ABSTRACT
BACKGROUND AND OBJECTIVE: Since the description of the syndrome of the second intermetatarsal space, this is a common diagnosis among foot and ankle surgeons. However, no series have been published that consider this syndrome as its own entity. The objective of this study is to evaluate the clinical and radiological results of the release of the intermetatarsal ligament and minimally invasive distal metatarsal osteotomy in patients diagnosed with second space syndrome. MATERIALS AND METHODS: An observational, longitudinal, retrospective study was carried out in patients with a clinical diagnosis of second space syndrome operated on using a minimally invasive technique. For the clinical results, the visual analog scale (VAS) for subjective pain, the Manchester-Oxford Foot Questionnaire (MOXFQ) and the scale for minor metatarsals and interphalangeals of the American Orthopedic Foot and Ankle Society (AOFAS-LMTS) were used for clinical-functional assessment. Consolidation or not of osteotomies was recorded and complications were recorded. RESULTS: Twenty-nine feet in 29 patients were included in the study. After a mean follow-up of 39 months (25-50), clinically and statistically significant improvement was obtained in the scores: pain VAS, scales and subscales of the MOXFQ and the AOFAS-LMTS (p < 0.0001). All osteotomies healed at the end of follow-up and no major complications were recorded. CONCLUSIONS: Percutaneous or minimally invasive surgery, in patients with second intermetatarsal space syndrome, obtains good clinical, functional and subjective results, with few complications. Therefore, we consider it an effective, safe and recommended technique in the hands of experienced surgeons.
Subject(s)
Hallux Valgus , Metatarsal Bones , Humans , Metatarsal Bones/diagnostic imaging , Metatarsal Bones/surgery , Retrospective Studies , Minimally Invasive Surgical Procedures/adverse effects , Minimally Invasive Surgical Procedures/methods , Osteotomy/adverse effects , Osteotomy/methods , Pain , Ligaments , Treatment Outcome , Hallux Valgus/surgeryABSTRACT
BACKGROUND: The objective was to evaluate the influence of the postoperative sesamoid position as measured with conventional radiographs on the patient-reported outcome after scarf osteotomy. The hypothesis was that incomplete reduction of the sesamoid would result in a decreased functional outcome. METHODS: Eighty-two patients who underwent scarf osteotomy for hallux valgus were prospectively assessed for up to two postoperative years. The Self-Reported Foot and Ankle Score (SEFAS) was used to assess the quality of life, and the American Orthopaedic Foot and Ankle Society Hallux Metatarsophalangeal-Interphalangeal Scale (AOFAS) for the functional outcome. A visual analogue scale (VAS) assessed pain, and Likert scale for patient satisfaction. Radiologically, hallux valgus angle (HVA), first-second intermetatarsal angle (IMA), and sesamoid position were analyzed. According to the final sesamoid position, patients were classified as normal position (48 patients) and outlier position (34 patients). A power analysis, conventional and logistic regression statistical analysis were performed. RESULTS: At the final follow-up, significant improvements in all clinical scores were observed for both groups (p = 0.001) with no significant difference in AOFAS score (p = 0.413), but SEFAS score (p = 0.023), VAS-pain (p = 0.006), and satisfaction (p = 0.014) were significantly better in the normal group than in the outlier group. There were significant differences between groups in final HVA (p = 0.042) and IMA (p = 0.040). In multivariate analysis, only lower VAS-pain score (OR 0.4, 95% CI 0.2-0.6; p = 0.039) and normal sesamoid position (OR 2.4, 95% CI 1.6-3.2; p = 0.012) were significant predictor of patient satisfaction. CONCLUSION: At two postoperative years, normal sesamoid position as measured on weight-bearing radiographs was associated with lower pain and better patient satisfaction in patients underwent scarf osteotomy for moderate to severe hallux valgus.
Subject(s)
Bunion , Hallux Valgus , Metatarsal Bones , Bunion/complications , Hallux Valgus/complications , Hallux Valgus/diagnostic imaging , Hallux Valgus/surgery , Humans , Metatarsal Bones/surgery , Osteotomy , Pain , Patient Reported Outcome Measures , Prospective Studies , Quality of Life , Retrospective Studies , Treatment OutcomeABSTRACT
Objetivo: Valorar la capacidad del índice O-POSSUM de predecir la morbimortalidad de los pacientes intervenidos por fractura de la cadera. Material y método: Se revisaron retrospectivamente las historias clínicas de todos los pacientes mayores de 65años intervenidos de fracturas de la cadera entre enero de 2012 y diciembre de 2013. Se incluyó a 229 pacientes, la edad media fue de 82,3años y 170 fueron mujeres. Se recogieron patologías asociadas, tipo de cirugía y valores esperados de morbimortalidad O-POSSUM. Resultados: Tras un seguimiento mínimo de un año se registraron 38 fallecimientos, y 77 pacientes tuvieron alguna complicación. La mortalidad esperada, según el O-POSSUM, fue de 36 pacientes, y la morbilidad, de 132. Conclusión: Comparando los resultados observados con los predichos por el sistema, la escala O-POSSUM aplicada a fracturas de la cadera es más fiable en la predicción de mortalidad y sobreestima la morbilidad
Purpose: The aim of this study is to evaluate the O-POSSUM score capacity to predict the morbidity and mortality of patients undergoing hip fracture surgery. Material and methods: We retrospectively reviewed the clinical records of patients older than 65years old, operated on for hip fractures between January 2012 and December 2013. Of 229 patients, the mean age was 82.3years and 170 were women. We collected comorbidities, type of surgery, and expected morbidity and mortality O-POSSUM values. Results: After a minimum follow up of one year, 38 deaths were reported and 77 patients had complications. The expected mortality according to the O-POSSUM was 35 patients and expected morbidity 132. Conclusion: By comparing the observed results with those predicted, the O-POSSUM scale is reliable in predicting mortality and overestimates morbidity
Subject(s)
Humans , Male , Female , Aged , Aged, 80 and over , Indicators of Morbidity and Mortality , Hip Fractures/surgery , Psychometrics/instrumentation , Predictive Value of Tests , Retrospective Studies , Hip Fractures/mortalityABSTRACT
PURPOSE: The aim of this study is to evaluate the O-POSSUM score capacity to predict the morbidity and mortality of patients undergoing hip fracture surgery. MATERIAL AND METHODS: We retrospectively reviewed the clinical records of patients older than 65years old, operated on for hip fractures between January 2012 and December 2013. Of 229 patients, the mean age was 82.3years and 170 were women. We collected comorbidities, type of surgery, and expected morbidity and mortality O-POSSUM values. RESULTS: After a minimum follow up of one year, 38 deaths were reported and 77 patients had complications. The expected mortality according to the O-POSSUM was 35 patients and expected morbidity 132. CONCLUSION: By comparing the observed results with those predicted, the O-POSSUM scale is reliable in predicting mortality and overestimates morbidity.
