[Arthrodesis of the First Metatarsophalangeal Joint by Locking Plate]. / Artrodéza I. metatarzofalangeálního kloubu úhlove stabilní dlahou.

PURPOSE OF THE STUDY The authors in their paper evaluate a group of patients who underwent arthrodesis of the first metatarsophalangeal joint using a locking plate. MATERIAL AND METHODS In the period 2010-2015, we performed surgery in 51 patients (56 forefeet), of which in 5 cases bilaterally and in 46 cases unilaterally, in 38 women and 13 men. The mean age was 57.8 years, the mean follow-up was 3.1 years. The indications for surgery were hallux rigidus in 23 patients, hallux valgus in 15 patients, hallux varus in 3 patients, and hallux erectus in 2 patients. In 4 patients the surgery was performed for valgus deformity associated with rheumatoid arthritis, 9 patients were indicated for a failure of the prior surgical intervention. In all 56 forefeet, the anatomic, low-profile titanium plate Variable Angle LCP 1st MTP Fusion Plate 2.4/2.7 was used. RESULTS According to Gainor s score the surgical outcomes were assessed as excellent in 46 patients who underwent surgery (90%), good in 4 patients (8%), fair in 1 patient (2%), and poor in 0 patient (0%). In 53 forefeet, the control radiographs showed solid bone union. In 2 patients and 3 forefeet, non-union of the arthrodesis occurred. In 2 forefeet, revision arthrodesis was performed, after which solid bone union followed. Malpositioned union was reported in 5 forefeet, of which in 4 cases into valgosity and in 1 case into dorsiflexion. DISCUSSION Numerous fixation materials can be used for arthrodesis of the first metatarsophalangeal joint. The use of the least stable Kirschner wires (cerclage) is being abandoned and substituted with a more stable fixation by screws, memory staples and locking plates. The achievement of excellent results requires proper positioning of the arthrodesis. Impingement syndrome between the big toe and the second toe can result in painful callosities formation, too large dorsiflexion can lead to a hallux hammertoe, with reduced big toe support function, to metatarsalgia. CONCLUSIONS The arthrodesis is indicated in patients with Grade III and IV hallux rigidus, with severe hallux valgus, hallux varus, and in patients in whom the previous surgeries failed. We tend to prefer stable arthrodesis. Fixation by anatomic LCP plate facilitates early rehabilitation, loading and early return to work and sports activities. Key words: arthrodesis, metatarsophalangeal joint, hallux rigidus, hallux valgus.

Hallux Varus: An Underreported Presentation of Rheumatoid Arthritis.

UNLABELLED: The prevalence of hallux varus deformity in rheumatoid arthritis (RA) has been reported to be extremely rare. However, in South Asian Countries, where open-toed shoes are habitual footwear for the majority of people, we have found that hallux varus is a common deformity in patients with RA. This rate of occurrence is much more common than that in published hallux deformities in RA and reinforces the impact of footwear on the development of hallux deformities. In this report, we present 3 illustrative cases of hallux varus developed in patients with RA and review the etiology of hallux varus deformity. LEVELS OF EVIDENCE: Therapeutic, Level IV: Case Study.

Desarrollo locomotor en pacientes con displasia del desarrollo de cadera y pie equino varo congénito que recibieron tratamiento ortopédico antes del año de vida. Estudio prospectivo comparativo / Locomotor development in infants with developmental dysplasia of the hip or idiopathic clubfoot undergoing orthopedic treatment. Prospective comparative study

Objetivos: Diversas afecciones de presentación temprana en la niñez, como la displasia del desarrollo de la cadera (DDC) y el pie equino varo congénito (PEVAC), requieren de tratamiento ortopédico, limitando la movilidad activa de las extremidades inferiores por un período prolongado. El objetivo es evaluar el impacto sobre el desarrollo locomotor del tratamiento ortopédico en niños menores de un año de vida. Pacientes y métodos: Se analizó una cohorte prospectiva de pacientes consecutivos con diagnostico de DDC (24 pacientes) y PEVAC (32 pacientes), tratados de manera ortopédica entre enero del 2007 y junio del 2009. Se utilizó como control un tercer grupo de 50 niños sanos. Se evaluaron el tiempo con ortesis y la edad al sentado, gateo y al comienzo de la marcha. Las comparaciones entre los 3 grupos fueron realizadas con una prueba de Kruskal-Wallis y entre sí con una prueba de U de Mann-Whitney. Un valor de p < 0,05 fue considerado como significativo. Resultados: El análisis de muestras independientes mostró que las medias de las edades en meses para sentarse entre los 3 grupos (control, DDC y PEVAC), 6,12, 6,42 y 6,19, respectivamente, fueron similares (p = 0,249). Las medias para gatear, 8,84, 9,38 y 9,17, fueron similares, aunque con una discreta tendencia a la significación estadística (p = 0,08). Las medias para el inicio de la marcha, 12,14, 13,21 y 12,41, fueron distintas entre los 3 grupos (p < 0,001). Conclusión: El tratamiento ortopédico de la DDC y el PEVAC en niños menores de un año retrasa levemente el desarrollo locomotor normal (AU)

Objectives: Several disorders of early childhood, such as developmental dysplasia of the hip (DDH) and clubfoot, requires orthopedic treatment that limits active mobility of the lower extremities for a period of time. The aim of our study was to evaluate the impact on locomotor development of the orthopedic treatment in infants less than one year-old. Patients and methods: The study included a prospective cohort of consecutive patients diagnosed with developmental dysplasia of the hip (Group A, 24 patients), and clubfoot (Group B,32 patients) treated from January 2007 to June 2009. A third group (Group C) of 50 healthy children was used as control. The variables evaluated were: months with a brace, age to sit withoutsupport, age at the start of crawling, and age at the beginning of walking. The results obtainedwere analyzed. Comparisons between the three groups were performed using the Kruskal-Wallis test and Mann-Whitney test. We chose a value of P<0.05 as level of statistical significance. Results: The analysis of independent samples showed that the mean age at which the patients began to sit were similar: 6.12, 6.42 and 6.19 months, respectively (P=0.249). The mean age for crawling was similar, although with a slight trend toward statistical significance: 8.84, 9.38 and 9.17 months, respectively (P=.08). The age at which they started walking was different between the three groups: 12.14, 13.21 and 12.41 months, respectively (P<0.001). Conclusion: Orthopedic treatment of DDH and clubfoot in children less than one year-old slightly slows down the course of normal locomotor development (AU)

Distal metatarsal osteotomy for hallux varus following surgery for hallux valgus.

We reviewed the outcome of distal chevron metatarsal osteotomy without tendon transfer in 19 consecutive patients (19 feet) with a hallux varus deformity following surgery for hallux valgus. All patients underwent distal chevron metatarsal osteotomy with medial displacement and a medial closing wedge osteotomy along with a medial capsular release. The mean hallux valgus angle improved from -11.6° pre-operatively to 4.7° postoperatively, the mean first-second intermetatarsal angle improved from -0.3° to 3.3° and the distal metatarsal articular angle from 9.5° to 2.3° and the first metatarsophalangeal joints became congruent post-operatively in all 19 feet. The mean relative length ratio of the metatarsus decreased from 1.01 to 0.99 and the mean American Orthopaedic Foot and Ankle Society score improved from 77 to 95 points. In two patients the hallux varus recurred. One was symptom-free but the other remained symptomatic after a repeat distal chevron osteotomy. There were no other complications. We consider that distal chevron metatarsal osteotomy with a medial wedge osteotomy and medial capsular release is a useful procedure for the correction of hallux varus after surgery for hallux valgus.