Assessment of the Initial Result of Screw Fixation for Proximal Crescentic Metatarsal Osteotomy with Distal Soft Tissue Reconstruction in Severe Hallux Valgus Treatment.

INTRODUCTION: Proximal crescentic metatarsal osteotomy and distal soft tissue reconstruction have been introduced to correct severe HV. The intrinsically unstable proximal first crescentic osteotomy depends on enough force fixation for stability. It is necessary to judge the number of fixation screws for osteotomy. METHOD: Fifty-two feet of 50 adult patients with severe HV were included in this study. The treatment was proximal crescentic metatarsal osteotomy with a single screw and distal soft tissue reconstruction in Group 1 and the fixation with two screws with distal soft tissue reconstruction in Group 2. Clinical and radiological follow-ups were assessed after 4 and 12 months of operation. In Group 1, HVA decreased from 46.4 ±3.28 to 19.9 ±4.70 after 12 months of operation and from 45.1 ±3.45 to 19.1 ±4.70 in Group 2. Regarding the intermetatarsal angle (IMA) in Group 1, it was changed from 18.5 ±1.98 to 9.25 ±1.11 after 12 months of operation. For group 2, it decreased from 18.3 ±1.81 to 9.53 ±1.70. Meanwhile, the AOFAS score improved from 63.1 to 83.9 after 12 months of operation in Group 1 and improved from 64.3 to 82.8 in Group 2. RESULTS: Furthermore, the VAS score reduced from 4.5±1.01 to 1.7± 0.43 in Group 1 and from 4.7±0.92 to 1.7±0.55 in Group 2 after 12 months of operation. There were no significant differences identified between Group 1 and Group 2 in terms of VAS and AOFAS scores and HVA and IMA measurements. CONCLUSION: There is less complication in two-screw fixation for crescentic osteotomy compared to a single-screw fixation.

Initial assessment of treatment of talar posterior process fractures with open reduction and percutaneous fixation.

The purpose of this study was to provide an initial assessment of treatment for talar posterior process fractures using open reduction and internal fixation (ORIF) through posteromedial approach and percutaneous screw fixation. From January 2014 to December 2018, 12 cases with displaced fracture of talar posterior process were treated in our department. The clinical and radiological results were assessed after 4 and 12 months of operation with Visual Analog Scale (VAS) pain and American Orthopedic Foot and Ankle Society (AOFAS) scores. ORIF was performed in four of the cases and percutaneous screw fixation was performed in eight of the cases. The average follow-up period was 13 months. Complications such as wound infection, nerve injury, screw loosening, malunion or nonunion of fracture were absent. For clinical assessment, considerable mprovements were observed for the AOFAS and VAS scores at 4 and 12 months postoperatively for both techniques. There was no significant difference for AOFAS scores and VAS scores between the two techniques (p > 0.05). Both techniques showed good functional outcome and were performed for posterior talar process fracture following the fracture displacement guidelines. Percutaneous screw fixation treatment with computer-assisted three-dimensional evaluation shortened the operation time and reduced incidences of surgical complications.

Definition of a safe zone for screw fixation of posterior talar process fracture by 3-dimensional technology.

BACKGROUND: Percutaneous screw fixation can provide stable fixation with a minimally invasive surgical technique for posterior talar process fracture. OBJECTIVES: The purpose of this study was to investigate the optimal posterior screw placement and the geometry of safe zone for screw insertion in the posterior talar process by analyzing with 3-dimensional (3D) technology. METHODS: 100 adult feet computed tomography (CT) scans were evaluated. CT data were imported into Materiaise's interactive medical image control system (MIMICS) 18.01 software for 3-dimensional reconstruction. Two 3.0mm-diameter screws were simulated from the posterior to anterior position for posterior talar process. The morphology parameters of posterior talar process were also quantitatively measured. The safe zone and the length and entry point of screw were defined. RESULTS: The optimal entry point of screw for posterior talar process fracture was lateral tubercle from the posterior to anterior position. The safe zone of medial tubercle entry point was smaller in lateral tubercle. These gender-specific measurements were all significant (P <.001). CONCLUSIONS: The predefined zone with computer-assisted 3D techniques for the most frequently positioned percutaneous screws may aid in preoperative planning, shorten the operation time and reduce the incidence of surgical complications.

Anatomical feasibility study of flexor hallucis longus transfer in treatment of Achilles tendon and posteromedial portal of ankle arthroscopy.

PURPOSE: The aim of this study was to evaluate the occurrence of anatomical variations of the musculotendinous junction of the flexor hallucis longus (FHL) muscle, the relationship between FHL tendon or muscle and the tibial neurovascular bundle at the level of the posterior ankle joint in human cadavers. METHODS: Seventy embalmed feet from 20 male and 15 female cadavers, the cadavers' mean age was 65.4 (range from 14 to 82) years, were dissected and anatomically classified to observe FHL muscle morphology define the relationship between FHL tendon or muscle and the tibial neurovascular bundle. The distance between the musculotendinous junction and the relationship between FHL tendon or muscle and the tibial neurovascular bundle was determined. RESULTS: Three morphology types of FHL muscle were identified: a long lateral and shorter medial muscle belly, which was observed in 63 specimens (90%); equal length medial and lateral muscle bellies, this variant was only observed in five specimens (7.1%); one lateral and no medial muscle belly, which was observed in two specimens (2.9%). No statistically significant difference was observed according to gender or side (p > 0.05). Two patterns were identified and described between FHL tendon or muscle and the tibial neurovascular bundle. Pattern 1, the distance between the neurovascular bundle and FHL tendon was 3.46 mm (range 2.34-8.84, SD = 2.12) which was observed in 66 specimens (94.3%); Pattern 2, there was no distance which was observed in four specimens (5.7%). CONCLUSION: Knowing FHL muscle morphology, variations provide new important insights into secure planning and execution of a FHL transfer for Achilles tendon defect as well as for the interpretation of ultrasound and magnetic resonance images. With posterior arthroscopic for the treatment of various ankle pathologies, posteromedial portal may be introduced into the posterior aspect of the ankle without gross injury to the tibial neurovascular structures because of the gap between the neurovascular bundle and FHL tendon.