Stener-like lesion of the lateral collateral ligament of the first metatarsophalangeal joint.

Displaced ulnar collateral ligament injuries of the metacarpophalangeal joint of the thumb, also known as Stener lesions, are a well-recognized clinical entity, requiring surgical intervention because of the trapped location of the torn lateral collateral ligament superficial to the adductor aponeurosis of the thumb. We report a similar lesion located at the first metatarsophalangeal joint, to our knowledge the first ever described in the literature. In our patient, magnetic resonance imaging showed a full-thickness tear of the lateral collateral ligament of the first metatarsophalangeal joint, as well as a full-thickness tear of the extensor hood, with dislocation of the proximal part of the ruptured lateral collateral ligament to a position superficial to the extensor hood. Analogous to true Stener lesions, we are convinced these patients also need early surgical repair. Therefore, we would like to raise awareness about their existence to ensure adequate management of these lesions, in order to prevent possible long-term complications like chronic pain, instability, and joint degeneration.

Preconceptional care: a systematic review of the current situation and recommendations for the future.

UNLABELLED:  OBJECTIVE: To review the current knowledge and implementation of preconceptional care (PCC) in the Western world, focusing both on health care workers and the general population, and to analyze pathways to disseminate the influence of preconceptional care on pregnancy outcome. METHODS: A systematic literature study was performed using OvidSP and Pubmed, searching for articles about PCC and its implementation, published between 1966 and October 2012. Only randomized controlled trials and systematic reviews dealing with PCC in the Western world were retained. RESULTS: Forty-six articles were identified for review. PCC might result in better pregnancy outcomes, including e.g. a reduction of congenital abnormalities. There are no proven disadvantages of PCC. Health care workers are in favor of the implementation of PCC, but claim that they don't have enough knowledge to do so. The general population shows interest in receiving PCC. The implementation of PCC should be improved by e.g. the development of guidelines and checklists. CONCLUSIONS: As PCC might improve pregnancy outcomes and is considered important by health care workers and the general population, its implementation should be improved, e.g. by the development of guidelines and checklists.