Analysis on effect of Scarf combined with Mcbride osteotomy for treatment of moderate to severe hallux valgus / 重庆医学

Objective To explore the surgical skill and curative effect of Scarf combined with modified Mcbride osteotomy for treating moderate to severe hallux valgus.Methods Thirty-eight patients (47 feet) with moderate to severe hallux valgus in the Southwest Hospital of Army Military Medical University from July 2014 to June 2015 were selected and treated by Scarf combined with modified Mcbride osteotomy,among them,31 cases(38 feet) were followed up.The cases of phalanx proximal articular angle(PAA) enlargement were added with Akin osteotomy hallex proximal phalanx,and 2,3 plantar Weil osteotomy was used in the patients with 2,3 plantar bone metastasis pain.The hallux valgus angle (HVA),1,2 intermetatarsal angle (IMA),distal metatarsal joint fixed angle(DMAA),PAA were compared between before and after surgery by the erect position,anteroposterior position and lateral X-ray films.The therapeutic effects were assessed by adopting the American Orthopedic Foot and Ankle Society(AOFAS) scoring system.Results The follow-up time was 12～18 months(average 16.42 months).HVA was decreased from preoperative(41.82±5.28)° to postoperative(17.03±4.04)°,IMA was decreased from preoperative(19.00 ± 3.78)°to postoperative(9.24 ± 1.98)°,DMAA was decreased from preoperative(19.42±5.65)°to postoperative(8.71±2.74)°,PAA was decreased from preoperative (5.66± 3.27) ° to postoperative (3.82 ± 2.09) °,and AOFAS score was increased from preoperative (41.47 ± 6.29) to postoperative (84.82 ± 6.43),the differences were statistically significant (P＜0.05).Conclusion Scarf combined with modified Mcbride osteotomy has satisfactory effect for treating moderate to severe hallux valgus.

The analysis of curative effect of the modified McBride's procedure on correcting mild-moderate hallux val-gus / 中国基层医药

Objective To explore the curative effect of clinical application of modified McBride's procedure on correcting mild-moderate hallux valgus.Methods We had retrospectively assessed 32 patients(52 feet)treated with the procedure of modified McBride's procedure.All patients were followed up,the follow -up period from 6 months to 6 years(3.1 years on average).There were 2 male(4 feet)patients and 30 female(48 feet)patients in this group.The average age at the time of surgery was 41.6 years old(from 21 to 59 years).Results According to the forefoot score of American Orthopedics Foot and Ankle Society(AOFAS),29 feet(55.8%)were excellent,17 feet (32.7%)were good,And the rate of excellent and good was 88.5%.The average correction of HVA and IMA was 13.68°and 3.24°respectively compared with the preoperative cases.Conclusion This procedure can not only effec-tively reduce the increased hallux valgus angle,but also narrow the angle between the 1st and 2nd metatarsal,relocate the sesamoid system,and effectively relieve patients'pain.This approach is of minor side effects to bone and joint structure,and of rapid recovery.It is a preferential choice to treat mild-to-moderate hallux valgus deformity.

Clinical Features of Ocular Disabilities

PURPOSE: To describe the characteristics of the disabled patients visiting the eye clinic in our institute. METHODS: We carried out a retrospective analysis of 35 cases in our clinic from April 2004 to June 2008 using the McBride disability evaluation. We investigated the clinical features and the causes of disorders through visual acuity, visual field and ocular motility. RESULTS: Thirty-three (94.3%) of the 35 patients had disabilities due to trauma; twelve (34.3%) of them were caused by traffic accidents, and 21 (60%) of them were due to blows or lacerations. Other causes of disability were glaucoma and retinal break (5.8%). Nine patients (25.7%) had abnormal findings in the visual field examination, and nine other patients (25.7%) had limitations in ocular motility. Twenty-eight patients (80%) had decreased visual acuity, and nine (25.7%) had multiple symptoms. CONCLUSIONS: Considering the contribution of disability estimation of visual field and ocular motility in McBride disability evaluations, we considered the importance of repetitive examinations and evaluations. When patients complained of unexplained decreased visual acuity with no anatomical abnormalities, multifocal ERG and multifocal VEP should be considered in order to distinguish it from malingering or functional visual loss.

Korean Guideline Development for the Evaluation of Permanent Impairment of the Spine: Proposal by the Korean Academy of Medical Sciences Committee

The criteria for the evaluation of spinal impairment are diverse, complex, and have no standardized form. This makes it difficult and somewhat troublesome to accurately evaluate spinal impairment patients. A standardized guideline was studied for the evaluation of spinal impairment, based on the American Medical Association (AMA) Guides and the McBride method. This guideline proposal was developed by specialty medical societies under the Korean Academy of Medical Sciences. In this study, the grades of impairment were assessed by dividing patients into three different categories: spinal cord impairment, spinal injury impairment and spinal disorder impairment. The affected regions of the spine are divided into three: the cervical region, the thoracic region, and the lumbosacral region. The grade of impairment was differentially evaluated according to the affected region. The restricted range of motion was excluded in the evaluation spinal impairment because of low objectivity. Even though the new Korean guideline for the evaluation of spinal impairment has been proposed, it should be continuously supplemented and revised.

Review of Korean Disability Evaluation Systems and Suggestions for the Improvement Direction / 대한법의학회지

In case of accident, appropriate payment for the injured is important in the point of justice or even for the early social rehabilitation of the injured. To evaluate the exact status of the injured is the prerequisite for this. The physical status is converted to social or legal status using impairment or disability evaluation system. For this many different systems are used in Korea right now, that are several legislations such as 'Nation Compensation Law', or popular McBride and AMA(American Medical Association) guidelines. These guidelines are not similar in main idea or in detail items. Furthermore as these are from another country, these could not reflect our national status. Several national legislations are also far from appropriateness. There are many cases that showed different evaluation results depending on what guidelines are adopted. To overcome this irrational situation, many trials have been made to establish Korean guideline for the disability evaluation by different groups of specialists using different concepts. In this study the irrational status that showed different rating results depending on different guideline adopted were showed through several case works. With thorough review of the related materials, the pros and cons of the major systems in Korea were pointed out. Guideline suggested recently in Korea by different groups were also reviewed thoroughly. To know the points that must be considered in making new guideline, many specialists and business mans who are actively participating in compensation related works were questioned on the major topics. With the introduction of major concept in compensation medicine, author tried to present the plausible way for the improvement of our system. Author believe that this results would be helpful in making direction for the Korean guideline for the disability evaluation and contribute in settling down the social or legal dispute around the disability evaluation around us.

Treatment of Hallux Valgus with Modified McBride Procedure and Proximal Metatarsal Crescentic Osteotomy / 대한족부족관절학회지

PROPOSE: This study was retrospectively to review the surgical results for moderate to severe hallux valgus corrected with a modified McBride procedure and proximal metatarsal crescentic osteotomy. MATERIALS AND METHODS: Between August 1997 and August 2001, 15 patients with 22 bunion underwent surgical correction and were followed for an average 29.3 months (range, 18 to 53 months). Clinical results were evaluated with AOFAS clinical rating system for hallux and radiological measurements were done preoperatively and at a minimum of 12 months postoperatively. RESULTS: The average AOFAS clinical rating score improved from 47.5 to 86.0. Union of the osteotomy site occurred at 9.5 weeks except one delayed union. The hallux valgus angle improved an from 36.5 degrees to 15.7 degrees and the intermetatarsal angle improved from 17.4 degrees to 8.6 degrees on average. Dorsiflexion of the first metatarsal at the osteotomy site was present in three (13.6%) with average 4 degrees. Complications were two recurred deformity, one hallux varus and one painful transfer lesion. There was a high level of satisfaction with clinical results in 11 patients (73.3%) with 17 feets and cosmesis in 18 feets (81.8%). CONCLUSION: Modified McBride procedure and proximal metatarsal crescentic osteotomy based on careful patient selection and meticulous technique showed satisfactory outcome for moderate to severe hallux valgus.

Medical Criteria for Evaluation of Degree of Disability Including Industrial Injury: Orthopedic Surgery

The number of orthopedic patients is increasing according to the increase of traffic and industrial accidents, and there are several approaches to evaluate physical disabilities ensuring after treatment of the injury: The McBride's criteria and the criteria for the evaluation of physical disabilities from industrial injury have been introduced to the medical field. As for the degree of physical disabilities, the McBride's criteria are based on occupations and injured sits, and also amputation, the conditions of joints, and complications of fracture and neural injury. On the other hand, the criteria of physical disability of industrial injuries by the Ministry of Labor in Korea are not satisfactory as compared with the McBride's criteria, and in the future various conditions of joints such as a limited angle of joints should be considered in the criteria of industrial injures.

Proximal Metatarsal Chevron Osteotomy Combined with Modified McBride Procedures for Hallux Valgus Patients / 대한정형외과학회잡지

Seventy cases of moderate to severe hallux valgus deformities were operated by proximal metatarsal chevron osteotomy combined with modified McBride procedures from September 1994 to September 1996. The hallux valgus angle improved from an average of 35.1 degrees to 12.1 degrees postoperatively. The first intermetatarsal angle improved from an average of 15.4 degrees to 7.9 degrees. The position of sesamoids was normalized and the metatarsal bone shortened minimally. Union occurred in 6 weeks. Subjectively, pain was relieved in 95% of the patients, while walking and standing abilities improved in 90%. The shoewear improved in only 60% of the patients, showing less satisfactory results compared to other factors. In terms of complications, two recurrences occured but were treated without repeat surgery. Two malunions and four superficial wound infections occurred. In conclusion, proximal chevron metatarsal osteotomy combined with modified McBride procedures is a reliable operation as regards stability, technical ease, low complications and satisfactory results for moderate to severe Hallux valgus deformities.

Problems of Application to McBride Disability Evaluation in Loss of Visual Effciency Patients

We had carried out a retrospective analysis which consisted of 61 consecutive cases on disability evaluated and estimation of loss of efficiency in this hospital for the last five years. Factors in disability evaluation were decreased visual acuity (27 patients, 44.2%), contracted visual field (5 patients, 8.1%) and disabled ocular motility (15 patients, 24.5%). Estimation errors in disability evaluation occurred in 9 (14.7%) in all cases. The average error rate was 10.2%. The causes were confusion of efficiency with loss of efficiency, conversion deficiency of 75% visual efficiency in pseudophakic eye and estimation errors in diplopia field test. Beforehead estimation cases in disability evaluation were 9 cases (4.7%). The case which needed request of calculation of medical fee after this were 19 cases (31.3%). The incidence of malingering were observed in 11 patients (18.0%) and the major factor of malingering was decreased visual acuity (8 patients, 72.7%). In conclusion, with the use of the estimation of loss of efficiency, we presented many problems such as estimation errors, beforehead estimation cases in disability evaluation, maligerings, request of calculation of medicalfee after this, and etc. Therefore, in accord with the actual condition, we request the establishment of standardization, methods, articles of estimation.

A Comparative Study on Evaluation Methods of Permanent Impairment in Korea / 예방의학회지

In this study, literature review was done to examine and compare the current status and problems of different evaluation approaches toward permanent impairment in Korea. Alternatives and improvements in the current approaches in Korea were suggested. Series of cases were also examined to compare different approaches applied to the real cases, using 105 cases from a hospital data and another 207 cases from insurance company data. The main findings of the literature review are as follows; 1. The current evaluation methods of permanent impairment in Korea are grouped into two categories, grading and rating. Grading of impairments are expressly specified in 17 various statutes. 2. In Grading methods, the rigid system of 14 different grades has been adopted uniformally for the convenience of administration, which may not be, appropriate or valid from medical and scientifical aspect. 3. The advantage of McBride method is assessment of occupational disability rate. However the classified compensable occupations are only 280 and limited to manufacturing industries in 1960s' of U.S.A., which is not appropriate to current Korean circumstances. Especially, the job list does not include managerial officers or mental workers. 4. AMA Guides is the scientific and reasonable method for the assessment of physical impairment rate. However compensation and reparation of impairment case is difficult because this method cannot assess the disability rate according to occupation, age, etc. The results of cases comparative study are as follows: 5. The physical impairment could be compared in 167 out of total 312 cases and for the cases of complex impairment, McBride method underestimate physical impairment rate compared with AMA method. 6. When disability rate was assessed, occupation was considered the compensation of only 85 cases, and age was used in only 21 cases. This was because occupation and age compensation in McBride method are unreasonable. 7. The most ideal alternative is to assess physical impairment according to AMA method and then to develop a compensation method appropriate for the circumstances of Korea society.

A Comparative Study on Evaluation of Physical Impairment Among Revised Evaluation by Medical Association, McBride Disablitlity Evaluation and Evaluation of Permanent Impairment by American Medical Association

In 1992 the Korean Medical Association intended to make revised evaluation and rate of physical impairment based upon rate and evaluation of physical impairment according to National Compensation Law which was composed of 14 subdivisions with various rates of physical impairment. Committee of Evaluation of Physical Impairment in Korean Neurosurgical Society provided revised evaluation of nervous or mental impairment, peripheral never impairment and spinal column impairment. Because McBride Disability Evaluation and Guide to the Evaluation of Permanent Impairment by American Medical Association have been used widely in this field the author describe evaluation and rate of physical impairment in each method briefly and compare to revised evaluation by Korean Medical Association in subject of neurologic and spinal impairment.