The Effect of Derotational Closing Wedge Akin Osteotomy for the Treatment of Hallux Valgus with the Pronation of Great Toe / 대한족부족관절학회지

PURPOSE: We tried to understand the effects of the derotational closing wedge Akin osteotomy during the operation for the hallux valgus with pronation of great toe. MATERIALS AND METHODS: Eighty five patients who had undergone Akin osteotomy among the eighty seven patients who had been treated with Scarf osteotomy with hallux valgus were included in this study. Derotational supination was added on the medial closing wedge Akin osteotomy at the base of proximal phalanx and it was secured with K-wire, headless screw or staple. We measured and analyzed pre- and post-operative hallux primus valgus angle and hallux pronational rotatory angle. RESULTS: The hallux primus valgus angle improved an average of 14+/-2.98 degrees to -1+/-1.68 degrees with the hallux pronational rotatory angle respectively from 24.8+/-7.64 degrees to 4.7+/-4.22 degrees. CONCLUSIONS: After the metatarsal osteotomy for the treatment of the hallux valgus with the pronation of great toe, derotational closing wedge Akin osteotomy can give us a belief that it can correct the hallux primus valgus angle and hallux pronational rotatory angle also and it can be a helpful method for minimizing the recurrence rate of the hallux valgus deformity.

Clinical Result of Arthroscopic Capsular Release and Repair for SLAP II Lesion with Stiffness

PURPOSE: We assessed the clinical results after the operative treatment of type 2 SLAP lesion with stiffness. MATERIALS AND METHODS: 13 patients who had SLAP lesion with stiffness were treated with arthroscopic capsular release, SLAP repair and treatment of the associated lesion. The average follow-up period was above 12 months. RESULTS: The postoperative mean VAS was scored 1.5 and the postoperative ROWE score was 92.3, which showed a significant improvement after the operation (P<0.001). The mean range of motion was a significantly improved after the operation (P<0.001). The ROWE score was excellent for all the cases. CONCLUSION: Arthroscopic capsular release and SLAP repair and treatment of the associated lesion in patients with type 2 SLAP lesion with stiffness are effective treatments for the increasing the range of motion and decreasing the pain.

Multi-dimentional Correction of the Scarf Osteotomy for the Treatment of Hallux Valgus / 대한족부족관절학회지

PURPOSE: Scarf osteotomy can provide the simultaneous correction of the hallux valgus angle (HVA), 1-2 intermetatarsal angle (IMA1-2), DMAA and the plantar displacement of the fragment. The study was conducted to understand the multi-dimensional correction of the hallux valgus. MATERIALS AND METHODS: Fourty eight patients who had undergone Scarf osteotomy with hallux valgus at more than 30 degrees of HVA and more than 15 degrees of IMA1-2 were studied. Before an osteotomy, a reference K-wire was inserted to the 1st metatarsal head. After the osteotomy, the plantar fragment was moved laterally and the proximal end of the fragment was forced beyond the distal end which resulted in an internal rotation of the head fragment to correct the DMAA. RESULTS: The HVA improved an average of 33.3 degrees to 7.7 degrees with the IMA1-2 respectively from 15.4 degrees to 6.5 degrees. The DMAA improved an average of 19.5 degrees (5.2-30.9 degrees) to 4.5 degrees (0.4-13.8 degrees). By checking the angle, which was at an average of 25 degrees between the plantar surface of the foot and the osteotomy plane, the average distance of 1.9 mm (1.18-3.1 mm) of plantar displacement was measured using the value of sine (sin 25 = 0.422). CONCLUSIONS: It is possible to correct the HVA, IMA1-2 and DMAA simultaneously with one osteotomy making the lateral shift, the internal rotation and the plantar displacement of the plantar head fragment as desired. Despite the technicality and difficulty of the Scarf osteotomy, once familiarized through myriad procedures, all disadvantages are outweighed by the success and satisfaction of both patient and surgeon.