Research progress of interphalangeal arthrodesis / 中国修复重建外科杂志

Objective: To review the research progress of interphalangeal arthrodesis in the treatment of interphalangeal joint deformity. Methods: The literature about interphalangeal arthrodesis at home and abroad was extensively consulted, and the indications, fusion methods, fixation methods, complications, and so on were summarized and analysed. Results: The indications of interphalangeal arthrodesis are hammer toe, claw toe, and mallet toe. From the different forms of fusion surface, fusion methods include end-to-end, peg-in-hole, conical reamer type, and V-shape arthrodesis. There are three kinds of fixation methods: Kirschner wire fixation, stainless-steel wire suture fixation, and intramedullary fixation, and there are many kinds of intramedullary fixation. The complications of interphalangeal arthrodesis include vascular injury, fixation related complications, and postoperative complications. Conclusion: Interphalangeal arthrodesis is a good way to correct some deformities of toes, but the incidence of various complications can not be ignored, and there is still a lack of clinical research on interphalangeal arthrodesis.

Treatment of Lesser Toe Deformities / 대한족부족관절학회지

Lesser toe deformities such as mallet toe, hammer toe and claw toe are annoying problems not only to patients but also to orthopaedic surgeons because they are not easy to manage or treat. Though they occupy very small portion in whole body, they are notorious for unpredictable surgical results. It can make clinical results better to understand these deformities more comprehensively and to make strategic surgical plan for each target deformity.

Analysis of the morphometry and variations in the extensor digitorum brevis muscle: an anatomic guide for muscle flap and tendon transfer surgical dissection / 대한해부학회지

The extensor digitorum brevis muscle (EDB) is a practical option for use as an island flap or free flap when reconstructing soft tissue defects in the ankle as well as in the entire lower limb. It is frequently used to correct crossover toe deformity and other painful toe disorders. We evaluated the morphometry of the EDB in 44 formalin-fixed limbs. Length and width of the muscles were measured. Surface area was calculated as the product of length and width of the muscle. The length of each tendon was also measured from its origin to the point of distal attachment. Presence of any additional tendons was noted. Mean length, width, and surface area of the muscle were 7.39+/-0.71 cm, 4.1+/-0.37 cm, and 30.5+/-4.78 cm2 on the right side and 7.2+/-0.84 cm, 3.9+/-0.37 cm, and 28.4+/-5.35 cm2 on the left side, respectively. Morphometry of the tendons revealed that the tendon of the great toe had the highest mean length (9.5 cm) and the tendon of the fourth toe had the lowest mean length (6.3 cm). Four of the limbs studied (9.09%) had only three tendons. Three of the limbs studied (6.81%) had five tendons, and in one exceptional case (2.27%), six tendons were detected. These observations have significant value and are applicable to plastic and orthopedic surgery.

The Effect of Operative Treatment for Lessor Toes Deformity Concomitant with Hallux Valgus on Clinical Outcomes / 대한족부족관절학회지

PURPOSE: This study was performed to evaluate the impact of the lesser toe operation on the overall clinical outcomes, and to analyze the clinical results of concomitant surgery for hallux valgus and lesser toe deformities. MATERIALS AND METHODS: Forty-six cases underwent surgery for hallux valgus with concomitant lesser toe deformities were followed up for at least 1 year. Lesser toe deformities consisted of 9 crossover toes, 10 claw toes, 12 hammer toes and 15 bunionettes. Clinical evaluation was performed according to AOFAS (American Orthopaedic Foot and Ankle Society) score, patient's satisfaction score, and pain VAS (visual analogue scale) score. Hallux valgus angle (HVA), intermetatarsal angle (IMA), and period to union were measured. Preoperative expectation about lesser toe deformities, postoperative satisfaction, complication rate, hospitalization period, medical expenses, and frequency of outpatient follow-up were analyzed. RESULTS: AOFAS score, VAS score, HAV and IMA had improved significantly. On preoperative expectation of patients, correction of lesser toe deformities was ranked third, following the improvement of big toe(bunion) pain and the correction of hallux valgus. Patient's satisfaction score was average 92.8 points, and the importance of lesser toe operation was 30.2%. When compared to hallux valgus operation only, there were average 2.5 days of additional hospitalization, 2.4 times of additional outpatient follow-up, 386000 won of additional medical expenses. CONCLUSION: Combined operation for hallux valgus and concomitant lesser toe deformities showed good clinical results. When compared to hallux valgus operation only, there were longer hospitalization, more frequent follow-up, more medical expenses, more complications. However, lesser toe deformity correction in patients underwent hallux valgus operation is considerable, because of high preoperative expectation and postoperative satisfaction.

The Proximal Lengthening of Long Flexor Tendon in the Management of Claw Toe Deformities / 대한정형외과학회잡지

PURPOSE: To evaluate the clinical results of acquired claw toe deformities that had been treated with proximal lengthening of the long toe flexor tendons. MATERIALS AND METHODS: Seventeen patients with a claw toe deformity due to contracture of the long flexor tendons were treated with proximal lengthening of the long toe flexor tendons from January 1993 to January 2003 and were followed up for at least 1 year. The average age at the time of the operation was 42 years and the average follow-up period was 34 months. Achilles tendon lengthening was also performed in 14 cases with an equinus deformity. At the final follow-up, a residual toe deformity, toe pain during walking, patient's satisfaction, and limitation of the shoe-wear were assessed. RESULTS: At the final follow up, all cases showed a complete correction of a claw toe deformity, and did not have callosity at the toe tip or dorsal aspect of the toes. Toe pain during walking was found in 1 case, and a limitation of the shoe-wear was noted in 6 cases. At the final evaluation, 10 cases were graded as excellent, 6 good, and 1 fair. There was no recurrence of the claw toe deformity or limitation of the toe motion. CONCLUSION: Proximal lengthening of the long toe flexor tendons is recommended for treating flexible claw toe deformities. The procedure produced excellent results regarding the deformity correction and pain relief.