Fuzzy logic: about the origins of fast ion dynamics in crystalline solids.

Nuclear magnetic resonance offers a wide range of tools to analyse ionic jump processes in crystalline and amorphous solids. Both high-resolution and time-domain [Formula: see text], [Formula: see text], [Formula: see text], [Formula: see text] NMR helps throw light on the origins of rapid self-diffusion in materials being relevant for energy storage. It is well accepted that [Formula: see text] ions are subjected to extremely slow exchange processes in compounds with strong site preferences. The loss of this site preference may lead to rapid cation diffusion, as is also well known for glassy materials. Further examples that benefit from this effect include, e.g. cation-mixed, high-entropy fluorides [Formula: see text], Li-bearing garnets ([Formula: see text]) and thiophosphates such as [Formula: see text]. In non-equilibrium phases site disorder, polyhedra distortions, strain and the various types of defects will affect both the activation energy and the corresponding attempt frequencies. Whereas in [Formula: see text] ([Formula: see text]) cation mixing influences F anion dynamics, in [Formula: see text] ([Formula: see text]) the potential landscape can be manipulated by anion site disorder. On the other hand, in the mixed conductor [Formula: see text] cation-cation repulsions immediately lead to a boost in [Formula: see text] diffusivity at the early stages of chemical lithiation. Finally, rapid diffusion is also expected for materials that are able to guide the ions along (macroscopic) pathways with confined (or low-dimensional) dimensions, as is the case in layer-structured [Formula: see text] or [Formula: see text]. Diffusion on fractal systems complements this type of diffusion. This article is part of the Theo Murphy meeting issue 'Understanding fast-ion conduction in solid electrolytes'.

One year after proximal or distal periprosthetic fracture of the femur -two conditions with divergent outcomes?

INTRODUCTION: Arthroplasty of the hip and knee is 1 of the 20 most frequent operations in Germany. Periprosthetic fracture is one of the most feared complications following primary or revision arthroplasty. Present publication aims to analyse differences between patients with periprosthetic fracture around total knee arthroplasty (PFTKA) and patients with periprosthetic fracture around total hip arthroplasty (PFTHA) concerning demographics, clinical course, complications and return to pre-fracture mobility. METHODS: Prospective single-centre observation study of periprosthetic femoral fractures with stable implants. Present subgroup analysis includes patients with PFTKA and PFTHA. All patients were treated with polyaxial angular stable plates using two standardized techniques: a minimally invasive percutaneous distal insertion technique and a mini-open technique. Data collection included implant- and operation-related information as well as demographics, clinical course, complications and return to pre-fracture mobility. Data were collected during a 12-month follow-up. RESULTS: We were able to analyse the data of 73 patients. The PFTKA group had 37 patients with a mean age of 76 ±â€¯10 years; 88% were female. After 1 year, 3 patients in this cohort had died; 68% of survivors had reached their pre-fracture mobility; 22% had undergone operative revisions for various reasons. The PFTHA cohort included 36 patients with a mean age of 80 ±â€¯13 years, 72% were female. After 1 year, 9 patients had died in this cohort, 42% of survivors had reached their pre-fracture mobility. Non-operative complications occurred for 16% in the PFTKA group and 64% in the PFTHA group (p < 0.001). 11% had undergone operative revisions for various reasons, among them, two cases of nonunion but no primary infection. CONCLUSION: On average, compared to the PFTHA patients, PFTKA patients were younger, underwent significantly lower rates of non-operative complications, had a tendency towards lower mortality, and returned to pre-fracture mobility at higher rates, although they tended to have more revisions when compared to treatment for PFTHA. Overall, when periprosthetic fractures of the femur were treated using polyaxial locking plate osteosynthesis, patients showed very low rates of nonunion and no primary infection.

[Atlas fracture due to aneurysmal bone cyst after minor trauma]. / Fraktur des Atlas durch eine aneurysmatische Knochenzyste nach Bagatelltrauma.

Aneurysmal bone cysts predominantly occur in young adults and the long bones, the lumbar spine and the pelvis are mainly affected. This article presents the case of a 22-year-old woman with the very rare localization of an aneurysmal bone cyst of the atlas and an atlas fracture after a minor trauma. The initial radiological diagnosis was a suspicted aneurysmal bone cyst which was confirmed histologically. Due to the unstable fracture it was decided to carry out surgical treatment with occipitocervical stabilization in combination with a transoral bone graft. After a period of 11 months the fracture had completely healed and the implants were removed without any complications.

[A novel two-incision minimally invasive method for the treatment of anterior acetabular fractures]. / Der Zwei-Inzisions-Zugang in der Versorgung von Acetabulumfrakturen.

OBJECTIVES: To present a novel two-incision minimally invasive (TIMI) method for the treatment of anterior acetabular fractures. INTERVENTION: The first TIMI incision is performed using a pararectal approach at the level of the proximal third of the arcuate line of the ilium. After transection of the abdominal wall the iliac vessels are mobilized medially and the neuromuscular bundle laterally. The second approach lies above the medial pubic bone. The soft tissue is held back using a retraction system. After fracture reduction and fixation by isolated screws a conventional reconstruction plate is inserted for fracture neutralization. RESULTS: Since January 2008 we have performed the TIMI method in 88 cases with good results. Recently we have published the data of a first series with 26 patients that were seen at least 12 months after surgery. The mean operative time was 109 ± 30 min and all incisions showed primary healing. Postoperative radiological examination revealed an anatomic reduction in 20 fractures and a satisfactory reduction in 6. There were no local soft tissue complications and no revisions were needed. Follow-up examinations were performed after a minimum of 12 months in 19 patients (73%). The average Harris hip score (HHS) was 86.6 ± 8. Quality of life was comparable to control persons in the same age group. CONCLUSIONS: The TIMI approach represents a viable alternative to the ilioinguinal approach. Despite the limited number of incisions a comparable quality of fracture reduction is achieved. The authors believe this technique would be most useful in patients with a higher risk for postoperative soft tissue complications.

NCB-plating in the treatment of geriatric and periprosthetic femoral fractures.

BACKGROUND: The aim of this study is the presentation of the polyaxial locking NCB-plate in the treatment of femoral fractures, especially in elderly patients and in proximity of a prosthetic implant. The reduction and fixation of these fractures is a challenging surgical procedure with high complication rates reported up to 40%. PATIENTS AND METHODS: A total of 72 patients with femoral fractures had polyaxial locking plate osteosynthesis. Indications included fractures of the shaft and around an implant. Concerning surgical procedures, three different standardized techniques were performed: (1) minimally invasive with percutaneous distal insertion using a targeting device; (2) mini-open with additional cerclage wire via the same approach and (3) a conventional open reduction and internal fixation. Data collection included intraoperative data and early complications at 6, 24 and 52 weeks. Fifty-two patients had an implant or prosthesis in situ. Thirty-three patients were treated by technique (1), 32 patients had mini-open surgery and seven patients conventional open surgery. RESULTS: Thirty-nine patients attended clinical follow-up after 52 weeks. Twenty-two patients were interviewed by telephone, two were untraceable and nine patients had died. Bony consolidation without secondary loss of reduction was confirmed after 52 weeks in all patients but two. Plate breakage occurred in these two at 25 and 31 weeks after surgery due to non-union. Implant related complications (17% in total) lead to surgical revision in five other cases: two deep wound infections as well as three minor revisions. When itemizing complications according to surgical technique used, most major complications occurred following open surgery. CONCLUSION: The availability of polyaxial locking implants widened the range of indications for plate fixation in femoral fractures. The advantages of the polyaxial locking implant combined with minimally invasive surgical technique contribute to successful management of this population category. Early revision rate is noticeably lower compared to similar procedures. LEVEL OF EVIDENCE: IV retrospective series.

[Minimally invasive treatment of geriatric and osteoporotic femur fractures with polyaxial locking implants (NCB-DF®)]. / Minimalinvasive Versorgung geriatrischer und osteoporotischer Femurfrakturen mit polyaxial-winkelstabilem Implantat (NCB-DF®).

BACKGROUND: Periprosthetic femur fractures in elderly patients are a challenging surgical procedure. The aim of this study was a prospective evaluation of minimally invasive implantation of non-contact bridging (NCB-DF®) plates. PATIENTS AND METHODS: A total of 30 osteosynthesis procedures in 29 patients (average age 76 years and mean ASA 2.9) with complex femur fractures were registered, 19 fractures were periprosthetic and osteoporosis was present in 17 bones. In 25 patients a minimally invasive percutaneous procedure was performed using a standardized technique. An x-ray examination and clinical follow-up were performed after 6, 12 and 24 weeks. RESULTS: The early complications (14% in total) included 1 plate breakage after 16 weeks as well as 3 minor revisions for screw length correction. The x-ray follow-up after 24 weeks showed a secondary extension deficit of 10° and 15° in the knee joint in 2 patients, respectively. CONCLUSION: The NCB-DF® implantation using a standardized minimally invasive technique in periprosthetic femur fractures is a safe alternative in elderly patients. In this very sensitive population the early revision rate within the first 24 weeks is noticeable lower compared to similar procedures.

[The importance of CT angiography for screening supra-aortic vascular damage in severely injured patients]. / Bedeutung der CT-Angiographie zum Screening supraaortaler Gefässverletzungen beim Schwerverletzten.

PURPOSE: Traumatic injury of supra-aortic vessels remains a challenge in the initial diagnostics of severely injured patients. The presented prospective study analyzed the impact of multislice computed tomography angiography (CTA) as the primary diagnostic method. METHODS: Patients with the following criteria were included and screened for a dissection of the supra-aortic vessels: a) admission directly from the scene, b) resuscitation room treatment indicated by the official criteria of the DGU (German Society for the Surgery of Trauma), c) suspected blunt trauma to head or trunk as well as d) age over 16 years. RESULTS: During a period of 18 months 374 patients were treated for blunt trauma in the resuscitation room. In 176 cases CTA of the supra-aortic vessels was performed and pathological findings were observed in 16 patients. In 4 cases (2%) a traumatic dissection of supra-aortal vessels was diagnosed and confirmed by magnetic resonance imaging (MRI). All patients received heparin in a PTT effective dosage for 2 weeks and after rehabilitation there were no neurologic deficits. CONCLUSION: Traumatic supra-aortic dissection was found in 2% of cases in the presented study group. The mechanisms of injury were not distinct in this group. Essentially MSCT angiography screening was demonstrated to be a safe diagnostic tool.

[Volar locking compression plating versus dorsal plating for fractures of the distal radius: a prospective, randomized study]. / Volare winkelstabile vs. dorsale Plattenosteosynthese bei der distalen Radiusextensionsfraktur: Eine prospektive, randomisierte Untersuchung.

INTRODUCTION: This study investigated the radiographic and functional outcomes of two different methods for treating fractures of the distal part of the radius. PATIENTS AND METHODS: In a prospective controlled study patients with forearm fractures were randomized by age, handedness, and fracture type. RESULTS: The study included 120 patients, with a mean age of 66 years. Forty-nine percent of the fractures were extraarticular, and 51% were intraarticular. In the group treated with volar locking compression plates, six patients needed operative decompression of the median nerve and one needed reconstruction of the extensor pollicis longus (EPL) tendon. The group with dorsal plating had three complications requiring operative treatment: one deep infection, one dislocation of the plate, and one reconstruction of the EPL tendon. The radiological results for the Stewart 1 score showed 68% excellent results in volar locking compression plating compared with 57% in dorsal plating. Regarding functional outcome, 48% with volar plating showed excellent results compared with 22% with dorsal plating, as measured by the Stewart 2 score. CONCLUSION: Despite significant advantages of the volar locked compression plating, subjective satisfaction did not differ between the two groups.

Emergency Transfusion Score (ETS): a useful instrument for prediction of blood transfusion requirement in severely injured patients.

BACKGROUND: Efficient blood transfusion management presents an ongoing challenge for many trauma centers. We present the Emergency Transfusion Score (ETS), a measure that may allow important time and cost savings in the treatment of severely injured patients in the Emergency Room (ER). METHODS: The ETS includes the parameters low blood pressure, free fluid on ultrasound, clinical instability of the pelvic ring, age, admission from the scene, and trauma mechanism. An ETS >or= 3 indicates a transfusion probability of 5% and was set as the cut-off to order blood products (10 packed red blood cells [PRBC]/10 fresh frozen plasma [FFP]). RESULTS: A total of 481 patients requiring trauma team activation (ISS 18 +/-18; 7/03-12/04) were prospectively included. The ETS was < 3 in 306 patients (64%) and >or= 3 in 175 subjects (36%). Some 40 patients (8.3%) received blood (8 +/- 8 PRBC) after 23 +/- 9 min during ER treatment, and 39 of these patients had an ETS of >or= 3 (5.4 +/- 1.5 points). Sensitivity of the ETS was 97.5%; specificity, 68%. Positive predictive value of the ETS was 0.222; negative predictive value, 0.998. CONCLUSIONS: (1) The ETS is a safe and highly sensitive tool with which to detect severely injured patients in need of blood products. (2) The ETS is highly predictive for patients not in need of PRBC (negative predictive value 0.998) and helps to avoid unnecessary cross-matching and transport. (3) After implementation of the ETS, a sum of about 109,296 USD was saved per year by reducing the costs for cross-matching, transportation, and wasted blood products.

[Penetrating gunshot injuries to the head and brain. Diagnosis, management and prognosis]. / Penetrierende Schädel-Hirn-Verletzungen durch Schusswaffen. Diagnostik, Behandlungsmanagement und Prognose.

Gunshot injuries to the head and brain are rare in Germany and the rest of western Europe. With the relatively low number of these injuries here, there are no standard methods of diagnosis and management, and there is some controversy over both. Quite a high proportion of such injuries result from suicide attempts and accidents. The main diagnostic procedure available is computed tomography of the head with contrast medium; in certain cases MRI is indicated. The operative management depends on the extent and prognosis of the injury; a ventricular drain is probably indicated in most cases. Debridement of the bullet's path and removal of the projectile are more controversial. Mortality is extremely high after such injuries; if the victim does survive the prognosis is comparable to that following closed cranial injuries.

[Injuries- and frequency of complaints in competitive tennis- and leisure sports]. / Verletzungs- und Beschwerdehäufigkeit im Tennisleistungs- und Breitensport.

Tennis is one of the most popular sporting activities in Germany and worldwide. According to this fact injuries and complaints associated with this sport are common in tennis players. Here a retrospective analysis was undertaken in 60 tennis players with and 50 tennis players without tournament experience. Injuries were seen in all players. The most common lesions were blisters, sunburn and abrasions (65.5 %) followed by cramps (51.8 %), strains (35.5 %) and sprains (25.5 %). More severe injuries like meniscal lesions or ruptures of the cruciate- and ankle-ligaments or the achilles tendon were found in 2 % to 4 %. Fractures were not seen in this study. The majority of tennis injuries occurred in the lower extremity (182 vs. 62) whereas chronic complaints domain in the upper extremity (38/91). Most of the injuries and complaints have been treated conservatively with good results. Only 3.3 % of all acute and 2.2 % of the chronic lesions were treated by surgical intervention.

[The accuracy of palpation from orientation points for the navigated implantation of knee prostheses]. / Antastgenauigkeit von Orientierungspunkten bei navigierter Implantation von Knieendoprothesen.

AIMS: Cinematic and pointing procedures are used for non-image based navigated implantation during total knee replacement. Pointing procedures require an exact knowledge of the landmarks. In this anatomical study, landmarks are defined and repeatedly referenced. Precision and reproducibility are evaluated by means of an inter- and an intra-observer study. The axes of the femur and tibia are calculated using the landmarks. MATERIAL AND METHODS: The specific landmarks of 30 femurs and 27 tibias were palpated by three surgeons and digitised by means of a photogrammetric system, as used intra-operatively. The recorded data were statistically evaluated. RESULTS: The specific landmarks can be referenced with great precision. The vectors that influence the implant position show a mean femoral deviation of 0.9 mm and a mean tibial deviation of 1.0 mm. The repeating accuracy of every observer was 1.5 mm femoral and 1.0 mm tibial. The calculated long axes at the femur and tibia thus reach a precision of 0.1 degrees (min.-max.: 0-0.9 degrees) at the femur and 0.2 degrees (.0-1.1 degrees) at the tibia. The short axes at the distal femur and proximal tibia exhibit an average deviation of from 0.7 degrees to 1.9 degrees (0-11.3 degrees). CONCLUSION: Long axes (mechanical axes) can be determined exactly but the precision of the short axes (rotational axes) is unsatisfactory, although palpation of landmarks was accurate. Therefore, palpation of more than one rotational axis at the femur and tibia is mandatory and should be visualized on the monitor during surgery.

[Primary external fixation with consecutive procedural modification in polytrauma]. / Primärer Fixateur externe mit konsekutivem Verfahrenswechsel beim Polytrauma.

AIM OF STUDY: It is the purpose of the current investigation to determine whether immediate external fixation of fractures, which is a simple and fast procedure, followed by secondary planned conversion represents a safe and reliable procedure without additional trauma in multiply injured patients (ISS > 15). METHODS: With a prospective protocol, all data of multiply injured patients with fractures which required immediate osteosynthesis were registrated. Demographic data, severity of injury (AIS and ISS), data of primary surgery and osteosyntheses, course of intensive care (organ failure, local/systemic complications, infectious protocol), secondary conversion (time, duration, osteosynthesis related complications) and further course were analysed. RESULTS: Out of 679 mulitiply injured patients (ISS 22), 118 required immediate surgical procedures for intracranial injury and 175 for further indications. In 45 multiply injured patients (ISS 37), 83 external fixations were performed. According to 59 planned secondary conversions (13 days), one patient developed deep infection, no other local complication was registrated. The average time for conversion procedures lasted three times longer as in immediate external fixation (43 vs. 139 min). CONCLUSIONS: Immediate external fixation in multiply injured patients is fast and poor of complications. It is a expedient procedure which is safe and careful for critically ill patients. The required conversion procedure shows no raised rate of complications.

[Postoperative morbidity in surgically treated extension fractures of the distal radius. A comparative study of dorsal and volar approach]. / Postoperative Morbidität der operativ behandelten distalen Radiusextensionsfraktur. Eine Vergleichsstudie zwischen dorsaler und volarer Plattenlage.

The aim of this study was to investigate perioperative morbidity in operative interventions in distal radiusfractures, comparing the operative approach from volar and dorsal. Only problems, resulting from the operative approach towards the distal aspect of the radius, were examined. In a Case-Control-Study, we investigated patients with operative by plate-osteosynthesis treated distal radius-extensions-fractures. During 3 years we investigated 92 patients. 49 were operated with a volar approach, and after changing the operative management, consecutive 43 patients with a dorsal approach to the distal radius. Indications for operative treatment were not changed. The approach to the distal aspect of the radius corresponded to the recent guidelines. Further perioperative procedures were identical, including procedures in anesthesiology. Datas of patients have been investigated for epidemiology, kind of operations, point of time in treatment, duration of operation, X-Ray, immobilisation and time of inhospital stay as well as all documented complications. It has been shown, that in respect of all criterias, concerning length of operation (106 vs. 83 min), intraoperative X-Ray (3.0 vs. 1.65 min) as well as postoperative immobilisation (33 vs. 25 days), and documented incidences of complications like secondary wound-healing (19/49 vs. 0/43) or nerval irritations (13/49 vs. 1/43), the dorsal osteosynthesis is definitively to be favored.

[Stable and unstable pertrochanteric femoral fractures. Differentiated indications for the dynamic hip screw]. / Die stabile und instabile pertrochantäre Femurfraktur. Differenzierte Indikationsstellung für die dynamische Hüftschraube.

The aim of all surgical procedures in the treatment of trochanteric fractures in elderly and even geriatric patients is achievement of initial stability. We examined in a clinical trial whether primary stability was achieved in all types of trochanteric fractures following osteosynthesis with the Dynamic Hip Screw (DHS). From 1994 to 1996, 122 patients with trochanteric fractures had osteosynthesis by dynamic hip screw. Patient records were evaluated and all data got registered with a standardized protocol;clinical radiological outcome was analysed after an average period of 1.9 years after injury according to the Traumatic Hip Rating Score. 22% of all patients died meantimes, 51.6% of the remaining 95 patients could get examined. The average age was 75.5 years, the patient population showed an increased preoperative morbidity (2.5 points) according to ASA-Score. 81% showed progressive osteoporosis. According to the AO-classification 47% stable fractures (type A-1) and 53% instable trochanteric fractures (type A-2 and A-3) occurred. Surgery lasted 77 minutes average in osteosynthesis of stable fractures. The duration of 108 minutes in instable fractures was significantly higher, as well as the blood loss was 43% increased in these complex fractures. Complications closely associated to the osteosynthesis appeared only in instable fractures (7%). Also common complications (24.6%) predominated with 15.6% in type A-2 and A-3 fractures versus 9% in type A-1 fractures; mortality was also different with 5.7% versus 1.6%. Assessment of the functional outcome according to THRS showed a significant deterioration of 20 points in 71% of all patients compared with the preoperative score. The results show that dynamic hip screw osteosynthesis in instable trochanteric fractures is associated to a higher incidence of complications. While the dynamic hip screw still represents the standard implant in stable fractures of the trochanteric region, being aware of improved intramedullary implants regarding biomechanical features and surgical technique, the results justify to critical consider the use of DHS for osteosynthesis in instable fractures of the trochanteric region.

Moderate to severe hallux valgus deformity: correction with proximal crescentic osteotomy and distal soft-tissue release.

Between 1991 and 1995, 96 patients (114 feet) were treated with a proximal crescentic metatarsal osteotomy and distal soft-tissue procedure for moderate to severe hallux valgus deformity [intermetatarsal (IM) angle > 15 degrees, or hallux valgus (HV) angle > 30 degrees]. At an average follow-up of 26 months, 8 men and 62 women (86 feet) with a mean age of 53.2 years were retrospectively reviewed. The HV angle averaged 41.1 degrees preoperatively and 14.6 degrees postoperatively. The respective values for the IM angle were 17.8 degrees and 7.8 degrees. Neither the average metatarsal shortening of 3 mm nor the dorsal angulation at the osteotomy site seen in 9% of cases evidenced any clinical significance at follow-up. Patient satisfaction was excellent or good in 91%, and the mean Mayo Clinic Forefoot Score (total 75 points) improved from 37.2 to 61.1 points. Complications included 8 cases of hallux varus and 5 cases of hardware failure. Based on this first study exclusively focusing on moderate to severe hallux valgus deformity, we conclude that proximal first metatarsal osteotomy in combination with a lateral soft-tissue procedure is effective in correcting moderate to severe symptomatic hallux valgus deformity with metatarsus primus varus (IM angle > 15 degrees or HV angle > 30 degrees).

Nonsurgical treatment of a severe tracheal rupture after endotracheal intubation.

OBJECTIVE: We report the case of an 82-yr-old woman with a large complete longitudinal tracheal rupture, following endotracheal intubation. The patient was treated nonoperatively with excellent outcome. The diagnostic and therapeutic course as well as other therapeutic options are discussed.

Comparison of the results of the Weil and Helal osteotomies for the treatment of metatarsalgia secondary to dislocation of the lesser metatarsophalangeal joints.

We retrospectively reviewed the outcome of 30 patients who were treated surgically for metatarsalgia resulting from dislocation of one or more lesser metatarsophalangeal (MTP) joints. We used two treatments, including an osteotomy of the metatarsal head (Weil osteotomy, N = 15) or an osteotomy of the metatarsal shaft (Helal osteotomy, N = 15). Before surgery, all patients had been treated with various nonoperative modalities for a minimum of 6 months. Between 1991 and 1993, 15 consecutive patients underwent a Helal osteotomy (22 metatarsals), and 15 consecutive patients were subsequently treated between 1994 and 1995 with a Weil osteotomy (25 metatarsals). All patients were evaluated clinically and radiographically at a mean follow-up period of 22 months (range, 12-39 months), noting especially persistent subluxation or dislocation, recurrent metatarsalgia, and transfer lesions. Patients managed with a Weil osteotomy had significantly higher satisfaction (P = 0.049), lower incidence of recurrent metatarsalgia (0 vs. 27%, P = 0.107), and fewer transfer lesions (0 vs. 41%, P = < 0.001) than those managed with a Helal osteotomy. Furthermore, those managed with the Weil procedure had a higher percentage of radiographic reduction and maintenance of the MTP joint dislocation (21 of 25, 84%; vs. 8 of 22, 36%; P = 0.002) than those managed with the Helal procedure. In the Weil group, there was also no malunion or pseudoarthrosis; in the Helal group there were five malunions and three pseudoarthroses. Although the follow-up period for the Weil osteotomy (15 months) was shorter than that for the Helal osteotomy (26 months), the former group had higher American Orthopaedic Foot and Ankle Society forefoot scores, which were significantly different from the results attained with the Helal osteotomy. A telephone update was performed on the Weil osteotomy group at an average of 27 months postsurgery, and no patient had experienced changes since the clinical follow-up. We concluded that the Weil procedure is a satisfactory method for correcting metatarsalgia caused by dislocation of the MTP joint and that, because of the high complication rate, the Helal osteotomy is not an acceptable procedure for correcting this condition.