ABSTRACT
The Ludloff osteotomy is a technique option to address hallux valgus in patients with a moderately to significantly increased first-second intermetatarsal angle. The Ludloff osteotomy is an oblique osteotomy of the first metatarsal extending dorsal-proximal to plantar-distal when viewed in the sagittal plane. The dorsal-proximal portion of the metatarsal is cut with the saw while maintaining the plantar-distal surface intact. A screw is inserted across the proximal aspect of the osteotomy, then the osteotomy is extended across the plantar surface distally. The metatarsal is rotated around the axis of the screw to the desired correction. In order to perform the osteotomy correctly, the surgeon must not only effectively complete the nuances of the technique, but also understand the limitations and contraindications of the Ludloff osteotomy. This review of current concepts for the Ludloff osteotomy reviews recent literature as well as technique pearls and pitfalls in the application of this powerful osteotomy.
Subject(s)
Hallux Valgus/surgery , Osteotomy/methods , Hallux Valgus/diagnostic imaging , Humans , Metatarsal Bones/surgery , RadiographyABSTRACT
BACKGROUND: Opening wedge osteotomy of the medial cuneiform has become an established intervention for correction of forefoot varus in relation to a flatfoot deformity. The purpose of this study was to use a newly described radiographic measurement to determine the effectiveness and durability of the medial column correction with a plantarflexion opening wedge osteotomy of the medial cuneiform without internal fixation using an allograft. METHODS: Twenty-three feet underwent medial cuneiform opening wedge osteotomies for correction of forefoot varus associated with flatfoot deformity. The angle between the proximal and distal articular surfaces was measured on lateral radiographs preoperatively, postoperatively prior to weightbearing and at final followup visit. RESULTS: The average angle between the proximal and distal articular surfaces of the medial cuneiform on lateral foot radiographs was 1.0 degree preoperatively (±0.8 degrees). The average angle post-osteotomy, pre-weightbearing, was 8.4 degrees (±3.6 degrees) and at final followup was 7.5 degrees (±2.9 degrees). All patients achieved bony union. CONCLUSION: We describe a new radiographic measurement to focus on the correction achieved by a plantarflexion osteotomy of the medial cuneiform. It was found to be stable without internal fixation and reliably proceeded to union without significant loss of correction.
Subject(s)
Flatfoot/diagnostic imaging , Flatfoot/surgery , Osteotomy/methods , Tarsal Bones/diagnostic imaging , Tarsal Bones/surgery , Adult , Aged , Female , Humans , Ilium/transplantation , Male , Middle Aged , Radiography , Retrospective StudiesABSTRACT
Introducción: La infancia es la etapa más importante del ciclo humano y el desarrollo humano integral de los niños pequeños es una meta necesaria para alcanzar el progreso humano y mejorar el capital social en nuestros tiempos. El desarrollo está ligado a diversos factores como un óptimo estado nutricional y una adecuada estimulación temprana. Objetivo: Evaluar el impacto de una intervención educativa acerca de alimentación infantil y estimulación temprana en el mejoramiento del estado nutricional y desarrollo psicomotor de niños menores de 2 años del distrito de San Andrés de Tupicocha de la provincia de Huarochirí. Diseño: Analítico, longitudinal, cuasi-experimental. Participantes: Niños y niñas menores de 2 años del distrito de San Andrés de Tupicocha - Huarochirí. Material y Métodos: Para lograr el efecto del estudio se dividió a los niños en 2 grupos, uno con intervención (aquellos donde las madres recibieron las sesiones de educativas en alimentación infantil y estimulación temprana) y sin intervención (aquellos donde las madres no recibieron las educativas). Se desarrolló en 4 fases. Fase Inicial o Diagnóstica: Evaluación nutricional a través de peso y talla, toma de hemoglobina y encuestas de consumo; evaluación del desarrollo psicomotor a través de la Escala de Evaluación del Desarrollo Psicomotor (EEDP) a niños menores de 2 años. Fase Educativa: Por 6 meses se realizaron 12 sesiones educativas y demostrativas diferentes en los temas de alimentación infantil y estimulación temprana. Fase de Evaluación Final: realizada después de finalizada la fase educativa. Fase de Evaluación de Impacto: Realizada después de 6 meses de haber finalizado la fase de evaluación final con el fin de conocer si el cambio en el estado nutricional y desarrollo psicomotor era sostenible. Principales Medidas de Resultados: Talla baja, anemia, frecuencia de consumo de alimentos fuente de hierro y vitamina A, nivel del desarrollo psicomotor. Resultados: En el indicador (...)
Introduction: The childhood is the most important stage in the cycle of life and the correct development of these children is a necessary goal towards the improvement of social capital. An optimal human development is related to an adequate nutritional status and psychomotor development. Objective: To evaluate the impact of an educative intervention about infant feeding and early stimulation in the nutritional status and the psychomotor development of children less than 2 years old Design: Analytical, longitudinal, cuasi-experimental. Participants: Children less than 2 years old in San Andres de Tupicocha-Huarochirí. Material and Methods: In order to compare the effects of the study the children were split up in two groups: with intervention and without intervention; selecting the children who were able to participate in the educative sessions as the intervention group and all the other children in the group without intervention. The intervention was developed in four phases. Initial phase or diagnostic phase: Nutritional assessment of weight and height, hemoglobin and surveys; psychomotor development assessment using the "Escala de Evaluación del Desarrollo Psicomotor (EEDP)" to children less than 2 years old. Educative phase: During six months educative sessions about infant feeding and early stimulation. Final Evaluation: Immediately after the educative phase finished. Impact Evaluation Phase: After six months the final evaluation in order to know if the change in nutritional status and psychomotor development was sustainable. Result indicators: Stunting, anemia, iron and vitamin A rich Food Frequency intake, psychomotor development Results: Regarding the H/A index, there were not significant differences between the initial and impact evaluation in the intervention group. However, there were significant differences in the anemia and psychomotor development with p=0.000 and p=0.002 respectively, between the initial and impact evaluation in the (...)
Subject(s)
Male , Female , Humans , Infant, Newborn , Infant , Psychomotor Performance , Nutritional Status , Early Intervention, Educational , Infant Nutrition , Infant Nutrition Disorders , Longitudinal StudiesABSTRACT
BACKGROUND: Oblique shortening osteotomy (Weil) can address lesser MP pathology but can have a high rate of complications. The purpose of this study was to review the results of a modification of the Weil osteotomy, the segmental resection metatarsal osteotomy. MATERIALS AND METHODS: Between 2004 and 2006, 48 patients underwent the segmental resection osteotomy with a mean followup of 13 (range, 6 to 26) months. All the patients were evaluated with the American Orthopaedic Foot and Ankle Society (AOFAS) forefoot score and a questionnaire addressing distances they were able to walk, work limitations, sporting activity, and overall satisfaction. RESULTS: The postoperative AOFAS forefoot score was an average of 87.6 (range, 59 to 100; SD, 10.97) and the overall satisfaction rate was 85.4%. The complication rate was 18.8% for transfer metatarsalgia, 27.1% for floating toes, 35.4% for toe weakness, 14.6% for infection, and 10.4% for wound healing problems. CONCLUSIONS: Despite the complications, the patients who underwent segmental osteotomy were satisfied with the outcome for lesser MTP joint pain and deformity. This is a preliminary study with significant refinement of the operative method as detailed in the surgical technique section. Further followup will elucidate whether additional changes are necessary in the surgical technique.
