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.

Tratamiento del hallux valgus rigidus con osteotomía tipo Mitchell modificada. Descripción de la técnica quirúrgica y evaluación funcional a mediano plazo / Modified Mitchell's osteotomy for the treatment of hallux valgus rigidus. Description of the surgical technique and medium-term functional evaluation

Objetivo: Describir la técnica quirúrgica de Mitchell modificada para el tratamiento del hallux valgus rigidus grado 2, y evaluar los resultados a mediano plazo.materiales y métodos:Estudio prospectivo observacional. Entre agosto de 2015 y enero de 2019, 21 pacientes (23 pies) con hallux valgus rigidus grado 2 fueron sometidos a una osteotomía tipo Mitchell modificada.Resultados: Se comunican los resultados sobre la base de la edad, el sexo, el seguimiento posoperatorio, el puntaje de la AOFAS, el pie afectado, la pérdida de reducción, el colapso de la cabeza del metatarsiano, el dolor residual y la necesidad de plantillado para el alta. El puntaje de la AOFAS a los 18 meses fue de 94,78. Los pacientes retornaron a su actividad laboral, en promedio, a los 16.6 días y a sus actividades previas, a los 3.43 meses.Conclusión:Presentamos una técnica quirúrgica que combina los beneficios de la osteotomía de Chevron y la de Mitchell, con excelentes resultados clínicos y funcionales. Nivel de Evidencia: IV

Objective: To describe the modified Mitchell's surgical technique for the treatment of grade II hallux valgus rigidus, and to evaluate medium-term outcomes. materials and methods: Prospective observational study. Between August 2015 and January 2019, 21 patients (23 feet) with grade II hallux valgus rigidus were treated. All underwent a modified Mitchell's osteotomy. Results: The results are reported based on age, gender, postoperative follow-up, AOFAS score, affected foot, loss of reduction, metatarsal head collapse, residual pain, and whether the patient needed insoles to be discharged. The AOFAS score at 18 months was 94.78. On average, the patients returned to work after 16.6 days and to their usual activities after 3.43 months. Conclusion: We present a surgical technique that combines the benefits of the Chevron and Mitchell osteotomy, with excellent functional clinical outcomes. osteotomy. Level of Evidence: IV

Seudoartrosis después de una osteotomía en Chevron: incidencia, tratamiento, seguimiento y evolución / Nonunion after Chevron osteotomy. Incidence, treatment, follow-up, and outcomes

Introducción: El hallux valgus es el trastorno más común del primer dedo del pie. Provoca dolor, discapacidad funcional y altera los patrones de la marcha. Las deformidades leves o moderadas se han corregido con osteotomías distales del primer metatarsiano, como la osteotomía en chevron, un procedimiento seguro, pero no exento de complicaciones. Los objetivos de este estudio fueron determinar la incidencia de seudoartrosis por dicha osteotomía y comunicar nuestro método terapéutico, el seguimiento y la evolución. materiales y métodos: Se realizó un estudio multicéntrico, retrospectivo que incluyó a pacientes operados entre 2009 y 2018. Se evaluaron 1156 osteotomías en chevron como tratamiento del hallux valgus leve o moderado en 1017 pacientes (rango etario 16-83 años; promedio 57.5) realizadas por 4 cirujanos experimentados. El criterio de inclusión fue que el paciente contara con estudios por imágenes compatibles con seudoartrosis a los 6 meses de la cirugía. Resultados: Se evaluó a 5 pacientes con diagnóstico de seudoartrosis después de una osteotomía en chevron para tratar el hallux valgus. Los puntajes promedio de la AOFAS fueron 51 antes del tratamiento del hallux valgus y 87,8 después del tratamiento de la seudoartrosis. Conclusiones: La incidencia de seudoartrosis fue del 0,4% en el posoperatorio alejado. Nuestro abordaje y el tratamiento de la seudoartrosis lograron una excelente mejoría clínica y funcional en todos los pacientes operados. Nivel de Evidencia: III

Introduction: Hallux valgus is the most common disorder of the first toe. It causes pain, functional impairment, and alters gait patterns. Mild to moderate deformities are tipically corrected with distal osteotomies of the first metatarsal, such as the chevron osteotomy, a safe procedure, but not without complications. The objectives of this study were to determine the incidence of pseudarthrosis following this osteotomy and report our therapeutic method, follow-up, and outcomes. Materials and methods: A retrospective multicenter study was carried out, which included patients operated on between 2009 and 2018. A total of 1156 chevron osteotomies were evaluated as a treatment for mild to moderate hallux valgus in 1017 patients (age range 16 -83 years; average 57.5 years) performed by 4 experienced surgeons. The inclusion criterion was that the patient had imaging studies compatible with pseudarthrosis six months after surgery. Results: We evaluated five patients who met our criterion. The average AOFAS (American Orthopedic Foot and Ankle Society) scores were 51 before hallux valgus treatment and 87.8 after pseudarthrosis treatment. Conclusion: The incidence of pseudarthrosis was 0.4% in the distant postoperative period. Our approach and treatment of pseudarthrosis achieved excellent clinical and functional improvements in all operated patients. Level of Evidence: III

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.

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)

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.

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.

Percutaneous Hallux Valgus: An Algorithm for the Surgical Treatment / Hálux valgo percutâneo: Um algoritmo de tratamento cirúrgico

Abstract Objective To present the clinical and radiographic results of hallux valgus surgical correction using four percutaneous techniques, chosen according to a predefined radiographic classification. Methods We prospectively evaluated 112 feet in 72 patients with hallux valgus operated over the course of 1 year. Percutaneous distal soft tissue release (DSTR) and the Akin procedure (DSTR-Akin) were performed in mild cases. In mild to moderate hallux valgus with distal metatarsal joint angle > 10°, we added the Reverdin-Isham (RI) osteotomy. In moderate cases with joint incongruity, we performed the percutaneous chevron (PCH). Finally, a Ludloff-like percutaneous proximal osteotomy fixed (PPOF) with a screw was proposed in severe cases with an intermetatarsal angle (IMA) > 17°. According to these criteria, 26 DSTRs-Akin, 36 PCHs, 35 RIs, and 15 PPOFs were performed. The mean follow-up was of 17.2 months (range: 12 to 36 months). The mean age at operation was 58.8 years (range: 17 to 83 years), and 89% of the patients were female. Results The mean preoperative hallux valgus angle (HVA) and the IMA decreased from 21° to 10.2° and from 11.2° to 10.3° respectively in the DSTR-Akin. In the RI, the mean HVA decreased from 26.6° to 13.7°, and the IMA, from 11.2° to 10.3°; in the PCH, the mean HVA decreased from 31° to 14.5°, and the IMA decreased 14.9° to 10.7°; as for the PPOF, the mean HVA decreased from 39.2° to 17.7°, and the IMA, from 11.8° to 6.8°. The average ankle and hindfoot score of the American Orthopaedic Foot and Ankle Society (AOFAS) increased from 49.2 to 88.6. The rate of complications was of 11%. Conclusion Our treatment protocol does not differ much from the classic ones, with similar results as well. We have as advantages less aggression to soft tissues and better cosmetic results. Level of Evidence: level IV, prospective case series.

Resumo Objetivo Apresentar os resultados clínicos e radiográficos da correção cirúrgica de hálux valgo utilizando quatro técnicas percutâneas escolhidas de acordo com uma classificação radiográfica predefinida. Métodos Avaliamos prospectivamente 112 pés em 72 pacientes com hálux valgo operado em um período de um ano. A liberação de tecido mole distal (LTMD) percutâneo e o procedimento de Akin (LTMD-Akin) foram realizados em casos leves. Em hálux valgo de leve a moderado com ângulo distal da articulação do metatarso acima de 10°, adicionamos a osteotomia de Reverdin-Isham (RI). Em casos moderados com incongruência articular, realizamos o chevron percutâneo (CHP). Finalmente, uma osteotomia proximal percutânea fixada (OPPF) com um parafuso, semelhante à de Ludloff, foi proposta em casos graves com ângulo intermetatarsal (AIM) acima de 17°. De acordo com esses critérios, foram realizados 26 LTMDs-Akin, 36 CHPs, 35 RIs e 15 OPPFs. O seguimento médio foi de 17,2 meses (12 a 36 meses). A média de idade em operação foi de 58,8 anos (17 a 83 anos), e 89% dos pacientes eram do sexo feminino. Resultados A média do ângulo de hálux valgo (AHV) pré-operatório e o AIM diminuíram de 21° para 10,2°, e de 11,2° para 10,3°, respectivamente, em casos de LTMD-Akin. Em casos de RI, a média do AHV diminuiu de 26,6° para 13,7°, e o AIM, de 11,2° para 10,3°; em casos de CHP, o AHV médio diminuiu de 31° para 14,5°, o AIM diminuiu de 14,9° para 10,7°, e a OPPF, de 39,2° para 17,7°, e o AIM 11,8° para 6,8°. A média do escore de tornozelo e retropé da American Orthopaedic Foot and Ankle Society (AOFAS) aumentou de 49,2 para 88,6. A taxa de complicação foi de 11%. Conclusão Nosso protocolo de tratamento não difere muito dos clássicos, com resultados semelhantes. Temos como vantagem menos agressividade aos tecidos moles e melhores resultados cosméticos. Nível de evidência: nível IV, série de casos prospectivos.

Osteotomía percutánea de la falange distal del hallux. Indicaciones y técnica / Percutaneous osteotomy of the distal phalanx of the hallux. Indications and technique

Introducción: Las técnicas para corregir las deformidades del hallux incluyen osteotomías metatarsianas y falángicas. Las osteo-tomías sobre la falange proximal corrigen el DASA y el ángulo interfalángico. Sin embargo, no se han publicado las indicaciones para la osteotomía de la falange distal. El objetivo de este artículo es comunicar la técnica y las indicaciones de la osteotomía percutánea de la falange distal del hallux, y evaluar los resultados de una serie de casos. materiales y métodos: Se analizaron 14 pies en los que se realizó una osteotomía de la falange distal del hallux para corregir una deformidad. Se midieron el DASA, la oblicuidad interfalángica y el ángulo falange distal-interfalángico en las radiografías. La técnica quirúrgica fue percutánea con control fluoroscópico. Los resultados se evaluaron mediante las escalas analógica visual de dolor y AOFAS. Seguimiento medio: 52 meses. Resultados: 13 pies de mujeres y un pie de hombre. Edad promedio: 58 años. Los resultados clínico y estético fueron excelentes, con alivio del dolor. Mejoría de la escala AOFAS: promedio 37 puntos. Análisis comparativo de ángulos preoperatorios y posoperatorios: DASA (p = 0,01), excepto cuando se aisló de la muestra a los pacientes con osteotomía tipo Akin (p = 0,33); ángulos F2-IF y F2-MTF (p <0,00001). Se registraron las complicaciones. Conclusiones: En la deformidad en valgo de la falange distal del hallux sintomática, se debe considerar una osteotomía correctora sola o asociada a osteotomía de la falange proximal. La osteotomía percutánea de la falange distal es un método eficaz, seguro y rápido. Nivel de Evidencia: IV

Introduction. There are many techniques to correct the hallux deformity. Most of them include metatarsal and/or phalanx osteotomies. The Akin osteotomy of the proximal phalanx is used to correct the distal articular set angle (DASA), or the interphalangeal angle. However, indications for the distal phalanx osteotomy remain unpublished. The aim of this study is to communicate the technique of performing and the indications for percutaneous osteotomy of the distal phalanx of the hallux, and evaluate the results of a cases series. Materials and methods. We report 14 cases in which distal phalangeal osteotomy was performed. Radiographic measurements were performed on dorsal-plantar view foot, to analyze distal articular set angle (DASA), interphalangeal obliquity, and F2-IP angle. Surgical technique was performed by minimally incision surgery. The clinical and functional results were evaluate by the visual analogue scale pain, and the AOFAS score. Mean follow-up was 52 months. Results. The clinical result for all the patients was excellent, pain was relieved and deformities corrected. Pre- and post-operative comparative angles: DASA (p: 0.01), except when isolated from the sample for Akin-type osteotomy (p: 0.33). Angle F2-IF and angle F2-MTF (p: <0.00001). The patients where highly satisfied with both the aesthetic and functional results. Complications were registered. Conclusion. In the symptomatic hallux´s distal phalanx deformity a corrective distal phalanx osteotomy should be considered alone, or associated with the osteotomy of the proximal phalanx. Percutaneous distal phalanx osteotomy is an effective, safe, and fast procedure. Level of Evidence: IV

Estudio prospectivo de cirugía de hallux valgus con técnica de Bosch y técnica MICA. Análisis radiológico comparativo a mediano plazo / Bösch vs MICA techniques in hallux valgus surgery. Medium-term prospective comparative radiographic analysis

Introducción: Existen múltiples tratamientos quirúrgicos del hallux valgus. El propósito de este estudio fue comparar los resultados radiográficos de corrección angular y su mantenimiento a mediano plazo, entre dos técnicas percutáneas: MICA y Bösch. Materiales y Métodos: Análisis prospectivo comparativo de pacientes sometidos a cirugía de hallux valgus mediante dos técnicas percutáneas (grupo Bösch: 42 pies, grupo MICA: 36 pies). Se compararon las correcciones de los ángulos IM, MTF y AMD, y el poder de corrección de ambas osteotomías y su mantenimiento a mediano plazo. Se registraron las complicaciones posoperatorias. Seguimiento mínimo: 6 meses. Resultados: La corrección promedio de los ángulos IM, MTF y AMD fue: 20,22°; 7,74°; 8,26° a los 6 meses en el grupo Bösch; y de 15,8°; 1,6° y 1,98° en el grupo MICA. El potencial de corrección IM fue mayor en el grupo Bösch. No hubo diferencias significativas entre ambos grupos en cuanto a la pérdida de corrección entre las 6 semanas y los 6 meses, salvo el ángulo MTF en el grupo MICA. La corrección del ángulo AMD fue mejor en el tiempo con la técnica MICA. Hubo 4 complicaciones con la técnica MICA y 8 con la técnica de Bösch. Conclusiones: Ambas técnicas logran una corrección adecuada del hallux valgus moderado. Sin embargo, el poder de corrección del ángulo IM a mediano plazo fue mayor con la técnica de Bösch. En el otro grupo, aunque se perdió la corrección del ángulo MTF entre las 6 semanas y los 6 meses, los valores se mantuvieron dentro de los 20° de valgo MTF. Nivel de Evidencia: II

Introduction: Multiple surgical treatments for the hallux valgus have been described. The purpose of this study is to compare the radiological results for the angular correction and its stability on the middle term between two percutaneous techniques (MICA versus BOSCH technique). Materials and methods: Prospective comparative analysis of surgically treated patients with hallux valgus by two percutaneous techniques (BOSCH group: 42 feet; MICA group: 36 feet) in homogenous groups. Intermetatarsal, metatarsophalangeal and distal metatarsal articular angle corrections were compared, as well as the correction power of both osteotomies and its stability in the middle term. Postoperative complications were recorded. Minimum follow-up: 6 months. Results: Average angle correction of MTP, IM y DMAA 6 months after surgery in Bosch group: 20,22°; 7,74°; 8,26°; MICA: 15,8°; 1,6° and 1,98° respectively. BOSCH group had a higher IM correction power. There were no significant statistical differences between both groups in the loss of correction by 6 weeks to 6 months; except for the MTP angle in the MICA group. MICA presented a better correction of the DMAA in time. Postoperatively, MICA had 4 complications, while BOSCH 8. Conclusions: We obtained good results with both techniques in the treatment of moderate hallux valgus. However, patients undergoing the Bosch technique had greater correction on the intermetatarsal angle in the mid-term follow-up. Although the MTP angle correction decreased between 6 weeksand 6 months in MICA technique, the values remained within normal 20° of valgus MTP. Level of Evidence: II

Feasibility study on local infiltration anesthesia for postoperative analgesia in patients with hallux valgus / 中国骨伤

OBJECTIVE@#To evaluate the clinical efficacy of local infiltration anesthesia of ropivacaine combined with compound betamethasone for postoperative analgesia in patients with hallux valgus.@*METHODS@#From September 2019 to December 2020, 48 patients with hallux valgus were treated surgically. According to different postoperative analgesia methods, the patients were divided into combined local infiltration group and intravenous analgesia pump group. There were 24 cases, in the combined local infiltration group including 2 males and 22 females;the age ranged from 21 to 78 years old, with an average of (58.3±7.7) years old;soft tissue release and chevron osteotomy were performed in 15 cases and metatarsophalangeal joint fusion in 9 cases;immediately after operation, 20 ml of ropivacaine combined with compound betamethasone mixed diluent was used for local infiltration anesthesia once. There were 24 patients in intravenous analgesia pump group, including 3 males and 21 females;the age ranged from 23 to 81 years old, with an average of(56.8±8.3) years old;soft tissue release and Chevron osteotomy were performed in 17 cases and metatarsophalangeal joint fusion in 7 cases;immediately after operation, intravenous analgesia pump was used for analgesia. The basic flow was 2 ml / h;the self control dose was 0.5 ml;and the locking time was 15 min. Visual analogue scale (VAS) was recorded at 12, 24, 48 and 72 hours after operation;and the VAS was recorded at 24 hours after operation. The occurrence of adverse drug reactions at 0 to 12 hours, 12 to 24 hours and 24 to 48 hours after operation were recorded;and the healing of incision was recorded.@*RESULTS@#All patients were followed up, and the duration ranged from 14 to 17 days, with a mean of (14.60±0.92) days. There was significantdifference in VAS at 12, 24 and 48 hours between the combined local infiltration group and the intravenous analgesia pump group(@*CONCLUSION@#Compared with intravenous analgesia pump group, ropivacaine combined with compound betamethasone can significantly reduce postoperative wound pain without increasing adverse drug reactions, and does not increase wound infection.

Minimally invasive osteotomy and manual reduction for hallux valgus / 中国骨伤

OBJECTIVE@#To explore clinical effects of minimally invasive osteotomy and manual reduction in treating hallux valgus.@*METHODS@#From January 2018 to May 2019, 31 patients (42 feet) with hallux valgus were treated with minimally invasive osteotomy and manual reduction, including 3 males and 28 females aged from 18 to 76 years old with an average of (50.1± 4.9) years old. Preoperative and postoperative hallux valgus (HVA), intermetatarsal angles(IMA), length difference between 1 and 2 metatarsals were recorded and compared, and American Orthopedic Foot and Ankle Society (AOFAS)score were observed and measured.@*RESULTS@#Thirty-one patients (42 feet) were followed up from 14 to 18 months with an average of (15.1± 1.2) months. HVA, IM before operation were (38.5±5.4)°, (13.0± 1.1)°, and improved to (14.3±4.7)°and (9.1±1.5)°after operation respectively(@*CONCLUSION@#Minimally invasive osteotomy and manual reduction in treating hallux valgus have advantages of shorter operation time, less length of incision, and could correct hallux valgus deformity, improve front feet and receive good clinical effect in further.

Corrección del componente rotacional prequirúrgico y postquirúrgico del primer metatarsiano secundario a osteotomía de Chevron modificado / Correction of the pre- and post-surgical rotational component of the first metatarsal secondary to modified Chevron osteotomy

Resumen: Introducción: Hallux valgus (HV) es una patología compleja del antepié, recientemente se ha mostrado interés en el componente rotacional (CR) distal del primer metatarsiano por su relación con recidivas postquirúrgicas de la deformidad. La selección de la técnica quirúrgica es controversial con escasa literatura acerca de la corrección de rotación con osteotomías comunes. Nuestro objetivo es evaluar características radiológicas prequirúrgicas y postquirúrgicas respecto a CR del primer metatarsiano en la cirugía de corrección de HV moderado a severo usando osteotomía de Chevron largo. Material y métodos: Estudio observacional, prospectivo y comparativo en el que se evaluó el CR del primer metatarsiano en nueve pies pertenecientes a seis pacientes con una edad media de 45 años. El CR fue evaluado con base en la metáfisis proximal del primer metatarsiano en fluoroscopías axiales sin carga y AP de pie. Las mediciones se realizaron por un residente de ortopedia y traumatología y un subespecialista en cirugía de pie y Tobillo. Resultados: Se documentaron diferencias significativas (p = 0.05) en el ángulo de pronación prequirúrgico y postquirúrgico al utilizar osteotomía de Chevron largo. El resultado funcional de los pacientes evaluados fue excelente a 11 meses de seguimiento. Conclusiones: Radiológicamente, la corrección rotacional es variable y previamente no se ha reportado en la literatura con esta osteotomía. Se establecen bases morfológicas para la realización de estudios posteriores en la evaluación de rotación de cabeza del primer metatarsiano con diferentes osteotomías.

Abstract: Introduction. Hallux valgus (HV) is a complex forefoot pathology, in which interest has recently been shown in the distal rotational component (CR) of the first metatarsal due to its relationship with postsurgical relapses of the deformity. The selection of surgical technique is controversial with little current literature on the correction of rotation with common osteotomies. The aim of this study is to evaluate preoperative and postoperative radiological characteristics regarding CR of the first metatarsal using long Chevron osteotomy for moderate to severe HV. Material and methods: An observational, prospective and comparative study was carried out in which the CR of the first metatarsal was evaluated in nine feet belonging to six patients with a mean age of 45 years. The RC was evaluated based on the proximal metaphysis of the first metatarsal in axial fluoroscopies of unloaded metatarsals and standing AP. Measurements were performed by an Orthopedic and Traumatology resident and a Foot and Ankle Surgery subspecialist. Results: Significant differences (p = 0.05) were documented in the preoperative and postoperative pronation angle when using long Chevron osteotomy. The functional result of the evaluated patients was excellent at 11 months of follow-up. Conclusions: Radiologically, the rotational correction is variable and has not previously been reported in the literature with this osteotomy. We establishes the morphological bases for the performance of subsequent studies in the evaluation of head rotation of the 1st metatarsal with different osteotomies.

Surgical Treatment of Pediatric Intra-Articular Proximal Phalangeal Head Fracture of the Big Toe

PURPOSE: Pediatric intra-articularproximal phalangeal head fractures of the big toe are very rare and few studies on this have been published. The purpose of this study is to present the diagnostic approach and surgical management of these extremely rare fractures, which might be easily underestimated or misdiagnosed.MATERIALS AND METHODS: The study retrospectively reviewed all the patients who were diagnosed as intra-articular proximal phalangeal head fracture of the big toe and who underwent surgical intervention in our institution. The size of the bony fragment and hallux valgus interphalangeus angle were measured on the preoperative X-rays. The size and rotation of the osteochondral fragment, the presence of avascular necrosis, ligamentous injury and soft tissue entrapment were assessed on the preoperative magnetic resonance images (MRIs). The radiologic and functional evaluation were performed at 1 year postoperatively.RESULTS: The average size of the bony fragments measured on the X-rays was 4.1 mm in width and 2.3 mm in length. Two cases showed hallux valgus interphalangeus. Preoperative MRI was performed in four cases and the average size of any osteochondral lesion was 5.3 mm in width, 3.9 mm in length, and 4.7 mm in height. Rotation of the osteochondral fragment was observed in one patient, and soft tissue entrapment was noted in two patients. Postoperatively, successful bony union was achieved in all the patients and the average time to union was 74.4 days.CONCLUSION: Intra-articular proximal phalangeal head fractures of the big toe are very rare and often neglected due to incomplete ossification in the pediatric population. It is important to suspect the presence of this intra-articular fracture and to appropriately implement further evaluation. Nonunion of chronic cases as well as acute fractures can be successfully treated through open reduction and internal fixation using multiple K-wires.

Correlación funcional radiológica en pacientes tratados mediante osteotomía de SCARF en el servicio de traumatología y ortopedia del Hospital Obrero N° 1, durante las gestiones 2011 ­ 2016 / Functional radiological correlationship in patients treated by SCARF osteotomy in the traumatology and orthopedics service of Hospital Obrero No. 1, term 2011 ­ 2016

INTRODUCCIÓN: la marcha es una actividad compleja, que requiere de un balance estricto, donde toda la extremidad inferior actúa de manera conjunta para realizar el movimiento y donde el pie es la única parte que actúa sobre el suelo. Por ello cualquier alteración anatómica y biomecánica del pie repercute en la ambulación. OBJETIVO: determinar el grado de correlación funcional ­ radiológica en pacientes tratados mediante osteotomía de scarf. MATERIAL Y MÉTODOS: rstudio correlacional y transversal. Se estudiaron 78 pacientes con diagnóstico de hallux valgus. Se realizó la valoración funcional (Escala AOFAS) y radiológica de todos los pacientes con hallux valgus operados mediante la osteotomía de scarf; se estableció además la correlación entre la valoración funcional y radiológica de cada paciente mediante la prueba de chi cuadrado. RESULTADOS: habiéndose obtenido el valor crítico de Chi ­ cuadrado (X2 c = 12.992), se comprobó que este es menor que el valor del Chi ­ cuadrado calculado, tanto para el ángulo metatarso-falángico (X2 = 40.715) y el ángulo inter-metatarsiano (X2 = 16.539); lo que significa que la hipótesis nula no se aceptó (Los resultados funcionales no se correlacionan con los resultados radiológicos de manera inversamente proporcional). CONCLUSIÓN: se determinó un grado de correlación inverso entre los resultados funcionales y radiológicos en pacientes tratados mediante osteotomía de scarf; α = 0.05; p = 0.95. Significa que a mayor gradación de hallux valgus (leve, moderado y severo), menor es el puntaje de la escala AOFAS (pobre, aceptable, bueno y excelente).

INTRODUCTION: walking is a complex activity, requiring a strict balance, where the entire lower limb acts together to perform the movement and where the foot is the only part that acts on the ground. Therefore, any anatomical and biomechanical alteration of the foot has an impact on the ambulation. OBJECTIVE: to determine the degree of functional ­ radiological correlation in patients treated by the scarf osteotomy. MATERIAL AND METHODS: correlational and cross-sectional study. 78 patients diagnosed with hallux valgus were studied. Functional and radiological (AOFAS Scale) assessment was performed on all patients with hallux valgus operated by scarf osteotomy; the correlation between each patient's functional and radiological assessment was also established using the squared chi test. RESULTS: having obtained the critical value of Chi ­ squared ((X2c x 12,992), it was found that this is less than the value of the Chi ­ calculated square, both for the phalangeal metatarsus angle (X2 x 40.715) and the inter-metatarsal angle (X2 x 16,539); which means that the null hypothesis was not accepted (Functional results do not correlate with radiological results inversely proportional). CONCLUSION: a degree of reverse correlation between functional and radiological results was determined in patients treated with scarf osteotomy; α = 0.05; p = 0.95. ­ meaning that the greater the gradation of hallux valgus (mild, moderate and severe), the lower the AOFAS scale score (poor, acceptable, good and excellent).

Evaluación de resultados radiográficos en población geriátrica con hallux valgus grado moderado a severo intervenido con técnica quirúrgica de Lelièvre y Vidalot / Evaluation of radiographic results in geriatric population with moderate to severe degree hallux valgus intervened with surgical technique of Lelièvre and Vidalot

Resumen: Antecedentes: Hallux valgus (HV) es una desviación en valgo de la articulación metatarsofalángica y en varo del primer metatarsiano. La cirugía pretende reestablecer la congruencia articular, corregir la deformidad y disminuir el dolor. Existe poca literatura de los resultados en población geriátrica. El propósito de este estudio es demostrar que la técnica quirúrgica abierta de Lelièvre y Vidalot logra resultados radiográficos aceptables en dicha población. Material y métodos: 68 pacientes entre 60 y 85 años intervenidos con técnica Lelièvre y Vidalot por HV moderado a severo de Isham, entre Enero 2014 y Enero 2017. Se evaluaron las radiografías preoperatoria, postoperatoria inmediata y a los seis meses, con radiometría convencional para esta afección; todas las mediciones se realizaron en sistema digital. Los datos se ingresaron en Microsoft Excel. Los valores de p < 0.05 se consideraron estadísticamente significativos. Resultados: De 68 pacientes (54 mujeres y 14 hombres), edad media 68.0 años, 12 presentaron afectación bilateral; 28 segundo dedo en garra. El ángulo metatarsofalángico con una media preoperatoria fue 36.6o, incrementado en 100% de los casos de ángulo intermetatarsal 1-2, existiendo una correlación p < 0.05 entre ángulo intermetatarsal y aumento del ángulo metatarsofalángico. Los resultados postquirúrgicos inmediato y a seis meses presentaron una correlación p = 0.3107. Conclusiones: El tratamiento de HV moderado a severo en nuestra población geriátrica bajo técnica Lelièvre y Vidalot logra una corrección aceptable demostrada radiográficamente en el postoperatorio inmediato y a los seis meses, esto traduce una opción viable de tratamiento quirúrgico en dicha población.

Abstract: Background: Hallux valgus (HV) defines a valgo deviation from the metatarsophalangeal joint and in a varo of the first metatarsal. The surgery aims to restore joint congruence, correct deformity and decrease pain. There is little literature on the results in the geriatric population. The purpose of this study is intended to demonstrate that the open surgical technique of Lelièvre and Vidalot achieves acceptable radiographic results in that population. Material and methods: 68 patients between 60 and 85 years of age were involved with Lelièvre Technique and Vidalot for moderate to severe HV of Isham, between January 2014 and January 2017. Immediate postoperative and six month radiographs were evaluated with conventional radiometry for this condition; All measurements were made in digital system. The data was entered in Microsoft Excel. p values < 0.05 were considered statistically significant. Results: Out of 68 patients (54 women and 14 men), average age 68.0 years. 12 had bilateral concern. 28 second finger claw. The metatarsphasopalangic angle with a preoperative mean was 36.6o, increased by 100% of cases of intermetatarsal angle 1-2, with a correlation p < 0.05 between intermetatarsal angle and metatarsal angle increase. Immediate and six-month post-surgical results with a correlation of p = 0.3107. Conclusions: The treatment of moderate to severe HV in our geriatric population under technique Lelièvre and Vidalot achieves an acceptable correction demonstrated radiographically in the immediate postoperative period and at six month, this translates a viable option of surgical treatment in these population.

Artrodesis metatarsofalángica del hallux: comparación retrospectiva entre placa bloqueada y tornillos canulados / Hallux metatarsophalangeal arthrodesis: retrospective comparison between blocked plate and cannulated screws

Resumen: Introducción: Existen múltiples métodos e implantes utilizados para la artrodesis metatarsofalángica del hallux sin evidencia a favor de uno u otro en la bibliografía. El objetivo fue comparar los resultados clínicos y radiológicos de dos métodos e implantes utilizados en nuestro centro. Material y métodos: Revisión retrospectiva de 37 pies entre 2013 y 2017 (22 pies mediante placa y 15 mediante tornillos canulados). Se recogieron variables clínicas y radiológicas y se aplicaron las escalas AOFAS y Manchester-Oxford. Se estudiaron las variables descriptivas y analíticamente mediante el programa SPSS v15. Resultados: El grupo intervenido mediante placa lo compuso 77% de mujeres, con una edad media de 65 años y una distribución por diagnósticos de hallux valgus (HV) severo (36%), recidiva de hallux valgus (RHV) (36%) y hallux rigidus (HR) (28%), frente a 80% de mujeres, con media de 68 años y HVS (34%), RHV (46%) y HR (20%) en el grupo de tornillos canulados. No se encontró diferencias significativas en la corrección de los ángulos para HVS o RHV. La tasa de seudoartrosis dolorosa fue de 13% en ambos y la reintervención fue de 18% en el grupo de placas y 26% en el grupo de tornillos. Tanto la escala AOFAS como la M-O fueron mejores en el grupo de placa 63.8 versus 52.6 (p = 0.07); 30.1 versus 41.0 (p = 0.10); así como la satisfacción del paciente 86 versus 66% (p > 0.05) y el dolor postoperatorio 3.68 versus 5.58 (p > 0.05). Conclusión: Son grupos pequeños de estudio, sin aleatorización de implantes, ambas opciones son funcionales sin poder encontrar una preferente.

Abstract: Introduction: There are multiple methods and implants used for the metatarsophalangeal arthrodesis of hallux without evidence in favor of one or the other in the bibliography. The goal was to compare the clinical and radiological results of 2 methods and implants used in our center. Material and methods: Retrospective review of 37 feet between 2013 and 2017 (22 feet by plate and 15 by cannulated screws). Clinical and radiological variables were collected and the AOFAS and Manchester-Oxford scales were applied. Variables were studied descriptively and analytically through the SPSSv15 program. Results: The group intervened by plate was composed of 77% of women, with an average age of 65 years and a distribution by diagnosis of severe hallux valgus (HV) (36%), hallux valgus relapse (HVR) (36%) and hallux rigidus (HR) (28%), compared to 80% of women, 68 years old and HV (34%), HVR (46%) HR (20%) in the group of cannulated screws. No significant differences were found in the correction of angles for HV or HVR. The rate of painful pseudoarthrosis was 13% in both and the re-intervention was 18% in the plate group and 26% in the screw group. Both the AOFAS and M-O scales were better in the plate group 63.8 vs 52.6 (p = 0.07); 30.1 vs 41.0 (p = 0.10); as well as patient satisfaction 86% vs 66% (p > 0.05) and postoperative pain 3.68 vs 5.58 (p > 0.05). Conclusion: Small study groups, not implant randomization, both options are functional without being able to find a preferred one.