ABSTRACT
BACKGROUND: Treatment for Freiberg disease has been largely conservative despite availability of various operative options for severe or refractory cases. The aim of this study was to evaluate the long-term results of pediatric patients with symptomatic Freiberg disease treated with intra-articular dorsal wedge osteotomy. METHODS: Pediatric patients treated for Freiberg disease with surgery between January 1982 and 1999 were identified and selected for long-term clinical evaluation. Patients were evaluated regarding operative satisfaction and clinical outcome, performed according to the American Orthopaedic Foot & Ankle Society (AOFAS) lesser toe metatarsophalangeal-interphalangeal scale and range of motion (ROM) of metatarsophalangeal (MTP) joint. Patients had radiographic assessment of degenerative joint status with anteroposterior and oblique foot x-ray. Twenty patients (18 female, 2 male; mean age 15.2 years; range 12-17 years) were identified. The mean follow-up period was 23.4 (range 15-32) years. RESULTS: The clinical outcomes of our patients were classified as excellent in 16 (80%) and good in 4 (20%). The AOFAS mean score was 96.8 (range 91-100) points at the last clinical appointment. A negative correlation between AOFAS score and time of follow-up (r's = -0.61, P < .001) was found. Also, a strong negative correlation was found between Smillie classification and AOFAS final score (r's = -0.88, P < .001). CONCLUSION: The patients were very satisfied with pain and quality of life at a mean follow-up time of 23.4 years. To our knowledge, this is the first long-term follow-up report supporting the procedure described by Gauthier and Elbaz as a good option for operative treatment of Freiberg disease. LEVEL OF EVIDENCE: Level IV, retrospective case series.
Subject(s)
Metatarsal Bones/surgery , Metatarsus/abnormalities , Osteochondritis/congenital , Osteotomy/methods , Adolescent , Child , Female , Follow-Up Studies , Humans , Male , Metatarsal Bones/diagnostic imaging , Metatarsophalangeal Joint/diagnostic imaging , Metatarsophalangeal Joint/surgery , Metatarsus/diagnostic imaging , Metatarsus/surgery , Osteochondritis/diagnostic imaging , Osteochondritis/surgery , Patient Satisfaction , Radiography , Retrospective StudiesABSTRACT
BACKGROUND: Lens probes used in arthroscopy typically have a small diameter and wide field-of-view. This introduces strong radial distortion (RD) into the image, ultimately affecting the surgeon's hand-eye coordination. This study evaluates potential benefits of using distortion-free images in arthroscopic surgery. METHODS: Distortion-free images were obtained using RDFixer™ software (Perceive3D, SA) to remove RD in the input video stream. Twelve orthopedic residents performed an arthroscopic task (loose body removal) in a dry-knee model using video with and without distortion. Residents were questioned about image quality, and surgical performance was rated using an adapted Global Rating Scale. RESULTS: A statistically significant improvement of all parameters was observed with distortion-free images. Residents perceived distortion-free images as providing a wider field-of-view and a better notion of relative depth and distance. CONCLUSION: RD correction improved the surgical performance of residents, potentially decreasing their learning curve. Future work will study whether the benefits are observable in experienced surgeons. Copyright © 2014 John Wiley & Sons, Ltd.
