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Jones fracture, a specialized fracture that occurs at the base of the fifth metatarsal, is located in the junction region of the proximal metaphysis and epiphysis of the metatarsal. Its treatment remains challenging because of its unique location, high functional demands from its victims and a high rate of delayed union or nonunion after surgical or non-surgical treatment. We present a review of recent studies on the mechanisms, risk factors, treatments, and rapid rehabilitation concepts for Jones fracture, hoping to deepen the understanding of the fracture so as to improve its treatment outcomes.
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SUMMARY: Stature estimation is one of the essential procedures for personal identification in forensic osteology. Therefore, the purposes of this study are to analyze the correlation between length and width of metatarsal measurements and stature, and to develop the regression equations for a Thai population. In this study, the samples were divided into two groups. The first group was called the "training group" for generating stature estimation equations, comprised of 200 skeletons, aged between 19-94 years. The second group was called the "test group" for evaluating the accuracy of generated equations, comprising 40 skeletons. The correlation between metatarsal parameters and stature were moderate to high, and all variables had positive significant correlation with stature. For males, the left ML2 is the length variable that showed the most correlation degree against stature (r=0.702), and the left MSW4 is the width variable that had the most correlation degree against stature (r=0.483). For females, right ML1 is the length variable that had the most correlation degree against stature (r=0.632), and right PW3 is the width stature that had the most correlation degree against stature (r=0.481). For all samples, left ML1 was the length variable that had the most correlation degree against stature (r=0.796) and right PW3 was the width variable that had the most correlation degree against stature (r=0.712). The results of generating multiple regression equations using a stepwise method reveals that the correlation coefficient (R) and standard error of estimate (SEE) were 0.761 and 4.96 cm, respectively, for males, and 0.752 and 4.93 cm for females, with 0.841 and 5.26 cm for all samples, respectively. According to these results, the mean of absolute error from the test group ranged from 3 to 5 cm. Therefore, stature estimation equations using length and width of metatarsals from our study can be applied to estimate stature in the Thai population.
La estimación de la estatura es uno de los procedimientos esenciales para la identificación personal en osteología forense. Por lo tanto, los propósitos de este estudio fueron analizar la correlación entre la longitud y el ancho de las medidas metatarsianas y la estatura, y desarrollar las ecuaciones de regresión para una población tailandesa. Las muestras se dividieron en dos grupos. El primer grupo se denominó "grupo de entrenamiento" para generar ecuaciones de estimación de estatura, compuesto por 200 esqueletos, con edades comprendidas entre los 19 y los 94 años. El segundo grupo se denominó "grupo de prueba" para evaluar la precisión de las ecuaciones generadas, que comprende 40 esqueletos. La correlación entre los parámetros metatarsianos y la estatura fue de moderada a alta, y todas las variables tuvieron una correlación significativa positiva con la estatura. Para el sexo masculino, la variable longitud ML2 izquierda es la que mayor grado de correlación presentó con la estatura (r=0,702), y la izquierda MSW4 fue la variable ancho la que mayor grado de correlación presentó con la estatura (r=0,483). Para el sexo femenino, ML1 derecho fue la variable longitud que tuvo mayor grado de correlación con la estatura (r=0,632), y PW3 derecha fue la variable ancho estatura que tuvo mayor grado de correlación con la estatura (r=0,481). Para todas las muestras, ML1 izquierdo fue la variable longitud que tuvo mayor grado de correlación con la estatura (r=0,796) y PW3 derecha fue la variable ancho que tuvo mayor grado de correlación con la estatura (r=0,712). Los resultados de generar ecuaciones de regresión múltiple usando un método paso a paso revela que el coeficiente de correlación (R) y el error estándar de estimación (SEE) fueron 0,761 y 4,96 cm, respectivamente, para los hombres y 0,752 y 4,93 cm para las mujeres, con 0,841 y 5,26 cm para todas las muestras, respectivamente. De acuerdo con estos resultados, la media del error absoluto del grupo de prueba osciló entre 3 y 5 cm. Por lo tanto, las ecuaciones de estimación de la estatura que utilizan la longitud y el ancho de los metatarsianos de nuestro estudio se pueden aplicar para estimar la estatura en la población tailandesa.
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Humains , Mâle , Femelle , Adulte , Adulte d'âge moyen , Sujet âgé , Sujet âgé de 80 ans ou plus , Jeune adulte , Taille , Os du métatarse/anatomie et histologie , Anthropologie médicolégale , Thaïlande , Analyse de régression , OstéologieRésumé
Objective:To compare the efficacy of staged versus elective operation for treating acute closed fracture-dislocation of tarsometatarsal joint complex.Methods:A retrospective cohort study was used to analyze the clinical data of 26 patients with acute closed fracture-dislocation of tarsometatarsal joint complex admitted to Tongji Hospital of Tongji University from January 2017 to January 2021, of whom 18 were males and 8 were females, aged 32-52 years [(44.3±5.2)years]. According to the time from injury to admission, 14 patients admitted within 8 hours after injury underwent staged surgical treatment (staged group), and 12 patients admitted more than 8 hours after injury underwent elective surgery (elective group). In the staged group, emergency reduction and temporary internal fixation with K-wire were done under the supervision of a C-arm X-ray machine in the first stage, while after the swelling subsided, open reduction and internal fixation were done for tarsometatarsal joint fracture-dislocation in the second stage. In the elective group, open reduction and internal fixation were performed for tarsometatarsal joint fracture-dislocation on a scheduled basis after the swelling subsided. The operation time, hospitalization time and fracture healing time were recorded. The visual analogue score (VAS) and American Orthopedic Foot and Ankle Society (AOFAS) midfoot score were evaluated before operation, at 1, 6, 12 months after operation and at the final follow-up. The rate of complications was observed after operation.Results:All patients were followed up for 12-24 months [(18.5±3.8)months]. The operation time, hospitalization time and fracture healing time in the staged group were (77.3±5.6)minutes, (14.3±2.2)days and (12.3±1.2)weeks, respectively, significantly shorter than those in the elective group [(101.5±7.5)minutes, (20.3±5.2)days and (14.3±2.2)weeks] (all P<0.01). VAS significantly decreased and AOFAS midfoot score significantly increased in both groups as postoperative time increased (all P<0.05). There were no significant differences in VAS between the two groups before operation, at 12 months after operation or at the final follow-up (all P>0.05). The VAS at 1, 6 months after operation was (4.4±0.8)points and (2.1±0.4)points in the staged group, significantly lower than those in the elective group [(6.0±1.0)points and (3.5±0.6)points] (all P<0.01). There was no significant difference in preoperative AOFAS midfoot score between the two groups ( P>0.05). The AOFAS midfoot score at 1, 6, 12 months after operation and at the final follow-up was (67.6±4.5)points, (75.7±5.2)points, (83.6±2.2)points and (85.9±4.3)points in the staged group, significantly higher than those in the elective group [(60.2±3.9)points, (70.2±3.4)points, (75.4±3.3)points and (78.7±4.4)points] (all P<0.01). The rate of complications was 14.3% (2/14) in the staged group, significantly lower than that in the elective group [33.3% (4/12)] ( P<0.05). Conclusion:Compared to traditional elective surgery, staged surgery for acute closed fracture-dislocation of tarsometatarsal joint complex has the advantages of shortened operation time, hospitalization time and fracture healing time, eary pain relief, improved functional recovery of the foot and reduced postoperative complications.
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Abstract Freiberg disease is a rare condition whose diagnosis requires a high clinical suspicion. Avascular necrosis of the metatarsal head progresses with articular collapse, leading to forefoot pain and limitation of the daily activities. Several surgical techniques have been described to address the disease, and since it is usually diagnosed in later-stages, most of them include joint-destructive procedures. The use of arthroscopy on the small joint of the foot has arisen in the last few years, but its application in Freiberg disease is still scant. Joint-preserving procedures have been advocated for cases of early-stage disease, aiming to relieve symptoms while preventing the progression of the disease. In the present report, we describe a successful treatment of a 12-year-old patient with early-stage Freiberg disease using core decompression and bone marrow graft through a minimally-invasive approach assisted by arthroscopy.
Resumo A doença de Freiberg é rara, e seu diagnóstico requer alto grau de suspeita clínica. A necrose avascular da cabeça do metatarso progride com colapso articular, e causa dor no antepé e limitação da atividade. Há diversas técnicas cirúrgicas para o tratamento da doença; como o diagnóstico geralmente é feito em estágios posteriores, a maioria dessas técnicas inclui procedimentos de destruição articular. A artroscopia tem sido utilizada nas pequenas articulações do pé nos últimos anos, mas sua aplicação na doença de Freiberg ainda é escassa. Procedimentos de preservação articular têm sido preconizados na doença em estágio inicial, com o objetivo de aliviar os sintomas e impedir a progressão. Neste relato, descrevemos o tratamento bem-sucedido de uma paciente de 12 anos de idade com doença de Freiberg em estágio inicial por meio de descompressão central e enxerto de medula óssea, por meio de abordagem minimamente invasiva assistida por artroscopia.
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Humains , Femelle , Enfant , Arthroscopie , Os du métatarse , Transplantation de moelle osseuse , PiedRésumé
OBJETIVO Evaluar el resultado quirúrgico de fracturas de las zonas 2 y 3 de la base del quinto metatarsiano usando tornillos de esponjosa de diámetro de 4,0 mm con rosca parcial. MATERIALES Y MÉTODOS Evaluación retrospectiva de pacientes operados entre 2010 a 2019. Incluimos todos los casos sintetizados con este dispositivo con seguimiento mínimo de tresmeses, y excluimos casos operados con otros dispositivos y seguimiento menor a tres meses. Evaluamos la consolidacioÌ n y la presencia de complicaciones. Determinamos el largo del tornillo, el diaÌmetro del canal endomedular, la distancia entre el borde proximal de la tuberosidad y la fractura, y la distancia de paso de la rosca sobre el rasgo de la fractura en radiografías anteroposterior (AP) y oblicua del pie. RESULTADOS Evaluamos 39 casos, y la muestra tenía una edad promedio de 27 años, y predominio del sexo masculino. El largo de tornillo más usado fue el de 45 mm, y los diámetros promedios del canal endomedular medidos en las radiografías AP y oblicua fueron de 4,6 mm y 3,96 mm, respectivamente. La distancia del borde de la tuberosidad hasta la fractura fue de 25,8 mm, y la distancia de paso de la rosca sobre el rasgo de la fractura fue en promedio de 24 mm. Hubo 100% de consolidación, en un promedio de 9,4 semanas, y 3 casos de retardo de consolidación, 2 de retroceso de tornillo, 1 de rosca intrafoco, y 1 de fractura cortical superior. No hubo retiros de tornillos a la fecha. DISCUSION No existe consenso respecto al tornillo ideal. La literatura internacional recomienda dispositivos intramedulares de diámetro de al menos 4,5 mm. Existen pocos reportes del uso de tornillos de diámetro de 4,0 mm. CONCLUSIONES El tornillo de esponjosa de diámetro de 4,0 mm con rosca parcial es una alternativa eficaz, segura y con baja tasa de complicaciones para el manejo de estas fracturas en nuestra población.
OBJETIVE To evaluate the surgical result of zone-2 and -3 fractures of the base of the fifth metatarsal bone using partially-threaded cancellous screws with a diameter of 4.0 mm. MATERIALS AND METHODS A retrospective evaluation of patients submitted to surgery between 2010 and 2019. We included all of the cases synthesized with this device with a minimum follow-up of three months, and excluded the cases operated on with other devices and follow-up shorter than three months. We evaluated the consolidation and the presence of complications, and determined, screw length, diameter of the endomedullary canal, the distance between the proximal edge of tuberosity and the fracture, and thread pitch over the fracture line on anteroposterior (AP) and oblique radiographs. RESULTS We evaluated 39 cases, and the sample had an average age of 27 years and male predominance. The most used screw length was 45 mm, and the average diameters of the medullary canal measured on the AP and oblique radiographs were of 4.6 mm and 3.96 mm respectively. The distance from the edge of the tuberosity to the fracture was of 25.8 mm, and the thread pitch over the fracture line was on average 24 mm. The rate of consolidation was of 100%, occurring in an average of 9.4 weeks, and there were 3 cases of consolidation delay, 2 of screw recoil, 1 of intrafocus thread, and 1 of superior cortex fracture. To date, there have been no cases of screw removal. DISCUSSION There is no consensus regarding the ideal screw. The international literature recommends intramedullary devices with a diameter of at least 4.5 mm. There are few reports of the use of screws with 4.0 mm in diameter. CONCLUSIONS The partially-threaded cancellous screw with a diameter of 4.0 mm is an effective and safe option, with a low complication rate for the management of these fractures.
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Humains , Adolescent , Adulte , Adulte d'âge moyen , Jeune adulte , Os du métatarse/chirurgie , Os du métatarse/imagerie diagnostique , Traumatismes du pied/chirurgie , Traumatismes du pied/imagerie diagnostique , Vis orthopédiques , Ostéosynthèse interneRésumé
Abstract Objective To describe the profile of the patients and the results obtained with the use of an external fixator for metatarsal lengthening in brachymetatarsia. Methods A retrospective analysis of the medical records of patients with brachymetatarsia treated between January 2018 and April 2020 was performed. During this period, eight feet of six patients were operated on. Frequencies were estimated according to demographic and surgical aspects. Results All patients (100%; n= 6) were female, with a mean age of 28 years old, ranging from 15 to 48 years old, and were motivated to seek the orthopedic service due to aesthetic deformity. The deformity was bilateral in two patients and unilateral in four patients. The average lengthening time was 22 days ( ± 7.15, 95% confidence interval [CI]: 19.04-26.81). The lengthening speed was 0.5 mm/day, and the average total length of the lengthening was 11.46 mm ( ± 3.57; 95%CI: 9.52-13.40). Half of the patients (50%; n= 3) had local infection of the pins and were treated with antibiotics, and the others did not report any postsurgical complications. All patients denied pain or calluses after the surgical procedure and reported satisfaction with the results. Conclusion All patients were female and sought surgery for brachymetatarsia for aesthetic reasons. Osteogenic distraction at a rate of 0.5 mm/day resulted in successful lengthening of the metatarsal, with a low frequency of complications, good clinical outcomes, and high patient satisfaction.
Resumo Objetivo Descrever o perfil dos pacientes e os resultados obtidos com o uso de fixador externo para alongamento de metatarso em braquimetatarsia. Métodos Foi realizada uma análise retrospectiva dos prontuários de pacientes com braquimetatarsia tratados entre janeiro de 2018 e abril de 2020. Durante este período, foram operados oito pés de seis pacientes. Foram coletadas e estimadas as frequências em relação a aspectos demográficos e cirúrgicos. Resultados Todas as pacientes (100%; n= 6) eram do sexo feminino, com média de idade de 28 anos, variando de 15 a 48 anos, e motivadas a buscar o serviço de ortopedia em função da deformidade estética. O acometimento era bilateral em duas pacientes e unilateral em quatro pacientes. O tempo médio de alongamento foi de 22 dias ( ± 7,15; intervalo de confiança [IC] 95%: 19,04-26,81). A velocidade de alongamento foi de 0,5 mm/dia e o comprimento médio total do alongamento foi de 11,46 mm ( ± 3,57; IC95%: 9,52-13,40). Metade das pacientes (50%; n= 3) teve infecção local dos pinos e foi tratada com antibióticos; as demais não relataram nenhuma complicação pós-cirúrgica. As pacientes negaram dor ou calosidade após o procedimento cirúrgico e relataram satisfação com os resultados. Conclusão Todas as pacientes eram do sexo feminino e buscaram a cirurgia para braquimetatarsia por motivos estéticos. A distração osteogênica a uma taxa de 0,5 mm/dia resultou em alongamento bem-sucedido do metatarso, com uma baixa frequência de complicações, bons resultados clínicos e alta satisfação das pacientes.
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Humains , Femelle , Adolescent , Adulte , Malformations , Anomalies morphologiques du pied , Os du métatarse , Satisfaction des patients , Procédures orthopédiques , Ostéogenèse par distractionRésumé
Objective:To report our clinical outcomes of open reduction and internal fixation (ORIF) of chronic isolated fractures of a metatarsal head in the lesser toes.Methods:A retrospective consecutive case-series study was performed in 5 patients with symptomatic chronic isolated shear fracture of a metatarsal head in the lesser toes who had been treated from January 2018 to April 2021 at Department of Foot and Ankle Surgery, Beijing Jishuitan Hospital. There were 4 males and one female, with an average age of 26.2 years (from 19 to 36 years) at the time of injury. The fracture had been missed at the initial diagnosis in 2 of the patients. Their main symptom was limited dorsiflexion of the metatarsophalangeal joint (MTPJ). Preoperative X-rays and CT scans revealed dorsal displacement of the distal fragment without dislocation of the MTPJ. All patients were treated by ORIF. Their American Orthopaedic Foot & Ankle Society-lesser metatarsophalangeal-interphalangeal (AOFAS-LMI) score, visual analog scale (VAS), and range of passive dorsiflexion of the MTPJ were compared between preoperation and the final follow-up. Postoperative complications were also recorded.Results:The 5 patients were followed up for an average of 27.8 months (from 6 to 45 months). All the chronic fractures achieved bony union. At the final follow-up, the average AOFAS-LMI score was 90.6 (from 82 to 100), the average VAS score 0 (from 0 to 2), and the average range of passive dorsiflexion of the MTPJ 40.0° (from 35° to 45°), all improved compared with the preoperative values [70.6 (from 59 to 79), 4 (from 2 to 5) and 10.0° (from 5.0° to 10.0°), respectively]. All the patients recovered their activity levels before injury. Three patients developed arthritis of the MTPJ.Conclusion:ORIF may achieve good short- and mid-term clinical outcomes in patients with chronic isolated shear fracture of a metatarsal head in the lesser toes.
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OBJECTIVE@#To explore the clinical efficacy of external micro-locking plate combined with closed reduction in the treatment of fifth metatarsal comminuted fracture with severe soft tissue injury.@*METHODS@#From January 2018 to December 2019, 13 patients received micro-locking plate combined with closed reduction treatment due to the fifth metatarsal comminuted fracture with severe soft tissue injury. There were 11 males and 2 females patients, ranging in age from 21 to 69 years. According to the fracture AO fracture classification, 9 cases belonged to type 87(S)-C2.2 and 4 cases belonged to type 87(S)-C2.1. The fifth metatarsal cuneiform articular surface was not involved, and all of them were comminuted fractures of the fifth metatarsal shaft. All soft tissues were damaged to varying degrees. Three patients got small defect of skin and soft tissue, and they were treated with debridement and suture after one-stage emergency surgery. The fracture healing and complications were observed, and the clinical efficacy was evaluated according to the midfoot function score of American Orthopaedic Foot & Ankle Society (AOFAS) at the latest follow-up.@*RESULTS@#All patients were followed up, and the duration ranged from 3 to 12 months. One patient had delayed union. One patient had local skin necrosis and was treated with second-stage skin grafting to repair the wound surface. No external screw breakage or infection was reported, the skin soft tissue healed satisfactorily and reached bony union, with the union time ranging from 8 to 19 weeks. The postoperative functional recovery was rated according to the midfoot score of AOFAS, the score ranged from 49 to 98, and 7 patients got an excellent result, 4 good, 1 fair and 1 poor.@*CONCLUSION@#The external micro-locking plate combined with closed reduction in the treatment of fifth metatarsal comminuted fracture with severe soft tissue injury has the advantages of simple operation, good stability and low infection rate, which is helpful to the repair of soft issue injury, and the fixation can be removed early in outpatient clinic. To sum up, this surgical procedure is suitable for patients with severe soft tissue injury and comminuted fracture to avoid periosteum stripping. The space occupying is smaller than the micro-external fixator, which is convenient for patients with early functional exercise.
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Adulte , Sujet âgé , Femelle , Humains , Mâle , Adulte d'âge moyen , Jeune adulte , Plaques orthopédiques , Ostéosynthèse interne/méthodes , Fractures osseuses/chirurgie , Fractures comminutives/chirurgie , Os du métatarse/chirurgieRésumé
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.
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Mâle , Femelle , Humains , Adulte , Adulte d'âge moyen , Sujet âgé , Hallux valgus/imagerie diagnostique , Os du métatarse/chirurgie , Fluorométholone , Rotation , Résultat thérapeutique , Radiographie , Oignon , Ostéotomie/méthodesRésumé
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.
Sujets)
Humains , Mâle , Femelle , Adolescent , Adulte , Adulte d'âge moyen , Sujet âgé , Sujet âgé de 80 ans ou plus , Os du métatarse/chirurgie , Hallux valgus/chirurgie , Évaluation des Résultats d'Interventions Thérapeutiques , Interventions chirurgicales mini-invasivesRésumé
Objective:To investigate the outcomes of the surgical treatment of fracture of the first metatarsal base with plantar plate via the first metatarsal medial approach.Methods:A retrospective study was conducted of the 12 patients who had been treated for fracture of the first metatarsal base from January 2016 to December 2018 at Department of Trauma Orthopaedics, Renji Hospital. They were 8 men and 4 women, with an average age of 39.6 years (from 27 to 54 years). The fracture affected the left foot in 5 cases and the right foot in 7. Their fracture of the first metatarsal base and tarsometatarsal joint instability were fixated by plantar plate via the first metatarsal medial approach, and reduction and fixation was also conducted via a dorsal incision when other metatarsotarsal joint injuries were combined. Postoperative X-ray follow-ups were performed regularly. The American Orthopedic Foot and Ankle Society (AOFAS) midfoot scores, visual analogue scale (VAS) pain scores and complications were recorded at the final follow-up.Results:All the patients were followed up for 12 to 19 months (mean, 15.1 months). Primary incision healing was observed in all the 12 patients. No complications like skin necrosis, infection or neurovascular lesion occurred. Fracture union was achieved in all the 12 patients after 12 to 14 weeks (average, 12.6 weeks). At the final follow-up, all the patients could walk with full weight-bearing, the plantar flexion and dorsiflexion of the ankle and the muscle strengths of varus and valgus were normal, and the X-ray film showed that reduction of the tarsometatarsal joint was not lost. At the final follow-up, the AOFAS midoot scores ranged from 82 to 96 (mean, 88.9) and the VAS scores from 0 to 3 (mean, 1.2).Conclusion:Plantar plate fixation via the first metatarsal medial approach can result in satisfactory outcomes for fractures of the first metatarsal base, especially for those with a major fracture fragment at the metatarsal planter side.
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Objective:To explore the clinical application of free chimeric medial femoral condyle osteofascial free flap (CMFCOF) in the treatment of traumatic composite bone and soft tissue defect of hand and foot.Methods:Between January, 2015 and March, 2020, 8 patients with traumatic composite bone and soft tissue defect in hand and foot were treated with CMFCOF. Of the 8 patients, there were 6 males and 2 females, with an average age of 41 (range, 24 to 56) years. The causes of injury included 3 of traffic accident, 3 of machine crush and 2 of crush. Two cases had proximal phalanx defect, 3 with metacarpal bone and 3 with metatarsal bone. The time between injury to the flap repair were 2 to 120 (mean, 84) days. The size of bone defect ranged from 2.0 cm×1.2 cm×1.2 cm to 4.4 cm× 3.0 cm×2.3 cm. The soft tissue defect ranged from 2.0 cm×1.4 cm to 5.6 cm×4.5 cm. All bone defects were on the diaphysis, without involvement of joints. Two cases had tendon defect. According to the defect of bone and soft tissue, the CMFCOF was prepared and skin graft was performed on the surface of its fascial flap.Results:The average time of flap harvesting was 53(52-96) minutes. All donor sites were directly closed. All flaps and skin grafts achieved stage I survival. All patients entered 9-16 months of follow-up, with an average of 14.5 months. The average healing time of bone was 7.5 (range, 6-10) weeks. At the last follow-up review, all flaps were not thinned. The function of donor site was restored well, without weight bearing disorder and paraesthesia in the anterior patella area. According to the trial standard of Digit Function Evaluation of the Hand Surgery Society of Chinese Medical Association, 3 patients were rated as excellent, 1 was good and 1 was fair. According to the Maryland foot evaluation criteria, 3 patients were rated as excellent for recovered with normal weight-bearing walking.Conclusion:CMFCOF can achieve satisfactory results in repairing composite bone and soft tissue defect of hand or foot. The flap has the advantages in simple operation, high quality of bone and concealed donor site.
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Abstract Objective The present study aims to describe a new weightbearing radiographic method to visualize the heads of the five metatarsals on the coronal plane, evaluating their accuracy through intraclass correlation coefficients. Methods The subjects were evaluated, with weightbearing, with the ankle at 20 degrees of plantar flexion and the metatarsophalangeal joints at 10 degrees of extension, positioned on a wooden device. Two independent foot and ankle surgeons evaluated the radiography, with one of them doing it twice, at different moments, achieving an inter and intraobserver correlation, with intraclass correlation coefficients. Results We radiographed 63 feet, achieving an interobserver correlation coefficient of the radiographic method for the metatarsal heads heights in the coronal plane of the 1st, 2nd, 3rd, 4th, and 5th metatarsals of, respectively, 0.90, 0.85, 0.86, 0.83, 0.89. The intraobserver correlation coefficient were, respectively, 0.95, 0.93, 0.93, 0.86, 0.92. Conclusion Those correlations demonstrate that the method is accurate and can be used to investigate metatarsal head misalignments in this plane.
Resumo Objetivo Este estudo tem como objetivo descrever um novo método radiográfico com carga fisiológica para visualizar as cabeças dos cinco metatarsos no plano coronal. Métodos Os indivíduos foram radiograficamente avaliados com carga, com o tornozelo a 20º de flexão plantar e as articulações metatarsofalângicas a 10º de extensão, posicionadas em um dispositivo de madeira. As medidas foram aferidas por dois avaliadores independentes, sendo que um deles mediu em dois momentos distintos, obtendo a correlação inter e intraobservador, com o coeficiente de correlação intraclasses. Resultados Examinamos 63 pés, obtendo um coeficiente de correlação interobservador do método radiográfico para as alturas das cabeças dos metatarsos no plano coronal do 1º, 2º, 3º, 4º e 5º metatarsos de, respectivamente, 0,90, 0,85, 0,86, 0,83, 0,89. O coeficiente de correlação intraobservador foi, respectivamente, 0,95, 0,93, 0,93, 0,86, 0,92. Conclusão Essas correlações demonstram que o método é preciso e pode ser usado para investigar os desalinhamentos de cabeça dos metatarsos nesse plano.
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Humains , Avant-pied humain/imagerie diagnostique , Os du métatarse , Radiographie , Métatarsalgie , Équipement et fournitures , Chirurgiens , Maladies du pied , Cheville , Articulation métatarsophalangienneRésumé
Intermetatarsal coalition (IC) is very rare; although few cases have been reported in foreign orthopedic journals, these have not originated in our country. We report the case of a 20-year-old man who complained of pain in the left forefoot only during long distance running (3 km). On examination, his foot shape, skin appearance, and gait were normal, with no plantar keratosis; however, the radiograph revealed coalition between the fourth and fifth metatarsals. Surgical excision was performed. In the histopathologic study, fibrous coalition was confirmed. This paper reports an uncommon case involving surgical excision of IC in the military service, involving active sport activity.
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Humains , Jeune adulte , Pied , Démarche , Kératose , Os du métatarse , Personnel militaire , Orthopédie , Course à pied , Peau , Sports , SynostoseRésumé
Abstract Objective To determine if the sesamoids migrate laterally in the feet with hallux valgus or if they only appear to move, maintaining their relationship with the other forefoot structures. Methods Anteroposterior radiographs of 80 patients (94 feet, all weight-bearing), from the period between 2015 and 2016, were evaluated. Forty-eight had a valgus hallux angle greater than 15° (hallux valgus group) and 46 presented a hallux valgus angle lower than 15° (control group). The distances from the firstmetatarsus head and the lateral sesamoid bone to the secondmetatarsus axis weremeasured. Subsequently, the coefficients of these distances were determined by the length of the second metatarsus to adjust it for different foot sizes. Results Both the absolute and the relativemeasures from the firstmetatarsus head to the second metatarsus axis were significantly different between the groups, with a positive correlationwith hallux valgus and intermetatarsal angles. However, neither the absolute nor the relative distance of the lateral sesamoid bone to the second metatarsus was different between the groups, as they did not correlate with hallux valgus or intermetatarsal angles. Conclusion Despite the medial deviation of the first metatarsus in hallux valgus, the sesamoid bone maintains its relationship with the second metatarsus in the transverse plane. This apparent lateral displacement may lead to misinterpretation of these radiographs. This fact is of paramount importance in the pre-, intra-, and postoperative period of patients with hallux valgus.
Resumo Objetivo Determinar se os sesamoides migramlateralmente nos pés comhálux valgo ou se apenas aparentam deslocar-se, mantendo sua relação com as demais estruturas do antepé. Métodos Foram avaliadas radiografias na incidência anteroposterior com carga dos pés de 80 pacientes (94 pés) entre o período de 2015 e 2016. Dessas, 48 tinham ângulo de hálux valgo maior do que 15º (grupo hálux valgo) e 46 tinham ângulo de hálux valgo menor do que 15º (grupo controle). Foram medidas as distâncias da cabeça do primeiro metatarso e do sesamoide lateral ao eixo do segundo metatarso. Posteriormente, forammedidos os coeficientes dessas distâncias pelo comprimento do segundo metatarso, a fim de se ajustarem aos diferentes tamanhos de pés. Resultados Tanto a medida absoluta quanto a medida relativa da cabeça do primeiro metatarso ao segundo metatarso foram significativamente diferentes nos dois grupos, tiveram correlação positiva com os ângulos de hálux valgo e intermetatarsal. Contudo, nem a distância absoluta nem a relativa do sesamoide lateral ao segundo metatarso foram diferentes nos dois grupos, bem como não se correlacionaram com os ângulos de hálux valgo e inter-metatarsal. Conclusão Apesar do desvio medial do primeiro metatarso no hálux valgo, o sesamoide mantém sua relação com o segundo metatarso no plano transverso. Esse aparente deslocamento lateral pode levar a interpretação equivocada dessas radiografias. Tal fato é de suma importância no pré-, peri- e pós-operatório dos pacientes com hálux valgo.
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Humains , Mâle , Femelle , Adolescent , Adulte , Os du métatarse , Hallux valgus , RadiographieRésumé
As one of the most common fractures of the foot, the blood supply characteristics and unique anatomy of proximal fifth metatarsal fracture makes a high risk of delayed union or non-union of fractures occurring at the junction of the diaphyseal-metaphyseal. At present, the classification system of proximal fifth metatarsal fracture is complicated and not yet unified, and Lawrence and Botte classification is more recommended. The system divides proximal fifth metatarsal fracture into three types:avulsion fractures of tuberosity(Zone I), fractures at the metaphysis-diaphysis junction, which extend into the fourth-fifth intermetatarsal facet (Zone II) and the proximal diaphyseal fractures(Zone III). Based on the classification system, each type of fracture has a corresponding treatment plan and prognosis. There are a variety of surgical methods for proximal fifth metatarsal fracture. For the fracture of Zone II and Zone III, percutaneous intramedullary screw is the first choice. In addition, clinicians should also have a thorough understanding of common complications of fracture and associated disposal methods.
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Humains , Vis orthopédiques , Pied , Traumatismes du pied , Fractures osseuses , Os du métatarseRésumé
OBJECTIVE@#To explore distal Chevron osteotomy of the first metatarsal and soft-tissue release for the treatment of mild and moderate hallux valgus.@*METHODS@#From June 2015 to June 2017, 32 patients(40 feet) with mild and moderate hallux valgus were treated with distal Chevron osteotomy with soft tissue release. including 3 males(3 feet) and 29 females (37 feet), aged from 22 to 80 years old with an average of 57.57 years old. The courses of disease ranged from 2 to 32 years with an average of 14 years. Among them, 9 feet were mild, 31 feet were moderate. Patients were combined with bunion, pain around the first metatarsal joint, and pain increased during weight-bearing walking before opertaion. AP and lateral X-rays on weight-bearing were performed, hallux valgus angle(HVA) and intermetatarsal angle(IMA) between the first and the second metatarsal were examined before and after operation. AOFAS score was applied to evaluate clinical effects.@*RESULTS@#All patients were followed up from 12 to 24 months with an average of 15.2 months.Fracture wounds were healed well without infection and metatarsal head necrosis occurred. Preoperative HVA (32.08±5.59)° and IMA (11.63±2.24)° decreased to (10.31±4.36)° and (5.02°±2.34)°after operation at 12 months, and had statistical difference before and after operation (<0.05). AOFAS score increased from 56.75±6.42 before operation to 88.80±3.99 after operation at 12 months(<0.05).@*CONCLUSIONS@#Distal Chevron osteotomy of the first metatarsal and soft-tissue release for the treatment of mild and moderate hallux valgus could obtain good effects and provide more options for hallux valgus treatment.
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Adulte , Sujet âgé , Sujet âgé de 80 ans ou plus , Femelle , Humains , Mâle , Adulte d'âge moyen , Jeune adulte , Oignon , Hallux valgus , Chirurgie générale , Os du métatarse , Ostéotomie , Radiographie , Résultat thérapeutiqueRésumé
BACKGROUND: We developed a modified proximal scarf osteotomy technique for moderate to severe hallux valgus in an attempt to obtain better correction of the deformity. In addition, we compared the clinical and radiographic results of this modified technique with those of the classic scarf osteotomy reported in other studies. METHODS: Between December 2004 and July 2009, 44 cases of modified proximal scarf osteotomy was performed in 35 patients with moderate hallux valgus. The American Orthopedic Foot and Ankle Society (AOFAS) score, visual analogue scale (VAS) score, range of motion of the first metatarsophalangeal joint, and radiographic results were evaluated. RESULTS: The mean hallux valgus angle and the mean first intermetatarsal angle improved from an average of 32.2° and 14.3°, respectively, to an average of 12.5° and 8.6°, respectively. The distal metatarsal articular angle improved from an average of 18.7° to 12.4°. The preoperative mean AOFAS and VAS scores were 47 points and 7 points, respectively, which improved to 86 points and 1 point, respectively, at the final follow-up. Limited range of motion occurred in two cases postoperatively. The height of the first metatarsal-cuneiform joint, which was an average of 15.9 mm preoperatively, did not change. The first metatarsal-talus angle increased from an average of 4.1° to 7.1°. CONCLUSIONS: The modified proximal scarf osteotomy for the treatment of moderate hallux valgus showed similar results with the classic scarf osteotomy with regard to changes in the first intermetatarsal angle and postoperative satisfaction. Therefore, we suggest the modified proximal scarf osteotomy be considered as well as other proximal osteotomy in the treatment of moderate to severe hallux valgus.
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Humains , Cheville , Malformations , Études de suivi , Pied , Hallux valgus , Hallux , Articulations , Os du métatarse , Articulation métatarsophalangienne , Orthopédie , Ostéotomie , Amplitude articulaireRésumé
BACKGROUND: Hallux valgus is a common orthopedic disease, and its causes are complex and treatment is varied. The mechanical analysis of hallux valgus is an issue of concern. The finite element analysis makes it predictable to treat hallux valgus. OBJECTIVE: To explore the clinical application of finite element analysis in biomechanical study of hallux valgus.METHODS: The first author searched CNKI and PubMed databases from January 1980 to March 2017 using the key words of "finite element, hallux valgus" in English and Chinese, respectively. The repetitive, irrelevant and low-quality articles were excluded. Finally 33 eligible articles were included in accordance with the inclusion criteria, and the critical issues of finite element analysis applied in hallux valgus were reviewed. RESULTS AND CONCLUSION: (1) There are many researches concerning finite element of hallux valgus, which mostly require physicians to work with engineers. These methods are already very mature, but most of the model and material properties of the data come from foreign researches. (2) The finite element analysis is important and reliable for the etiology of hallux valgus, preoperative planning and prognosis. (3) The finite element model of the hallux valgus is only used on static analysis and gait cycle analysis, the modeling details and definition of material properties still need to be improved.
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Objective To investigate high-frequency ultrasonic characters and screening method of plantar metatarsal level in normal adults.Methods Plantar metatarsal level were examined with high frequency ultrasound in 40 normal adults.The base,body and head of the first to the fifth metatarsal were used as anatomical location markers.The ultrasonic characters and screening method were described and recorded.Results The plantar skin,plantar fat pad,plantar aponeurosis and deep muscular structures,including the flexor digitorum brevis,abductor hallucis,abductor digiti minimi,lumbricalis,felxor hallucis brevis,flexor digiti minimi brevis,abductor hallucis and plantar interossei were illuminated in detail with high-frequency ultrasound.Conclusion High frequency ultrasound can be used to depict anatomical structures of plantar metatarsal level.