras), datos radiológicos (AIM, AHV), así como complicaciones postoperatorias (desplazamiento de osteotomía, fractura del primer metatarsiano o seudoartrosis). Resultados: el zapato de suela rígida mostró menor dificultad para subir y bajar escaleras (OR 3.8 (IC 95% 1.2-12.8), p 0.02), sólo para subir (OR 3.2 (IC 95% 1.1-10), p 0.03), así como una disminución de la necesidad de muletas (OR 1.7 (IC 95% 1.04-2.6), p < 0.03). El dolor de columna lumbar o articular de extremidades inferiores no mostró diferencias estadísticas. No se encontraron diferencias estadísticas en los datos epidemiológicos y radiológicos entre los grupos. Conclusiones: el zapato de suela parece aportar más comodidad a los pacientes sin aumentar las complicaciones radiológicas.

Abstract: Introduction: the orthopedic shoe is usually prescribed during postoperative care after hallux valgus surgery to protect the osteotomy and provide functional comfort to the patient. In this regard, the superiority of rigid sole shoe (RSS) compared to the reverse camber shoe (RCS) remains controversial. The aim of this study is to compare the clinical, functional and radiological outcomes from using the rigid sole shoe (RSS) vs. the reverse camber shoe (RCS) after hallux valgus surgery. Material and methods: fifty-seven hallux valgus surgery patients were included and analyzed retrospectively. The 1st group included 28 patients using the RSS and the 2nd group included 29 patients using the RCS. The orthopedic shoe was used for six weeks postoperatively. Clinical data (lumbar and lower limb pain, need of crutches and problems with going up and down stairs), radiological data (IMA, HVA) and postoperative complications (displacement of osteotomy, metatarsal fracture or non-union) were collected. Results: the RSS showed less difficulty going up and down stairs (OR 3.8 (CI 95% 1.2-12.8), p 0.02), only going upstairs (OR 3.2 (CI 95% 1.1-10), p 0.03), as well as a decreased need for crutches (OR 1.7 (CI 95% 1.04-2.6), p < 0.03). Lumbar spine or lower limb pain did not show any statistical differences. No statistical differences in the epidemiological and radiological data were found between the groups. Conclusions: the RSS seems to provide more comfort to the patients without worsening the radiological results.

Hemiartroplastía por interposición utilizando el extensor hallucis brevis para el tratamiento de hallux rigidus con involucro unicompartimental lateral: reporte de un caso / Interposition hemiarthroplasty using extensor hallucis brevis for the treatment of hallux rigidus with lateral unicompartmental involvement: a case report

Resumen: Hallux rigidus es la patología degenerativa de la articulación metatarsofalángica del hallux. Esta patología provoca dolor y disminución en el movimiento. Existen múltiples tratamientos quirúrgicos para esta patología, todas con sus respectivas indicaciones. Presentamos el caso de un paciente de 54 años de edad con el diagnóstico de hallux rigidus quien tenía afectación únicamente del aspecto lateral de la cabeza del metatarsiano. Este paciente fue tratado con un procedimiento quirúrgico novedoso, se realizó una hemiartroplastía de interposición utilizando el extensor hallucis brevis asociado a una queilectomía y exostectomía. El paciente tuvo una favorable evolución clínica con mejoría evidenciado por escalas clínicas, con resolución de la sintomatología y sin complicaciones. La hemiartroplastía de interposición utilizando el extensor hallucis brevis es un tratamiento exitoso de preservación articular y del movimiento para el hallux rigidus en pacientes jóvenes en los que hay afectación unicompartimental lateral de la cabeza metatarsiana, en quienes es importante preservar el movimiento.

Abstract: Hallux rigidus is the degenerative pathology of the metatarsophalangeal joint of the hallux. This pathology causes pain and decreased movement. There are multiple surgical treatments for this pathology, all with their respective indications. We present the case of a 54-year-old patient diagnosed with hallux rigidus who had only the lateral aspect of the metatarsal head affected. This patient was treated with a novel surgical procedure, performing an interposition hemiarthroplasty using the hallucis brevis extender associated with a cheilectomy and exostectomy. The patient had a favorable clinical evolution with improvement evidenced by clinical scales, with resolution of the symptoms and without complications. Interposition hemiarthroplasty using the extensor hallucis brevis is a successful joint and movement preservation treatment for hallux rigidus in young patients with lateral unicompartmental involvement of the metatarsal head, in whom it is important to preserve movement.

Evaluación radiológica pre y posoperatoria de la osteotomía de Austin y uso de AutoCAD® / Preoperative and Postoperative Radiological Evaluation of Austin Osteotomy and Use of Autocad®

Introducción: Se han descrito más de 300 técnicas quirúrgicas para la corrección del hallux valgus. Una de ellas es la técnica de Austin, la cual constituye una osteotomía capital en V con una angulación de 60º utilizada en el tratamiento quirúrgico del hallux valgus leve-moderado. Objetivos: Analizar el grado de corrección que tiene la osteotomía de Austin sobre diferentes parámetros radiológicos y describir la frecuencia con la que se utilizan técnicas complementarias sobre la falange proximal. Métodos: Se realizó un estudio descriptivo, transversal, observacional y retrospectivo. Se seleccionó una muestra de 29 pies intervenidos mediante la técnica de Austin, a los que se les realizaron varias mediciones sobre sus radiografías pre y posoperatorias con AutoCAD®. Resultados: Se obtuvieron diferencias estadísticamente significativas en todos los parámetros evaluados. Conclusiones: Esta técnica corrige significativamente todos los parámetros analizados. Se demuestra que el uso de técnicas quirúrgicas complementarias sobre la falange proximal es bastante frecuente al realizar esta osteotomía(AU)

Introduction: More than 300 surgical techniques have been described for the correction of hallux valgus. One of them is the Austin technique, which constitutes a capital V osteotomy with an angulation of 60º used in the surgical treatment of mild-moderate hallux valgus. Objectives: To analyze the degree of correction that Austin osteotomy has on different radiological parameters and to describe the frequency with which complementary techniques are used on the proximal phalanx. Methods: A descriptive, cross-sectional, observational and retrospective study was carried out in a sample of 29 feet operated on using the Austin technique. Several measurements were made on their pre- and postoperative radiographs with AutoCAD®. Results: Statistically significant differences were obtained in all the parameters evaluated. Conclusions: This technique significantly corrects all the parameters analyzed. It is shown that the use of complementary surgical techniques on the proximal phalanx is quite frequent when performing this osteotomy(AU)

Minimally Invasive Chevron Surgery and Bosch Percutaneous Osteotomy in Hallux Valgus Treatment. Midterm Results. Comparative Radiological Study / Cirurgia minimamente invasiva em chevron e osteotomia percutânea de Bosch no tratamento de hálux valgo. Resultados em médio prazo. Estudo radiológico comparativo

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.

Hiperplasia endotelial papilar intravascular (tumor de Masson) na matriz ungueal do hálux: um relato de caso / Intravascular papillary endothelial hyperplasia (Masson's tumor) in hallux nail matrix: a case report

A hiperplasia endotelial intravascular ou tumor de Masson é uma lesão vascular benigna que não possui patogênese bem definida. Acredita-se que a resposta à lesão dos vasos sanguíneos seja um dos principais motivos para o seu desenvolvimento. É uma lesão tipicamente indolor, única e de evolução lenta. O objetivo deste relato é descrever um caso de tumor de Masson em uma região não habitual, na matriz ungueal do hálux, e discutir suas principais características

Intravascular endothelial hyperplasia, or Masson's tumor, is a benign vascular lesion with no well-defined pathogenesis. The response to vascular damage is believed to be one of the main reasons for its development. It is a typically painless injury, solitary, with slow evolution. This report aims to describe a case of Masson's tumor in an unusual place, the hallux nail matrix, and discuss its main characteristics.

Unha em arpão: uma forma incomum de onicocriptose / Harpoon nail: an unusual form of onychocryptosis

A onicocriptose é uma doença ungueal frequente, que afeta mais comumente os pododáctilos e apresenta algumas variantes, dentre as quais a pouco conhecida "unha em arpão". O diagnóstico costuma ser clínico, e o tratamento cirúrgico emprega diferentes técnicas descritas na literatura. Relatamos o caso de um paciente masculino, 25 anos, com unha em arpão no hálux esquerdo, e a técnica cirúrgica utilizada para o tratamento com excelente resultado

Onychocryptosis is a frequent nail disease, which most commonly affects the toes. It has some variants, including the little known "Harpoon Nail". The diagnosis is usually clinical, and the treatment is surgical, with different techniques described in the literature. We report the case of a 25-year-old man with a harpoon nail on the left hallux and the surgical method used for treatment with excellent results

Repair the donor site of ipsilateral fibular hallux flap with transverse V-Y advancement flap of the great toe / 中华显微外科杂志

Objective:To explore the clinical application and effect of repairing the donor site of ipsilateral fibular hallux flap with the transverse V-Y advancement flap of the great toe.Methods:Form January 2017 to January 2020, the donor sites of the ipsilateral fibular hallux flap were repaired by the transverse V-Y advancement flap of the great toe in the Department of Hand Surgery, 521 Hospital of Weapon Industry on 20 patients, including 16 males and 4 females with an average age of 33 (18-52) years old. First, the donor site of the fibular hallux flap was sutured to reduce the size of wound. The width of the remaining wound was 0.4 to 1.6 cm, and the area of the remaining wound was 0.5 cm×0.8 cm-1.6 cm×1.8 cm. Then the remaining wound was repaired with the transverse V-Y advancement flap of the ipsilateral great toe. The distance for transfer of transverse advancement V-Y flap was 0.2-0.8 cm, and the area of the transverse V-Y advancement flap was 1.0 cm×1.4 cm-1.8 cm×2.4 cm. The end of postoperative follow-up was scheduled in July 2021. The follow-up items included: survival of the transverse V-Y advancement flap, wound infection, appearance, shape, texture and sensation of the V-Y advancement flap, pain on the V-Y advancement flap and the great toe, cold tolerance and the scar condition at the donor site of the ipsilateral fibular hallux flap and the V-Y advancement flap, the appearance, sensation and flexion and extension of the great toe at the donor site, other discomforts in the donor site of great toe, walking and other functions affected by the discomforts.Results:The postoperative follow-up lasted from 12 to 18(average of 14) months. All the V-Y advancement flaps survived without infection at the donor sites of the great toe, and donor sites healed primarily. The appearance, shape and texture of the advancement V-Y flap were close to the skin of the same area of the contralateral great toe. The TPD of the V-Y advancement flap and the ipsilateral great toe ranged from 4 to 7 mm. The average score of the Visual analog scale(VAS) was 0.3 and 0.6 respectively in the evaluation of cold tolerance of the advancement V-Y flap and the ipsilateral great toe. The average score of the Vancouver scar scale(VSS) was 0.2 and 1.2 respectively in the scar evaluation of the V-Y advancement flap and the ipsilateral great toe. There was no visual difference between the appearance of the great toe at the donor site and the contralateral toe. There was no pain and other discomfort on the V-Y advancement flap and the ipsilateral great toe. The functions of the donor foot were not affected in walking, running, jumping and tiptoeing in all cases.Conclusion:It is a simple, safe and effective method to repair the donor site of the small-area ipsilateral fibular hallux flap by the transverse V-Y advancement flap of the great toe. It only causes a small wound but the appearance and function of the ipsilateral great toe can be repaired with a transverse V-Y advancement flap of the great toe.

Effect of hallux toe nail flap and adjacent island flap of the middle and ring fingers in repair of degloving injury of distal thumb / 中华显微外科杂志

Objective:To summarise the clinical efficacy and surgical indications for free hallux toe nail flap and adjacent island flap of the middle and ring fingers in repair of distal thumb degloving injuries.Methods:From May 2009 to May 2021, a total of 24 patients (24 digits) with degloving injury of distal thumbs were treated in the Department of Hand and Microsurgery of Baoji Third Hospital. The flap was selected according to the patient's wishes and occupation. Of the 24 patients, 13 were repaired by free hallux toe nail flap transfer (group of hallux toe nail flap), and 11 were repaired by combining the proper palmar digital artery island flap of middle (ulnar side) and ring (radial side) fingers with the same volar common digital artery vascular pedicle (group of tile combined flap). Follow-up was performed at the 1st, 3rd, 6th,12th and 18th months after surgery respectively through outpatient clinic and telephone or WeChat interviews. The follow-ups focused on the appearance, colour, texture and two-point discrimination (TPD) of the flap, as well as thumb flexion, extension, opposition and grasping functions. Functional recovery evaluated according to the Evaluation Standard of Upper Limb Partial Functional of Hand Surgery of Chinese Medical Association.Results:All the 24 flaps survived and all were included in the follow-up. The follow-up lasted 12-60 and 6-18 months, with an average of (18.5±0.5) months and (6.8±0.3) months in group of hallux toe nail flap and group of tile combined flap, respectively. Appearance of thumb body and function at the last follow-up showed: in the group of hallux toe nail flap, the nails, thumbtips and fine sensations were restored, with the TPD at 5-8 mm. The thumb flexion, extension, opposition and grasping functions were good. Apart from without nails and fingerprint, the flaps in the group of tile combined flap had good appearance and texture, and the protective feeling was restored with the TPD at 6-11 mm. The affected thumbs also recovered the basic functions of flexion, extension, opposition and grasping. According to the Trial Standard of Upper Limb Function Evaluation of the Chinese Medical Association Hand Surgery Society, 7 cases were excellent, 5 cases were good, and 1 case was poor in the group of hallux toe nail flap. In the group of tile combined flap, 3 cases were in excellent, 5 in good, and 3 in poor. Appearance of flaps (such as nails and thumbtip fingerprint), fine sensory recovery, and the accuracy and stability of the grasping function, the group of hallux toe nail flap was significantly better than that of the group of tile combined flap. There was no functional impact on the donor site.Conclusion:Both types of flap are classic surgical procedures for repair of distal thumb degloving injury. In order to meet the individual requirement and to improve the efficacy of the treatment, such as for those who have high expectation for digit restoration, especially those who are young with aesthetical or professional requirement, free hallux toe nail flap repair is used to restore the perfect shape and function. And for those who are reluctant to sacrifice their toes or for the middle-aged and elderly people who do not have high expectation for the shape of thumb, a tile combined flap repair is used to restore thumb function.

Rotating Scarf osteotomy in treating hallux valgus combined with the first metatarsal rotation / 中国骨伤

OBJECTIVE@#To explore clinical effect of rotational Scarf osteotomy in treating hallux valgus (HV) with rotation of the first metatarsal bone.@*METHODS@#From January 2018 to October 2019, 35 patients (40 feet) with HV and rotation deformity of the first metatarsal were treated with rotational Scarf osteotomy, including 5 males and 30 females;aged from 25 to 76 years old with an average of (40.32±5.43) years old. Hallux valgus angle(HVA), intermetatarsal angle (IMA), distal metatarsal articular angle (DMAA), the first metatarsal length (FML) were observed and compared, American Orthopedic Foot and Ankle Society(AOFAS) of hallux metatarsophalangeal interphalangeal joint score and visual analogue scale (VAS) were used to evaluate functional evaluation.@*RESULTS@#Thirty-five patients(40 feet) were followed up from 12 to 36 months with an average of (14.35±3.62) months. HVA, IMA and DMAA were corrected from (36.32±4.51) °, (14.21±3.22) ° and (28.35±4.32) ° before operation to (14.32±5.71) °, (5.83±3.97) ° and (7.32±2.14) ° after operation respectively (P<0.05). There was no satistical difference in FML before and after operation (P>0.05). AOFAS score and VAS improved from (57.00±4.31) and (6.00±1.21) before operation to (90.31±3.28) and (1.42±0.83) after operation, respectively, and had significant difference(P<0.05);according to AOFAS score, 23 feet got excellent results, 15 feet good and 2 feet fair.@*CONCLUSION@#Rotational Scarf osteotomy with strong correction and high dimension could effectively correct HV combined with rotation deformity of the first metatarsal bone, improve function of the forefoot, and obtain good clinical results.

Scarf osteotomy combined with soft tissue balance release for severe hallux valgus / 中国骨伤

OBJECTIVE@#To explore clinical effect of Scarf osteotomy combined with soft tissue balance in treating severe hallux valgus.@*METHODS@#Totally 38 patients(50 feet) with severe hallux valux who underwent Scarf osteotomy combined with soft tissue balance surgery from June 2019 to June 2021 were retrospectively analyzed, aged from 29 to 64 years old with an average of(54.7±6.8) years old; 26 feet on the left side and 24 feet on the right side;the courses of disease ranged from 5 to 23 years with an average of (12.4±3.9) years. Hallux valgus angle (HVA), intermetatarsal angle (IMA), and distal metatarsal articular angle (DMAA) were compared before and after operation, and postoperative complications was observed. American orthopedic foot ankle society(AOFAS) score before operation and final follow-up was used to evaluate recovery of forefoot function, and visual analogue scale (VAS) was used to evaluate pain relief.@*RESULTS@#Thirty-eight patients (50 feet) were followed up from 15 to 23 months with an average of (18.3±3.2) months. Preoperative HVA, IMA and DMAA were (44.61±3.92)°, (18.74±2.51)°, (12.85±2.11)°, and improved to (13.45±2.13)°, (7.83±1.36)°, (7.03±1.39)°at final follow-up, which had statistical differneces(P<0.05). No delayed union or nonunion of osteotomy end, fracture or loosening of internal fixation, hallux varus occurred. VAS and AOFAS score improved from (6.81±2.14), (43.6±8.4)points before operation to (1.97±0.78), (87.6±5.2) points at final follow-up, which had statistical difference(P<0.01). According to AOFAS at final follow-up, 20 feet got excellent result, 28 feet good and 2 feet moderate.@*CONCLUSION@#Scarf osteotomy combined with soft tissue balance release for severe hallux valgus has good stability and corrective effect, but learning curve and postoperative complications should be paid attention.

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.

Case-control study on Scarf and double metatarsal osteotomy of the first metatarsal for the treatment of hallux valgus deformity / 中国骨伤

OBJECTIVE@#To compare clinical efficacy of scarf osteotomy and double metatarsal osteotomy(DMO) in treating moderate to severe hallux valgus.@*METHODS@#Fifty patients (81 feet) with moderate to severe hallux valgus deformity were treated from January 2017 to December 2019, and were divided into Scarf osteotomy (SO) group or DMO group according to different osteotomy methods. There were 26 patients (44 feet) in SO group, including 1 male and 25 females, aged from 48 to 65 years old with an average of (55.5±4.67) years old;18 patients (30 feet) with moderate and 8 patients (14 feet) with severe. There were 24 patients(37 feet) in DMO group, including 1 male and 23 females, aged from 45 to 62 years old with an average of (52.1±6.8) years old;there were 14 patients (24 feet) with moderate and 10 patients (13 feet) with severe. Hallux valgus angle (HVA), intermetatarsal angle (IMA), distal metatarsal articular angle (DMAA) and relative length of the first metatarsal(RLFM) on weight-bearing anteroposterior radiographs before and after operation were compared. American Orthopaedic Foot and Ankle Society (AOFAS) hallux, metatarsal, and interphalangeal joint scores was used for evaluate clinical effects. Weight bearing time and complications were observed.@*RESULTS@#Fivty patients were followed up. The follow-up time in SO group ranged from 12 to 36 months with an average of(20.50±6.22) months and from 16 to 28 months with an avaerge of(19.80±2.44) months in DMO group while there was no significant difference between two groups(P>0.05). All incision healed at stage I, and osteotomy healed at (20.31±3.17) months after operation. One patient occurred hallux adduction deformity, without transferred metatarsalgia;2 patients occurred metastatic metatarsalgia in DMO group. There were no significant difference in HVA, IMA, DMAA, and AOFAS scores between two groups(P>0.05) before and after operation. There was no significant difference in RLFM between two groups(P>0.05), while had significant difference in RLFM between two groups at final follow-up (P<0.05). Partial weight-bearing time and full weight-bearing time in SO group were significantly earlier than those in DMO group (P<0.05).@*CONCLUSION@#Both of Scarf osteotomy and the first metatarsal biplane osteotomy could effectively treat moderate to severe hallux valgus deformity, with similar imaging and clinical evaluation. However, the relative length of the first metatarsal bone in SO group was longer than that in DMO group after operation, and the time of weight bearing in Scarf osteotomy is earlier than that of double metatarsal osteotomy of the first metatarsal.

Scarf osteotomy for hallux valgus correction: radiological and clinical analysis / Osteotomia de scarf para correção do hálux valgo:análise radiológica e clínica

ABSTRACT Objectives: This article aims to radiographically and clinically evaluate the results of the surgical correction of hallux valgus using the scarf technique. The pre- and postsurgical hallux valgus angles - metatarsophalangeal angle (MP), intermetatarsal angle (IM), and degree of dislocation of the sesamoids - were retrospectively evaluated, as well as their clinical parameters. Methods: 70 pre- and postoperative radiographs of patients undergoing surgical correction of hallux valgus by the scarf osteotomy technique were retrospectively evaluated. The American Orthopedic Foot And Ankle Society Score (AOFAS) was used for pre- and postoperative clinical evaluation. Results: There was a statistically significant improvement in the MP, IM, and sesamoid position, in addition to the clinical improvement verified by the AOFAS. Conclusion: Scarf osteotomy improves the MP and IM angles and correct the position of the sesamoid, as well as improve the AOFAS. Level of Evidence IV, Retrospective Comparative Study.

RESUMO Objetivos: Analisar radiograficamente e clinicamente os resultados da correção cirúrgica do hálux valgo pela técnica de Scarf, assim como os ângulos pré e pós-cirúrgico do hálux valgo - ângulo metatarsofalângico (MTF) e ângulo intermetatarsal (IM) -, grau de luxação dos sesamoides e parâmetros clínicos. Métodos: Foram avaliadas retrospectivamente 70 radiografias com carga pré e pós-operatórias dos pacientes submetidos à correção cirúrgica do hálux valgo pela técnica de osteotomia de Scarf. Para avaliação clínica pré e pós-operatória foi utilizado a escala da American Orthopaedic Foot And Ankle Society (AOFAS). Resultados: Foi observado melhora estatisticamente significativa dos ângulos MTF e IM e posição dos sesamoides, além de melhora clínica verificada pela escala AOFAS. Conclusão: A osteotomia de Scarf é capaz de melhorar os ângulos MTF e IM e corrigir a posição dos sesamoides, acompanhado da melhora da escala AOFAS. Nível de Evidência IV, Estudo Retrospectivo Comparativo.

Modified Chevron osteotomy in the treatment of moderate and severe hallux valgus / 中国骨伤

OBJECTIVE@#To investigate the method and clinical effect of modified Chevron osteotomy of the distal end of the first metatarsal in the treatment of moderate and severe hallux valgus.@*METHODS@#From January 2015 to January 2019, 28 patients(30 feet) with moderate and severe hallux valgus were treated with modified Chevron osteotomy combined with lateral soft tissue release of the first metatarsophalangeal joint, including 2 males (2 feet) and 26 females (28 feet). The age ranged from 35 to 74 (57.3±9.3) years;10 feet on the left, 16 feet on the right, 2 cases on both sides(4 feet);the course of disease was 3 to 12 (9.32±3.89) years. The changes of hallux valgus angle(HVA), intermetatarsal angle(IMA) between the first and second metatarsals and distal metatarsal articular angle(DMAA) of the first metatarsal were measured and compared before and 6 months after operation. The American Orthopaedic Foot and Ankle Society(AOFAS) thumb joint scoring system was used to evaluate the curative effect.@*RESULTS@#All 28 patients were followed up for 8 to 16 (11.28±3.42) months. The incision healed well in all patients, and there were no complications such as incision infection and metatarsal head necrosis. The healing time of osteotomy site was 6 to 10(7.12±1.34) weeks. Preoperative HVA, IMA, DMAA and AOFAS were (36.06±6.02) °, (21.78±4.16) °, (8.21±2.65) ° and (52.90±10.97) respectively, at six months after operation, they were (8.87±2.46) °, (11.66±2.84) °, (3.65±1.00) ° and (87.45±10.55) respectively, there was significant difference between preoperative and 6 months after operation(P<0.05). At 6 months after operation, AOFAS score was excellent in 20 feet, good in 7 feet and poor in 3 feet. Among the 3 patients with poor scores, 2 were excellent after revision, and 1 was significantly improved after using custom insoles.@*CONCLUSION@#Modified Chevron can effectively correct HVA, IMA and DMAA and improve functional recovery. The modified Chevron osteotomy increases the moving distance and the contact of the osteotomy surface. It can be fixed with multiple screws, has strong correction ability, and can exercise early. It is one of the optional methods for the treatment of moderate and severe hallux valgus.