First metatarsophalangeal joint fusion using a Fyxis plate.

PURPOSE: To report the outcome of fusion of the first metatarsophalangeal joint (MTPJ) using the Fyxis plate and compression screws. METHODS: Medical records of 12 men and 39 women (54 feet) aged 28 to 74 (mean, 58) years who underwent primary fusion of the first MTPJ using the Fyxis plate and compression screws for hallux rigidus (n=38), severe hallux valgus (n=8), or rheumatoid arthritis (n=8) were reviewed. The outcome measures included the fusion rate, time to fusion, complication rate, hallux valgus angle, dorsiflexion angle, and the American Orthopaedic Foot and Ankle Society (AOFAS) scale. RESULTS: The mean follow-up was 14.8 (range, 12-20) months. The mean time to fusion was 3.2 months. 48 feet achieved complete fusion at 3 months, 5 at 6 months, and one had non-union at 12 months, which was treated with revision surgery. The mean hallux valgus angle improved from 23º to 12º. The mean dorsiflexion angle improved from 22º to 23º. The mean AOFAS scale score improved from 31 to 86. 98% of the feet achieved a score of >72. One patient with non-union had a score of 59. Two feet developed superficial wound infection, which resolved with antibiotic treatment. Two other feet developed numbness over the medial aspect of the great toe, which persisted after one year. CONCLUSION: The outcome of fusion of the first MTPJ using the Fyxis plate and compression screws was good.

Scarf osteotomy with or without proximal phalangeal osteotomy for severe hallux valgus deformity.

PURPOSE: To report outcome of Scarf osteotomy with or without proximal phalangeal osteotomy for correction of severe hallux valgus deformity. METHODS: Records of 48 women and 4 men aged 28 to 68 (mean, 52) years who underwent 57 Scarf osteotomies with or without proximal phalangeal osteotomy for severe hallux valgus by a single surgeon were reviewed. The patients had a hallux valgus angle (HVA) of up to 55º. An additional proximal phalangeal osteotomy was performed in 11 of the patients whose hallux valgus persisted (HVA >10º). The American Orthopaedic Foot and Ankle Society (AOFAS) hallux score, the HVA and intermetatarsal angle (IMA) on radiographs, and the complication rate were assessed. RESULTS: The mean follow-up period was 26 (range, 24-36) months. The mean AOFAS hallux score improved from 57.4 (range, 49-64) to 91.6 (range, 75-100). The mean HVA improved from 38.1º (range, 28º-52º) to 12.8º (range, 5º-20º). The mean IMA improved from 17.0º (range, 13º-24º) to 6.8º (range, 3º-10º). One patient developed chronic regional pain syndrome. There were no instances of non-union, delayed union, or malunion of the osteotomy site. CONCLUSION: Scarf osteotomy with or without proximal phalangeal osteotomy is an effective treatment for correcting severe hallux valgus deformity.

Secondary aneurysmal bone cyst of the patella: a case report.

A 20-year-old man presented to our clinic with pain and swelling in the right knee of one year's duration. Biopsy of the patella revealed an aneurysmal bone cyst secondary to a giant cell tumor. He was treated by curettage and bone cement to fill the defect. The rarity of this lesion in the patella and its treatment modalities are discussed.

Multifocal skeletal tuberculosis: a report of three cases.

Tuberculosis of the bone is a well-recognized clinical condition that can be diagnosed and managed by physicians and orthopaedic surgeons, often with an excellent outcome. However, the occurrence of multifocal skeletal involvement in immunocompetent patients is rare, even in countries where tuberculosis is endemic. Patients with multifocal skeletal tuberculosis may present with multiple vague somatic symptoms. We report three cases of multifocal skeletal tuberculosis in non-immunocompromised patients. All three patients were effectively treated with antituberculous drugs.