Distal first metatarsal dome (crescentic) osteotomy for repair of mild to moderate hallux valgus deformity.

Hallux valgus is one of the most common foot deformities. Despite the large number of techniques described for hallux valgus correction, there has been much controversy regarding the best procedure to use. Distal osteotomies have long been done for mild to moderate deformities. Although presented previously, based on a review of the literature, this technique does not appear to be regularly used by many surgeons. This article presents a distal metatarsal osteotomy as easy to perform and useful for the repair of mild to moderate hallux valgus deformity, wherein the first metatarsal angle measures less than 14 degrees.

Combined fibular and tarsal agenesis in a case of lower extremity hemimelia.

Fibular hemimelia is a congenital disorder characterized by partial or total absence of the fibula. The appearance of the affected limb can range from barely detectable to severe deformity. An affected extremity typically displays a valgus foot and ankle, shortening of the leg, anterior bowing of the tibia and knee, tarsal coalition, as well as radiographic absence of 1 to several lateral rays (1, 2). We encountered an adult patient who displayed fibular agenesis in combination with absence of the ipsilateral talus and cuboid. Because of the rarity of this deformity, we believed that it was important to describe her case despite the fact that, after evaluation and discussion of treatment options, the decision was made to continue to accommodate the deformity with an orthosis.

[The results of curettage and bone cementing for enchondromas of the distal femur]. / Femur alt uç enkondromlarinin küretaj ve kemik çimentosu ile tedavi sonuçlari.

OBJECTIVES: We evaluated patients who were treated with curettage and cementing for enchondromas localized in the distal femur. METHODS: The study included 13 patients (7 females, 6 males; mean age 54 years; range 43 to 65 years) who underwent surgery for enchondromatosis in the distal femur. Enchondromas were detected incidentally in 10 patients; of these, complaints of pain appeared afterwards in seven patients. Surgery involved curettage and cement filling of the defects. Preoperative biopsies were obtained in seven patients. Clinical evaluations were made with a visual analog scale. The mean follow-up period was four years (range 1 to 5 years). RESULTS: Radiographically, the size of the lesions ranged from 3 cm to 6 cm (mean 4.5 cm). Computed tomography showed cortical extension in five patients and erosion leading to narrowing in the posterior cortex in one patient. The mean pain score decreased from 3.63 (range 0 to 7) to 0.54 (range 0 to 3) postoperatively (p<0.05). Histopathological diagnoses of surgical specimens were enchondroma in 12 patients and grade 1 chondrosarcoma in one patient. Postoperatively, only one patient who had erosion and narrowing in the posterior cortex required cast immobilization for three weeks. None of the patients had recurrence, sarcomatous changes, or infection. No functional loss developed after surgical treatment. CONCLUSION: Treatment of femoral enchondromas with curettage and cementing yields successful functional and radiologic results.

[Results of the surgical treatment for symptomatic mesoacromion]. / Semptomatik mezo-akromiyon cerrahi tedavisinin sonuçlari.

OBJECTIVES: Functional results of patients who were operated on for symptomatic meso os acromiale were retrospectively evaluated. METHODS: The study included six patients (5 females, 1 male; mean age 58.5 years; range 51 to 64 years) who underwent surgical treatment for symptomatic os acromiale following unsuccessful conservative treatment. Internal fixation and bone grafting were performed in all the patients. Evaluations were based on physical assessment, radiographic examination, and the UCLA (University of California at Los Angeles) score. All the patients had symptoms of subacromial impingement accompanied by various degrees of rotator cuff tears. Symptomatic os acromiale was diagnosed by imaging studies and tenderness over the acromion during palpation. In case of suspected stability of the acromion, arthroscopy was performed. Fixation was performed with cannulated screws (n=4) or K-wires (n=2) and a cerclage wire or nonabsorbable sutures. Bone graft was harvested locally. The mean follow-up period was 29 months (range 18 to 35 months). RESULTS: The mean UCLA score increased from a preoperative 11.8 to postoperative 28.2. Union was achieved in four patients in whom cannulated screws were used. Two patients who were fixed with K-wires remained ununited. CONCLUSION: It is possible to obtain satisfactory results with cannulated screws which probably enable a more rigid fixation in symptomatic os acromiale. Arthroscopic evaluation may be helpful in deciding whether or not os acromiale is symptomatic.