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.

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.

Evaluation of therapeutic efficacy of arthroplasty with Swanson prosthesis in the surgical treatment of 2-5 metatarsophalangeal joint diseases / 北京大学学报(医学版)

OBJECTIVE@#Metatarsophalangeal joint is an important joint for daily weight-bearing walking. Osteoarthritis, osteochondrosis of the metatarsal head, rheumatoid arthritis can often cause the destruction of 2-5 metatarsophalangeal joint, leading to pain, limited joint movement and toe deformities, severely affecting the forefoot function. The purpose of this study is to report the results of middle-long term follow-up after performing Swanson double-stem silicon implant arthroplasty in patients with diseases of 2-5 metatarsophalangeal joint.@*METHODS@#From January 2010 to October 2015, 21 patients with 2-5 metatarsophalangeal joint replacement were performed with Swanson double-stem silicone prosthesis. In the study, 16 cases were successfully followed up, 2 men and 14 women with an average age (66.7±5.5) years. There were 9 cases diagnosed with rheumatoid arthritis, 5 cases with severe osteoarthritis and 2 cases with osteochondrosis of the metatarsal head. The American Association of foot and ankle surgery Maryland foot scoring system and visual analogue score (VAS) were used to evaluate the walking function, metatarsophalangeal joint mobility and pain degree before and after surgery.@*RESULTS@#The follow-up time ranged from 17 months to 5 years, with an average of 3.2 years. According to Maryland foot scoring system of the American Association of foot and ankle surgery, the preoperative score was (60.69±6.12) points and postoperative score was (88.13±5.84) points. Range of motion of metatarsophalangeal joint: preoperative: back extension 5.4°±3.1°, plantar flexion 4.4°±2.7°; postoperative: back extension 15.7°±4.5°, plantar flexion 12.2°±4.3°, the motion of 2-5 metatarsophalangeal joint after operation was significantly improved compared with that before operation (P < 0.01). The preoperative VAS was (6.8±0.9) points and the last follow-up was (2.3±0.8) points, the pain symptom of metatarsophalangeal joint was improved obviously after operation. The postoperative score was significantly higher than the preoperative score according to Maryland foot scoring system (P < 0.01), the excellent rate was 81.3%.@*CONCLUSIONS@#With the advantages of alleviating pain, preserving the length and alignment of metatarsophalangeal joint, improving the function of walking, and correcting the deformity, Swanson double-stem silicon implant arthroplasty is a reproducible and safe option for the reconstruction of the 2-5 metatarsophalangeal joint. However, there is still some probability of adverse reactions and still room for improvement.

Propuesta de una capsulorrafia como parte del tratamiento quirúrgico del hallux valgus: estudio en cadáver / A cadaveric study of a new capsulorrhaphy for the surgical treatment of hallux valgus

Resumen: Antecedentes: Existen numerosas técnicas quirúrgicas para el tratamiento del hallux valgus en combinación con diversas capsulorrafias para su corrección. Material y métodos: El trabajo presentado corresponde a un estudio descriptivo donde se propone una capsulorrafia no desarrollada con anterioridad del hallux valgus. Se realizaron seis disecciones en cadáver con la deformidad de hallux valgus a través de la siguiente técnica quirúrgica: abordaje medial sobre el primer dedo del pie de manera longitudinal, disecando por planos y localizando la cápsula articular metatarsofalángica; se incidió longitudinalmente. Se separó la cápsula y se llevó a cabo la exostectomía de la cabeza del primer metatarsiano; se regularizaron los bordes y se realizó la liberación del abductor del primer dedo. Posteriormente, se resecó el remanente capsular y se reparó. Resultados: Seis pies de cadáver portadores de hallux valgus; cinco con deformidad leve, uno pie moderado, un pie con segundo dedo en supraducto. Discusión: Muchas capsulorrafias han sido reportadas en la literatura, incluyendo en «L¼, triangular, «V-Y¼, rectangular, con resultados satisfactorios, junto con las osteotomías del primer metatarsiano. Aquí se describe una propuesta de capsulorrafia. Conclusión: La corrección de la deformidad del hallux valgus en pies de cadáver aplicando esta propuesta de reparación capsular fue satisfactoria, con adecuada tensión y una movilidad conservada de la articulación metatarsofalángica.

Abstract: Background: There are many surgical options for the treatment of hallux valgus in combination with capsular repairs for the correction of hallux valgus. Material and methods: This report corresponds to a descriptive study where a new capsulorrhaphy technique in hallux valgus is proposed. Six dissections were performed on cadavers with hallux valgus deformity using the following surgical technique: medial approach on the first toe longitudinally, dissecting by planes and locating the metatarsophalangeal joint capsule; it was incised longitudinally. The capsule was separated and an exostectomy of the first metatarsal head was done, the edges were regularized and a release of the abductor hallucis was performed. Later, the capsular remnant was resected and repaired. Results: Six cadaveric feet with hallux valgus were studied, five with mild deformity, one with moderate deformity, one foot with the 2nd finger on supraductus. Discussion: Many capsular repairs have been reported in the literature, including «L¼, triangular, «V-Y¼, rectangular, with satisfactory results, along with osteotomy of the first metatarsal. In this report, a new capsular repair was described. Conclusion: Applying this new capsular repair, we reduced the metatarsophalangeal and intermetatarsal angles and achieved a capsular closure with suitable tension; the metatarsophalangeal joint mobility was preserved.

Osteotomía percutánea de Bosch ¿El paciente acepta el clavo? Análisis clínico-funcional y resultados a corto plazo / Bosch percutaneous osteotomy. Does the patient accept the nail? Clinical and functional analysis and short-term results

El hallux valgus es una deformidad frecuente de la articulación metatarsofalángica del primer rayo. El tratamiento quirúrgico en forma percutánea es un procedimiento demandante que implica una curva de aprendizaje prolongada y constituye un desafío para el cirujano especialista. Materiales y Métodos: Estudio de cohorte retrospectivo. Setenta pacientes operadas de hallux valgus con técnica percutánea de Bõsch. Se evaluaron las características del intraoperatorio y la hospitalización, los resultados funcionales según el puntaje de la AOFAS y las molestias con el uso del clavo de Steinmann para fijación de osteotomía; y los resultados radiológicos. El seguimiento promedio fue de 12.8 meses. Resultados: El tiempo promedio de uso del clavo de Steinmann fue de 31.44 días, 18 pacientes refirieron insatisfacción o incomodidad con el clavo de Steinmann en el posoperatorio, pero manifestaron que se volverían a operar con una técnica quirúrgica similar. Sin embargo, tres pacientes que estuvieron conformes, afirmaron que no volverían a operarse con esta técnica. Conclusión: La cirugía de Bõsch y la estabilización de la osteotomía con un clavo de Steinmann es una solución eficaz para el tratamiento del hallux valgus. Nivel de Evidencia: IV...

Hallux valgus is a common deformity of the metatarsophalangeal joint. Its percutaneous surgical treatment is a demanding procedure that involves a long learning curve and constitutes a challenge for the surgeon. Methods: Retrospective cohort study. Seventy patients with hallux valgus operated on with percutaneous Bõsch technique. Intraoperative characteristics and hospitalization, functional results according to AOFAS score and discomfort with the use of a Steinmnann pin for osteotomy fixation, and radiological results were evaluated. The average follow-up was 12.8 month. Results: The Steinmann pin was used for an average of 31.44 days. Eighteen patients showed discomfort with the Steinmann pin in the postoperative period, but they said they would turn to operate on with a similar surgical technique. However, three patients who were dissatisfied said they would not be operated on with this technique. Conclusion: Bõsch surgery and the stabilization of the osteotomy with a Steinmann pin is an effective solution for the treatment of hallux valgus. Level of Evidence: IV...

Changing Paradigms in the Treatment of Radial Club Hand: Microvascular Joint Transfer for Correction of Radial Deviation and Preservation of Long-term Growth

Radial longitudinal deficiency, also known as radial club hand, is a congenital deformity of the upper extremity which can present with a spectrum of upper limb deficiencies. The typical hand and forearm deformity in such cases consists of significant forearm shortening, radial deviation of the wrist and hypoplasia or absence of a thumb. Treatment goals focus on the creation of stable centralized and functionally hand, maintenance of a mobile and stable wrist and preservation of longitudinal forearm growth. Historically centralization procedures have been the most common treatment method for this condition; unfortunately centralization procedures are associated with a high recurrence rate and have the potential for injury to the distal ulnar physis resulting in a further decrease in forearm growth. Here we advocate for the use of a vascularized second metatarsophalangeal joint transfer for stabilization of the carpus and prevention of recurrent radial deformity and subluxation of the wrist. This technique was originally described by the senior author in 1992 and he has subsequently been performed in 24 cases with an average of 11-year follow-up. In this paper we present an overview of the technique and review the expected outcomes for this method of treatment of radial longitudinal deficiency.

Changing Paradigms in the Treatment of Radial Club Hand: Microvascular Joint Transfer for Correction of Radial Deviation and Preservation of Long-term Growth

Radial longitudinal deficiency, also known as radial club hand, is a congenital deformity of the upper extremity which can present with a spectrum of upper limb deficiencies. The typical hand and forearm deformity in such cases consists of significant forearm shortening, radial deviation of the wrist and hypoplasia or absence of a thumb. Treatment goals focus on the creation of stable centralized and functionally hand, maintenance of a mobile and stable wrist and preservation of longitudinal forearm growth. Historically centralization procedures have been the most common treatment method for this condition; unfortunately centralization procedures are associated with a high recurrence rate and have the potential for injury to the distal ulnar physis resulting in a further decrease in forearm growth. Here we advocate for the use of a vascularized second metatarsophalangeal joint transfer for stabilization of the carpus and prevention of recurrent radial deformity and subluxation of the wrist. This technique was originally described by the senior author in 1992 and he has subsequently been performed in 24 cases with an average of 11-year follow-up. In this paper we present an overview of the technique and review the expected outcomes for this method of treatment of radial longitudinal deficiency.

[Treatment of symptomatic Freiberg's disease by resection arthroplasty]

Freiberg's disease is osteochondrosis or a vascular necrosis of metatarsal head. In many cases treatment is no operative. In patients who fail no operative treatment, surgical treatment may be offered. In this article, we studied surgical treatment with resection arthroplasty of metatarsophalyngeal joint in patients with unsuccessful no operative treatment. Resection arthroplasties of metatarsophalyngeal joint were performed in 16 patients with Freiberg's disease and unsuccessful no operative treatment between 2001 and 2007. In all patients, second metatarsophalyngeal joint involved. The average of follow up was 34 months [12-56]. There were 12 female [75%] and 4 male [25%] patients with an average age of 25 years [range 18-40]. There were excellent outcome in 12 [75%], good in 2 [12.5%] and moderate in 2 [12.5%] cases. Surgical treatment with metatarsophalyngeal joint resection arthroplasty has very good result in patients with Freiberg's disease that conservative treatments have failed

Osteoplastía de Golden modificada para la correción de hallux valgus y metatarso primo varo / Modified golden ostoeplasty for correction of hallux valgus and varus prime-metatarsal bone

Se sometieron 15 pacientes, 2 hombres y 13 mujeres a corrección de hallux valgus mediante la técnica de golden, cuyo fundamento es la osteotomía de la base del primer metatarsiano en cuña de cierre de abducción y plastía tipo Lelièvre de la cápsula medial. Los resultados mostraron corrección del ángulo metatarso-falángico de 30.3 grados preop. a 17.6 postop. y en ángulo intermetatarsiano cambió de 13 grados promedio a 7.1. El resultado global final fue excelente en 6, bueno en 5 y malo en 4

Hallux valgus, experiencia de 5 años: Hospital Español de México / Hallux valgus: five year experience in the Spaniard Hospital of Mexico

Se realizó un estudio retrospectivo sobre el tratamiento de hallux valgus en el Hospital Español de México, de enero de 1990 a diciembre de 1995. El objetivo, analizar las diversas técnicas quirúrgicas empleadas, así como la evolución trans y postoperatoria. El seguimiento fue de 2 a 7 años. De los 191 pies operados, en 106 pacientes, 15 fueron derechos, 6 izquierdos y 85 bilaterales. La distribución por sexo fue de 104 mujeres y 2 hombres. Edad mínima de 14 años y máxima de 79 años, con promedio de 46 años. La técnica más empleada fue la Lelièvre (Artroplastía-cerclaje fibroso) con 105 pies operados (54.98 por ciento), reportando excelentes resultados en 101 de los pies operados con esta técnica (52.87). Del resto de técnicas empleadas: Mc Bride, Keller, Silver, Du Vries y otras, hubo recidiva en aquellas que manejaron tejidos blandos o trastornos en la marcha cuando se hizo resección amplia de la primera falange

Osteotomía basal de apertura asociada a plastía de Lelièvre, en la correción del hallux valgus metatarso primo varo / Proximal opening wedge osteotomy associated to Lelièvre plasty for correction of hallux valgus and prime-varus metatarsal bone

Se presentan 100 casos de hallux valgus, operados con la combinación de las técnicas de resección basal de la primera falange, plastía capsular medial tipo Lelièvre y resección del juanete, y osteotomía basal abductora del primer metatarsiano en cuña de apertura con injerto óseo. Los resultados fueron excelentes y buenos en el 85 por ciento de los casos, regular en 12 por ciento y malos en 3 por ciento

Hallux rigidus: resección artroplástica metatarsofalángica

La función normal de la primera articulación metatarsofalángica depende no sólo de aspectos inherentes a la propia articulación, sino también de la movilidad sesamoidea y de la capacidad del primer metatarsiano para la flexión plantar. Microtraumatismos agudos o crónicos pueden dañar la superficie articular cuando la flexión plantar del primer metatarsiano se encuentra limitada por un metatarsiano hipermóvil o un metatarsiano de excesiva longitud o un metatarsus primus elevatus. Clasificamos a los hallux rigidus según Regnauld y consideramos las conductas terapéuticas en los distintos estadios, analizando en particular nuestra experiencia con la técnica de Valente Valenti o artrectomía en bisagra, que venimos efectuando desde hace más de 10 años. Analizamos resultados y complicaciones