Anatomic correction of polysyndactyly of the fifth toe fused with the fourth toe.

A new surgical technique for correction of polysyndactyly with the fifth toe fused with the fourth toe was devised. The technique consists of the creation of a dorsal rectangular flap on the dorsum of the syndactyly web for the new fourth web, making a medially based plantar rectangular flap on the plantar surface of the fifth toe, and a sixth toe-tip-based rectangular hinge flap to reconstruct the lateral side of the fourth toe and medial side of the new fifth toe, respectively. All suture lines are intended to be located in the transition of the plantar and dorsal surfaces of the web and digit. This technique is characterised by accurate anatomic reconstruction, which produces better aesthetic results with no wasting of any skin components.     

Operation for polysyndactyly of the fifth toe using Z-plasty.

A new operative procedure was devised to treat polysyndactyly of the fifth toe. This procedure, which consists of removal of the fifth toe, correction of the alignment of the preserved sixth toe by arthroplasty and construction of an interdigital space by Z-plasty, is technically simple and produces good results, both functionally and aesthetically.     

Butler's procedure for correction of overriding fifth toe: A retrospective study

Congenital overriding fifth toe is a well-recognised deformity often treated surgically. In this article, we have compared our experience of Butler's procedure in 12 patients with the three articles published so far. One patient was lost to follow-up. The average age and follow-up of our patients was 15 and 6 years, respectively. We achieved six excellent, three good and two poor results. The 10–15 year age group had the highest percentage of excellent/good results. Nine patients were satisfied. However, residual deformity was noted among all the age groups. We conclude that it is difficult to correlate the results of the operation with the age of the patient at surgery.     

The surgical approach to the lateral nasal gland. A new method for studying the canine thermoregulatory response.

The lateral nasal gland is surgically accessible, its duct readily cannulated and its secretory output can be easily collected, thus providing a means of monitoring the thermoregulatory response of the dog to either varying environmental conditions, or to change that is due to internal and pharmacological manipulations.     

A new method for surgical consultations with videoconference

BACKGROUND: The aim of our prospective study was to examine the technical ability and the medical suitability of a realtime teleconferencing system in surgical consultations. METHOD: A personal computer-based-videoconferencing system was used over an architecture of the IP (Internet Protocol) over ATM (Asynchronous Transfer Mode) area network connecting Satakunta Central Hospital, Pori with a health center in the community of Noormarkku (15 km apart from Pori). A document camera was used for transfering the radiographs and paper documents. The material consisted of 50 patients who needed surgical consultation. The patients were examined by a physician in the health center of Noormarkku, and the surgeon interviewed and observed the physical examination with the aid of teleconference. RESULTS: Technically the videoconferencing system functioned reliably, and the visual quality of the videopicture was good after more powerful personal computers (Pentium II with a 266 MHz prosessor and 64 Megabits RAM-memory) were changed for the videoconferencing system. All patients, except one, saved the travelling to the face-to-face appointment because they got a definite decision of the treatment already at the videoconsultation. According to the opinion of the consulting surgeon, the decision which was made in the teleconference was good or very good, except in one case very poor. The physicians of the health centers were satisfied both with the decisions of the treatment of their patients and with the educational effect of a consultation where two physicians are present at the same time. All patients thought that it was good to be in consultation with two doctors. CONCLUSION: Surgical videoconsultations are a reliable method and a real alternative to sending a patient to a distant place for consultation.     

Isolated hexadactylia: A rare case of central polydactyly of the foot

BackgroundCentral polydactyly of foot is uncommon form of polydactyly but it usually causes intermetatarsal widening because of metatarsal bifurcation. Central polydactyly associated with T shaped bifurcation of metatarsal in vertical plane has not been reported yet.CaseWe present a 4 year male child with extra toe on the dorsal aspect of right foot with complains of difficulty in wearing footwear and poor cosmesis. The extra digit was fully developed with bifurcation of 2^nd metatarsal bone proximal to the head without any intermetatarsal widening. The angular deviation was 45° to the longitudinal axis of foot and in a plane vertical to the transverse arch of foot. The child was operated with excision of extra toe without any residual bony deformity.ConclusionThe central polydactyly is rare type of polydactyly of foot. Central polydactyly with metatarsal extension causing intermetatarsal widening has been well described entity. But the previous classifications need to be modified to include central polydactyly with vertical oriented T bifurcation of metatarsal bone without intermetatarsal widening.     

A new method for the surgical treatment of the dumping syndrome.

A new method for the operative treatment of the dumping syndrome is reported and an analysis of the results obtained in 28 patients followed up for periods of 10 months to 10 years presented. There were no deaths, the complication rate was low, and the results in terms of relief of dumping symptoms and weight gain satisfactory. The method offers a surgical approach for the treatment of patients with severe and disabling dumping symptoms.     

Stress fractures of the lateral rays in the cavovarus foot: indication for surgical intervention

Lateral ray stress fractures are a known complication of the cavovarus foot deformity. Malpositioning of the forefoot and hindfoot leads to increased pressure on the heel and lateral rays, resulting in significant morbidity. Patients with nonprogressive deformities can be managed surgically or nonsurgically in an attempt to decrease adverse events. It is often difficult to predict which patients will benefit most from a surgical intervention. This article describes 2 model cases of stress fractures in patients with nonprogressive cavovarus foot deformities. Patient 1 was an active patient with a minor, flexible cavovarus deformity, and patient 2 was a relatively inactive patient with a severe, fixed deformity. These cases serve to illustrate a spectrum of the 2 major risk factors for the development of a stress fracture of the lateral rays: severity of deformity and activity level of the patient. We believe the relationship between these 2 risk factors constitutes a threshold that allows the development of a stress fracture to serve as an adequate marker for surgical intervention. Within this patient population, a stress fracture indicates that given a patient's lifestyle, his or her deformity is sufficient enough to cause significant and repeated morbidity. Surgical restoration of the foot to plantigrade will eliminate the increased forces to the lateral metatarsals and decrease the incidence of further injury. Thus, stress fractures of the lateral rays in patients with nonprogressive cavovarus deformities should be considered an indication for surgical intervention.     

Juvenile hallux valgus deformity: surgical management by lateral hemiepiphyseodesis of the great toe metatarsal

Surgical correction of juvenile hallux valgus (JHV) by soft tissue balancing or skeletal realignment is associated with a high rate of recurrence of the deformity. An alternative treatment strategy for the management of symptomatic or progressive JHV, consisting of lateral hemiepiphyseodesis of the great toe metatarsal physis, has been used at our institution since 1996. A review of these cases was performed to determine the outcomes in the technical and patient satisfaction domains. Preoperative and follow-up radiographs of the foot were analyzed to measure the intermetatarsal angle (IMA), the hallux valgus angle (HVA), the proximal metatarsal articular angle (PMAA), and the metatarsal length ratio. Repeated measures of the radiographs were performed to determine intraobserver reliability. The medical records were reviewed to determine the children's age at presentation, chief complaints, age at surgery, tourniquet time of the surgical procedure, length of follow-up, the need for subsequent foot surgeries, and complications. Follow-up clinic or telephone interviews were performed to determine patient satisfaction. Seven children with 11 feet treated for JHV were available for study. Mean age at the time of the index surgery was 10 years 4 months (range, 9 years 7 months-11 years 1 month). Mean follow up after surgery was 4 years 2 months (range, 1 year 7 months-7 years 6 months). The mean improvement in the IMA was 2.32 degrees (range, 0-5 degrees; P < 0.0001). The mean improvement in the HVA was 3.45 degrees (range, 0-9 degrees; P = 0.027). Significant correction of both the IMA and the HVA was achieved in 6 (55%) of 11 of the feet. In no case did either of the measures worsen. The mean change in the PMAA in the anteroposterior plane was 5.09 degrees (range, 0-11 degrees; P = 0.001). The mean change in the PMAA in the lateral plane was 1.00 degree (range, 0-3 degrees; P = 0.008). The mean change in the metatarsal length ratio was 0.01 (range, 0.07-0.11), which was not statistically significant (P = 0.65). Lateral hemiepiphyseodesis of the great toe metatarsal was effective at halting the progression of the JHV deformity in all cases and achieved significant correction of both the IMA and the HVA in more than 50% of the feet. Lateral hemiepiphyseodesis of the great toe metatarsal is a reasonable alternative for the management of symptomatic or progressive JHV, given the high recurrence rate associated with other soft tissue and skeletal surgical procedures.     

Ilizarov技术自体骨段延长治疗胫骨感染性骨折不愈合伴骨缺损

目的 探讨Ilizarov技术自体骨段延长治疗胫骨感染性骨折不愈合的疗效.方法 2000年9月至2006年6月共收治胫骨感染性骨折不愈合伴骨缺损患者14例,男11例,女3例;年龄19～49岁,平均31.9岁;胫骨近端3例,中段8例,远端3例.原始损伤:5例为开放骨折钢板内固定,3例为开放骨折髓内钉内固定,4例为开放骨折外固定架固定,2例为闭合骨折钢板内固定术后所致.患者自受伤至此次治疗时间为2～24个月,平均7.54个月;手术次数平均6次(3～14次).根据Jain骨缺损和感染程度分型:A2型5例,B1型2例,B2型7例.窦道形成10例,骨外露4例;骨外露面积最大7 cm×5 cm,最小2 cm×1 cm;清创后骨缺损长度3～12 cm,平均6.71 cm.14例患者均采用清创联合Ilizarov技术自体骨段延长治疗.结果 14例患者均获8个月～6年(平均20个月)随访,均获稳定骨折愈合.住院时间1～7个月,平均3个月;骨折愈合时间6～12个月,平均7.79个月;骨外固定时间8～14个月,平均9.64个月.并发症:针道感染1例,皮肤过敏1例,骨折畸形愈合再截骨1例,提前矿化再截骨1例,断针1例,无深部感染、骨折不愈合和膝关节僵直发生.根据Paley骨折愈合评分标准:优13例,良1例.结论 Ilizarov骨段延长是治疗胫骨感染性骨折不愈合伴大段骨缺损的一种有效方法.     

Techniques for small-bone lengthening in congenital anomalies of the hand and foot.

The purpose of this study is to analyse three different lengthening techniques used in 31 small bones for congenital malformations of the hand and foot: 15 metacarpals, 12 metatarsals, 1 foot stump and 3 spaces between a previously transplanted phalanx end of the carpus or the metacarpal. Progressive lengthening with an external fixator device was performed in 23 cases: the callus distraction (callotasis) technique was used in 15 cases, whereas in the other 8 cases the speed of lengthening was faster and the defect bridged with a bone graft as a second stage. In another eight cases, a one-stage lengthening was performed. In the callotasis group, the total length gained ranged from 9 mm to 30 mm and the percentage of lengthening obtained (compared with the initial bone length) averaged 53.4%; in the fast lengthening group, the length gained ranged from 8 mm to 15 mm, and the average percentage of lengthening was 53.1%; and in the one-stage group, the length gained ranged from 7 mm to 15 mm, and the average percentage of lengthening was 43%. The overall complication rate was 22.5%.     

A new method for treating isolated fractures of the os trapezium

Isolated trapezium fractures are rare events. As standard radiographic methods may fail to diagnose this injury, specific radiographic projections are needed to separate the outline of the trapezium from the other carpal bones. Computed tomography can be helpful in visualizing the true shape of fragments. In this report a vertical and transversal isolated fracture of the trapezium was repaired by using the dynamic Herbert compression screw technique. Open reduction and internal fixation resulted in union with excellent thumb function and joint restoration. A report of this case and the special technique of treatment is combined with a discussion of literature. Received: 4 May 1994