Lengthening scarf osteotomy for recurrent hallux valgus.

BACKGROUND: We describe using the scarf osteotomy to correct a recurrent hallux valgus deformity and lengthen the shortened first metatarsal in symptomatic iatrogenic first brachymetatarsia. METHODS: Thirty-six lengthening scarf osteotomies were undertaken in 31 patients. Clinical and radiographic measures were taken pre and postoperatively. RESULTS: Mean age at presentation was 53.4 years, and mean followup 3.9 years. The mean lengthening achieved was 4.9mm. All osteotomies united with no complications. The mean IMA reduction was 4.0° (p<0.001) and HVA 13.0° (p<0.001). The mean AOFAS score increase was 33.8 (p<0.001). There was a positive trend but no correlation (r=0.28) between amount of metatarsal lengthening and AOFAS score change. CONCLUSIONS: We describe the largest lengthening scarf osteotomy series for recurrent hallux valgus with iatrogenic first brachymetatarsia. The results suggest the procedure is successful, with a low complication rate. We anticipate that restoring first metatarsal length and alignment may reduce biomechanical transfer metatarsalgia over time.

Brachymetatarsia of the fourth metatarsal, lengthening scarf osteotomy with bone graft.

A 16-year-old girl presented with left fourth metatarsal shortening causing significant psychological distress. She underwent lengthening scarf osteotomy held with an Omnitech(®) screw (Biotech International, France) with the addition of two 1 cm cancellous cubes (RTI Biologics, United States). A lengthening zplasty of the extensor tendons and skin were also performed. At 6 weeks the patient was fully weight bearing and at one-year follow up, the patient was satisfied and discharged. A modified technique of lengthening scarf osteotomy is described for congenital brachymatatarsia. This technique allows one stage lengthening through a single incision with graft incorporation by 6 weeks.

The use of collagen injections in the treatment of metatarsalgia: a case report.

Metatarsalgia is an increasingly common condition seen in the outpatient setting. A number of conservative and surgical management options are available for this condition. We present an interesting case that was unsuccessfully treated with'dermal filler.' To our knowledge, we have not found any published material in peer-reviewed journals documenting the use of collagen injections in the treatment of metatarsalgia. The authors feel that the lesson learned from this case should be highlighted for other foot and ankle surgeons.

Occupationally related bilateral calcific tendonitis of Flexor carpi ulnaris: case report.

We present a case of bilateral calcific tendonitis of the Flexor Carpi Ulnaris attributable to repetitive wrist action which was occupationally related. This was treated conservatively with avoidance of aggravating movement, resting splints and anti inflammatory medication when acute flare ups occurred. Since avoidance of repetitive strain on the wrists he has had no further flare ups in over 2 years. This is the only case of bilateral calcific tendonitis of Flexor Carpi Ulnaris that has been reported in the literature, further more it is the only one which has been attributed to occupation and settled following a change of career.

The Biomet Bi-Metric total hip arthroplasty and universal acetabular cup: high polyethylene failure rate in the medium term.

We report on the medium-term results of the Bi-Metric (Biomet UK Ltd, Bridgend, UK) uncemented total hip arthroplasty system used with the Universal acetabular cup and polyethylene liner secured with the Ringloc (Biomet UK Ltd) mechanism. Fifty-eight total hip arthroplasties in 49 patients (mean age at implantation, 57.1 years) were identified, with 45 hips followed up at a mean of 7.6 years (range, 5-13 years). Of those hips not requiring revision, the mean Harris hip score was 89, 87% of the hips were judged to be very good or good according to d'Aubigne and Postel (J Bone and Joint Surgery 1954;36A:451), and the radiographic criteria by Engh et al (Clin Orthop Relat Res 1990;257:107) demonstrated the femoral components to be well fixed. Six patients required a revision procedure at a mean of 6.2 years postsurgery, with all failures attributed to marked wear of the polyethylene liner.

The complexity of seat belt injuries including spinal injury in the pediatric population: a case report of a 6-year-old boy and the literature review.

We present, along with a literature review, the case report of a 6-year-old boy, involved in a high-speed motor vehicle accident, who sustained a seat belt injury of the lumbar spine. We discuss the clinical presentation of thoracolumbar fractures in children, the sensitivity of clinical examination and radiographic evaluation and the associated abdominal injuries that are commonly present with seat belt spinal injuries. Computerized tomography is limited in the detection of soft tissue spinal fractures because these fractures occur in the plain of the section. Plain lateral x-rays of the lumbar spine and computerized tomographic three-dimensional reconstruction images can be helpful but they cannot evaluate the extent of the soft tissue injury. The magnetic resonance imaging scan is the best diagnostic tool to provide the diagnosis.

Iliopsoas tendonitis a complication after total hip arthroplasty.

The causes of pain after total hip arthroplasty are multiple. We present a series of 15 patients (16 cases) who presented with pain related to the iliopsoas tendon. All patients had previously undergone cementless hip arthroplasty and presented with similar symptoms and clinical signs. Surgery was carried out after failure of conservative measures. Release of the iliopsoas tendon from the lesser trochanter gave good symptomatic relief in all except one patient who required reposition of acetabular prosthesis, with the average Harris Hip Score improving from 58 (range, 44-70) to 91 (range, 78-95) postoperatively. This relatively uncommon condition should be considered in the differential diagnosis of all patients who present with groin pain after total hip arthroplasty. Surgical release of the iliopsoas tendon can give excellent results in these patients.