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1.
E. Crespo Romero R. Peñuela Candel S. Gómez Gómez A. Arias Arias A. Arcas Ordoño J. Gálvez González R. Crespo Romero 《Musculoskeletal surgery》2017,101(2):167-172
Background
This study aims to illustrate the results of percutaneous forefoot surgery (PFS) for correction of hallux valgus.Materials and methods
A prospective study of 108 patients, with hallux valgus deformity, who underwent PFS was conducted. The minimum clinical and radiological follow-up was two years (mean 57.3 months, range 22–112).Results
Preoperative mean visual analog scale was 6.3 ± 1.5 points, and AOFAS scores were 50.6 ± 11 points. At the last follow-up, both scores improved to 1.9 ± 2.4 points and 85.9 ± 1.83 points, respectively. Mean hallux valgus angle changed from 34.3° ± 9.3° preoperatively to 22.5° ± 11.1° at follow-up. At follow-up, 76.5% of the subjects were satisfied or very satisfied. Recurrence of medial 1st MT head pain happened in 22 cases (16.7%).Conclusions
PFS, in our study, does not improve the radiological and patient satisfaction rate results compared with conventional procedures. The main advantage is a low postoperative pain level, but with an insufficient HVA correction.Level of evidence
II, prospective study.2.
Objective
Realignment and stabilization of the hindfoot by subtalar joint arthrodesis.Indications
Idiopathic/posttraumatic arthritis, inflammatory arthritis of the subtalar joint with/without hindfoot malalignment. Optional flatfoot/cavovarus foot reconstruction.Contraindications
Inflammation, vascular disturbances, nicotine abuse.Surgical technique
Approach dependent on assessment. Lateral approach: Supine position. Incision above the sinus tarsi. Exposure of subtalar joint. Removal of cartilage and breakage of the subchondral sclerosis. In valgus malalignment, interposition of corticocancellous bone segment; in varus malalignment resection of bone segment from the calcaneus. Reposition and temporarily stabilization with Kirschner wires. Imaging of hindfoot alignment. Stabilization with cannulated screws. Posterolateral approach: Prone position. Incision parallel to the lateral Achilles tendon border. Removal of cartilage and breakage of subchondral sclerosis. Medial approach: Supine position. Incision just above and parallel to the posterior tibial tendon. Removal of cartilage and breakage of subchondral sclerosis. Stabilization with screws.Postoperative management
Lower leg walker with partial weightbearing. Active exercises of the ankle. After a 6?week X?ray, increase of weightbearing. Full weightbearing not before 8 weeks; with interpositioning bone grafts not before 10–12 weeks. Stable walking shoes. Active mobilization of the ankle.Results
Of 43 isolated subtalar arthrodesis procedures, 5 wound healing disorders and no infections developed. Significantly improved AOFAS hindfood score. Well-aligned heel observed in 34 patients; 5 varus and 2 valgus malalignments. Sensory disturbances in 8 patients; minor ankle flexion limitations. Full bone healing in 36 subtalar joints, pseudarthrosis in 4 patients.3.
D. Arbab C. Wingenfeld D. Frank B. Bouillon D. P. König 《Operative Orthopadie und Traumatologie》2016,28(2):128-137
Objective
Distal, lateral soft tissue release to restore mediolateral balance of the first metatarsophalangeal (MTP) joint in hallux valgus deformity. Incision of the adductor hallucis tendon from the fibular sesamoid, the lateral capsule, the lateral collateral ligament, and the lateral metatarsosesamoid ligament.Indications
Hallux valgus deformities or recurrent hallux valgus deformities with an incongruent MTP joint.Contraindications
General medical contraindications to surgical interventions. Painful stiffness of the MTP joint, osteonecrosis, congruent joint. Relative contraindications: connective tissue diseases (Marfan syndrome, Ehler–Danlos syndrome).Surgical technique
Longitudinal, dorsal incision in the first intermetatarsal web space between the first and second MTP joint. Blunt dissection and identification of the adductor hallucis tendon. Release of the adductor tendon from the fibular sesamoid. Incision of the lateral capsule, the lateral collateral ligament, and the lateral metatarsosesamoid ligament.Postoperative management
Postoperative management depends on bony correction. In joint-preserving procedures, dressing for 3 weeks in corrected position. Subsequently hallux valgus orthosis at night and a toe spreader for a further 3 months. Passive mobilization of the first MTP joint. Postoperative weight-bearing according to the osteotomy.Results
A total of 31 patients with isolated hallux valgus deformity underwent surgery with a Chevron and Akin osteotomy and a distal medial and lateral soft tissue balancing. The mean preoperative intermetatarsal (IMA) angle was 12.3° (range 11–15°); the hallux valgus (HV) angle was 28.2° (25–36°). The mean follow-up was 16.4 months (range 12–22 months). The mean postoperative IMA correction ranged between 2 and 7° (mean 5.2°); the mean HV correction was 15.5° (range 9–21°). In all, 29 patients (93?%) were satisfied or very satisfied with the postoperative outcome, while 2 patients (7?%) were not satisfied due to one delayed wound healing and one recurrent hallux valgus deformity. There were no infections, clinical and radiological signs of avascular necrosis of the metatarsal head, overcorrection with hallux varus deformity, or significant stiffness of the first MTP joint.4.
Stefan Hinterwimmer Matthias J. Feucht Jochen Paul Chlodwig Kirchhoff Martin Sauerschnig Andreas B. Imhoff Knut Beitzel 《International orthopaedics》2016,40(9):1849-1854
Purpose
Limited literature reports on internal and external rotation of the distal fragment in the context of valgus open wedge (OW) high tibial osteotomy (HTO). In the authors clinical observation, the distal fragment was always rotated internally in relation to the proximal fragment by the end of the surgical procedure. The purpose was to evaluate the influence of valgus OW-HTO on post-operative tibial torsion.Study design
Prospective case series.Methods
Fifty patients (10 female, 40 male; mean age 42.1?±?9.4 years) underwent valgus OW- HTO. The osteotomy was spread and fixed with a locking plate at the posteromedial aspect of the proximal tibia. The osteotomy of the tibial tuberosity was performed either proximally or distally dependent on the patello-femoral findings. Two independent observers measured axial tibial rotation using K-wires placed into the anterior margin of the tibia proximal and distal to the osteotomy.Results
An overall mean of 4.4?±?2.8° internal rotation of the distal tibia has been shown. In four patients with additional single step double bundle ACL-replacement after harvesting ipsilateral autologous hamstring grafts, the distal tibia rotated internally by 0.1?±?0.3°, accordingly in the other 46 patients by 4.8?±?2.6°.Conclusions
Valgus OW-HTO produces significant internal axial rotation of the distal tibia. This might be caused by soft tissue tension of the medial hamstrings/soft tissue structures and the location of the lateral tibial hinge.Clinical relevance
Surgeons have to take into consideration that valgus OW HTO might result in significant 3D changes of the tibia. Higher degrees of internal torsion of the tibia might influence overall gait mechanics and specifically alternate patellofemoral kinematics.5.
Narelle Wyndow Natalie J. Collins Bill Vicenzino Kylie Tucker Kay M. Crossley 《Journal of foot and ankle research》2018,11(1):65
Study design
Controlled laboratory study; cross-sectional design.Background
Foot and ankle characteristics and dynamic knee valgus differ in people with and without patellofemoral (PF) pain. However, it is unknown if these characteristics are evident in people with PF osteoarthritis (OA), compared to pain-free older adults.Objectives
To compare foot and ankle mobility, foot posture and dynamic knee valgus, measured as the frontal plane projection angle (FPPA) during single-leg squatting, between individuals with and without PFOA.Methods
Fifty-one participants with PFOA (66% women, mean?±?SD age 57?±?10?years, body mass index (BMI) 27?±?6?kg/m2), and 23 controls (56% women, age 56?±?9?years, BMI 24?±?4?kg/m2) had ankle dorsiflexion measured using the knee-to-wall test, foot mobility calculated as the difference in midfoot height or width between non-weightbearing and weightbearing, and static foot posture characterized utilizing the Foot Posture Index. Peak FPPA was determined from video recordings while participants performed 5 single-leg squats. Linear regressions examined between-groups relationships for foot and ankle characteristics and the FPPA.Results
The PFOA group had less ankle dorsiflexion (odds ratio 6.7, 95% confidence interval 2.46–18.2), greater midfoot height mobility (5.2, 1.78–15.14) and width mobility (4.3, 1.33–14.39), and greater foot mobility magnitude (8.4, 2.32–30.69) than controls. There was no difference in FPPA (knee valgus angle) between groups (15, 0.63–377.99).Conclusion
Foot and ankle characteristics were different in individuals with PFOA compared to control participants, however there was no difference in dynamic knee valgus during single leg squat. Clinical interventions to address greater foot mobility may be relevant for PFOA.6.
Background
Measuring acetabular anteversion is relevant to routine follow-up of total hip arthroplasties (THAs) and for malfunctioning THAs. Imageless navigation facilitates acetabular component orientation relative to the anterior pelvic plane (APP) or to the APP adjusted for sagittal pelvic tilt (PT). The optimal plain radiographic method for the postoperative assessment of anteversion is not agreed upon.Questions/Purposes
(1) Do anteversion measurements on plain radiographs correlate more with APP anteversion or PT-adjusted anteversion? (2) Do measurements of anteversion performed on supine anteroposterior (AP) radiographs more accurately reflect intraoperative anteversion values for navigated THA compared to anteversion measured on cross-table lateral (CL) radiographs?Methods
Seventy patients receiving primary navigated THA were included. APP and PT-adjusted anteversion were recorded; the latter defined the intraoperative target for anteversion. Postoperative anteversion was measured on supine AP pelvis radiographs with computer software and CL radiographs with conventional methods. Intraoperative measurements were used as the reference standards for comparisons.Results
Mean intraoperative APP anteversion was 20.6°?±?5.6°. Mean intraoperative PT-adjusted anteversion was 22.9°?±?4.5°. Mean anteversion was 22.7°?±?4.7° on AP radiographs and 27.2°?±?4.2° on CL radiographs (p?<?0.001). Only correlations between PT-adjusted anteversion and radiographic assessments of anteversion were significant. The mean difference between PT-adjusted anteversion and anteversion on AP radiographs was ?0.2°?±?4.3°, while the mean difference between the PT-adjusted anteversion and anteversion measured on CL radiographs was 4.3?±?5.1° (p?<?0.001).Conclusion
Plain film assessment of anteversion was more accurate on supine AP radiographs than on CL radiographs, which overestimated acetabular anteversion.7.
Mehmet Akif Altay Cemil Ertürk Nuray Altay Ahmet Şükrü Mercan Serkan Sipahioğlu Ali Murat Kalender Uğur Erdem Işıkan 《International orthopaedics》2016,40(7):1447-1454
Purpose
The purpose of this study was to prospectively evaluate the clinical and radiographic outcomes, and complication rates, after a minimum of five years of follow-up after medial open wedge high tibial osteotomy (MOWHTO) using an Anthony-K plate.Methods
MOWHTO was performed on 35 knees of 34 consecutive patients. A visual analogue scale (VAS), and Western Ontario and McMaster University Osteoarthritis (WOMAC) and Lysholm scores, were used in clinical evaluation. Upon radiographic assessment, alignment was expressed as the femorotibial angle (FTA). The posterior tibial slope (PTS) and the Insall-Salvati Index (ISI) were also measured.Results
VAS, WOMAC, and Lysholm scores improved significantly upon follow-up (p?<?0.001 for all). The overall mean FTA was 4.68?±?4.39° varus pre-operatively; at the last post-operative follow-up, the value was 8.43?±?2.02° valgus. The mean correction angle was 13.1?±?2.7°. A significant increase in PTS was evident (p?<?0.01), as was a significant decrease in the ISI (p?<?0.01). The overall complication rate was 8.6 %.Conclusions
The Anthony-K plate affords accurate correction, initially stabilises the osteotomy after surgery, and maintains such stability until the osteotomy gap is completely healed, without correction loss. The plate survival rate was 97.2 % after a minimum of five years of follow-up. The plate increased the PTS, as do other medial osteotomy fixation plates.8.
Introduction
The objective of this study was to evaluate the malpractice claims related to percutaneous surgery of the hallux valgus using the insurance database of MIC–Branchet specialized in professional civil liability during the last 10 years.Material and method
We identified 21 cases of claims in relation with percutaneous surgery among a total of 136 claims for hallux valgus including all techniques.Results
All patients were female. The mean age was 48.3 (19–73 years). The courts of law were “commissions de conciliation et d’indemnisation” (CCI) in 9 cases and “tribunaux de grande instance” (TGI) in 12 cases. Complications in relation with the claims were: insufficient results in 6 cases, stiffness of the MTA in 3 cases, algodystrophy in 3 cases, hallux varus in 2 cases, infection in 2 cases, hallux flexor tendon rupture in 2 cases, metatarsal nonunion in 2 cases, and osteonecrosis of the metatarsal head in 1 case. Surgeons were exonerated in 16 cases. A technical fault was held in 4 cases and lack of information in 1 case (stiffness of the MTA).Discussion and conclusion
It is necessary to know the specific outcomes and complications of hallux valgus percutaneous surgery to inform patients before surgery and to reduce medicolegal procedures. An adaptive and specific information must be delivered before surgery.9.
Background
It is unclear whether isolated gastroc/soleus tightness can increase the risk of lower extremity injury in an otherwise healthy child.Questions/Purposes
(1) Is there a difference in gastroc/soleus tightness, as represented by ankle dorsiflexion with the knee extended, in children presenting with upper versus lower extremity complaints? (2) Is there a difference in gastroc/soleus tightness in children presenting with atraumatic versus traumatic lower extremity complaints?Methods
We performed a cross-sectional study of 206 consecutive walking age children presenting to a county orthopedic clinic with new upper or lower extremity complaints. Passive ankle dorsiflexion was measured based on the lateral border of the foot versus the anterior lower leg with the knee fully extended and the foot in inversion.Results
Average age was 10.0?±?4.5 years. In the 117 patients presenting with upper extremity complaints, ankle dorsiflexion was 15.0°?±?11.6°. Of the lower extremity patients, 40 presented without trauma, with dorsiflexion of 11.8°?±?14.5°, while 49 presented with trauma, with dorsiflexion of 6.5°?±?12.0°. Multiple regression analysis found significantly decreased ankle dorsiflexion with increasing age and in the lower extremity trauma group. Twelve percent of upper extremity patients had 0° or less of dorsiflexion, as compared to 25% of lower extremity nontrauma patients and 41% of lower extremity trauma patients.Conclusions
Patients presenting with lower extremity trauma had significantly more gastroc/soleus tightness in their well leg than patients presenting with upper extremity complaints. Gastroc/soleus tightness may present a simple target for reducing lower extremity injury rates in children.10.
M. Walther S. Kriegelstein S. Altenberger A. Röser 《Operative Orthopadie und Traumatologie》2016,28(4):309-320
Objectives
Correction of calcaneal malalignment as part of a hindfoot correction procedure.Indications
Varus and valgus malalignment of the calcaneus, increased calcaneal pitch.Contraindications
Osteoarthritis of the subtalar joint. Fixed and symptomatic deformities of the subtalar joint.Surgical technique
After having identified and marked the desired planes of the osteotomy under image intensifier, a percutaneous v?shaped calcaneal osteotomy is performed. The osteotomy allows 3?dimensional correction of the calcaneus by defining the planes of the osteotomy. The procedure allows correction of varus and valgus deformities, as well as a change of the calcaneal pitch. The osteotomy is fixed by percutaneous screws.Postoperative management
Postoperative care includes a 6-week period of partial weight bearing with 10 kg. The ankle joint should be mobilized. After x?ray control of sufficient bone healing, weight bearing can be increased stepwise over another 4?week period up to full body weight. A full length orthotic is recommended for at least 12 months with heel cup and good medial support.Results
The procedure allows correction of calcaneal deformities with preservation of soft tissue, normally as part of a hindfoot correction, e.?g., in posterior tibial tendon insufficiency, varus deformities or total ankle replacement. In the literature and in our patients, the rate of injuries of the neurovascular bundle was not increased compared to open surgery. The average calcaneal shift was 1 cm, when necessary an additional correction was realized by rotation of the tuber calcanei.11.
Bakir Kadum Hamid Hassany Mats Wadsten Arkan Sayed-Noor Göran Sjödén 《International orthopaedics》2016,40(4):751-758
Purpose
The aim of this study was to investigate the ability of a stemless shoulder prosthesis to restore shoulder anatomy in relation to premorbid anatomy.Methods
This prospective study was performed between May 2007 and December 2013. The inclusion criteria were patients with primary osteoarthritis (OA) who had undergone stemless total anatomic shoulder arthroplasty. Radiographic measurements were done on anteroposterior X-ray views of the glenohumeral joint.Results
Sixty-nine patients (70 shoulders) were included in the study. The mean difference between premorbid centre of rotation (COR) and post-operative COR was 1?±?2 mm (range ?3 to 5.8 mm). The mean difference between premorbid humeral head height (HH) and post-operative HH was ?1?±?3 mm (range ?9.7 to 8.5 mm). The mean difference between premorbid neck-shaft angle (NSA) and post-operative NSA was ?3?±?12° (range ?26 to 20°).Conclusions
Stemless implants could be of help to reconstruct the shoulder anatomy. This study shows that there are some challenges to be addressed when attempting to ensure optimal implant positioning. The critical step is to determine the correct level of bone cut to avoid varus or valgus humeral head inclination and ensure correct head size.12.
Dhanasekararaja Palanisami Geethan Iyyampillai Sivaraj Shanmugam Rajkumar Natesan Rajasekaran S 《International orthopaedics》2016,40(10):2049-2054
Aim
Our aim was to determine the variation in valgus correction angle and the influence of individualised distal femoral cut on femoral component placement and limb alignment during total knee replacement (TKR) in knees with varus deformity.Materials and methods
The study was done prospectively in two stages. In the first stage, the valgus correction angle (VCA) was calculated in long-limb radiographs of 227 patients and correlated with pre-operative parameters of femoral bowing, neck-shaft angle and hip-knee-ankle angle. In the second part comprising of 240 knees with varus deformity, 140 (group 1) had the distal femoral cut individualised according to the calculated VCA, while the remaining 100 knees (group 1) were operated with a fixed distal femoral cut of 5°. The outcome of surgery was studied by grouping the knees as varus <10°, 10–15° and >15°.Results
Of the 227 limbs analysed in stage I, 70 knees (31 %) had a VCA angle outside 5–7°. Coronal bowing (p?<?0.001), neck-shaft angle (p?<?0.001) and preoperative deformity (p?<?0.001) significantly influenced VCA. Results of the second phase of the study showed a significant improvement in both femoral component placement and postoperative alignment when VCA was individualised in the groups of knees with varus 10–15° (p 0.002) and varus >15° (p 0.002).Conclusion
Valgus correction angle is highly variable and is influenced by femoral bowing, neck-shaft angle and pre-operative deformity. Individualisation of VCA is preferable in patients with moderate and severe varus deformity.Level of evidence
Level 2.13.
Robert K. Zahn Sarah Grotjohann Heiko Ramm Stefan Zachow Michael Putzier Carsten Perka Stephan Tohtz 《International orthopaedics》2016,40(8):1571-1575
Purpose
Pelvic tilt determines functional orientation of the acetabulum. In this study, we investigated the interaction of pelvic tilt and functional acetabular anteversion (AA) in supine position.Methods
Pelvic tilt and AA of 138 individuals were measured by computed tomography (CT). AA was calculated in relation to the anterior pelvic plane (APP) and relative to the table plane. We analysed these parameters for gender-specific and age-related differences.Results
The mean pelvic tilt was -0.1?±?5.5°. Pelvic sagittal rotation displayed no gender nor age related differences. Females showed higher angles of AA compared with males (20.0° vs 17.2°, p?<?0.001; AA relative to the APP). Anterior tilting of the pelvis positively correlated with AA and individuals with high AA had a higher anterior pelvic tilt compared with those with low AA (p?<?0.0001; AA relative to the APP).Conclusions
AA has to be calculated regarding pelvic sagittal rotation for correct acetabular orientation. Pelvic tilt is dependent on acetabular orientation and compensates for increased AA.14.
Huipeng Yin Kun Wang Yong Gao Yukun Zhang Wei Liu Yu Song Shuai Li Shuhua Yang Zengwu Shao Cao Yang 《Journal of orthopaedic surgery and research》2018,13(1):312
Background
Junction tuberculous spondylitis involves the stress transition zone of the spine and has a high risk of progression to kyphosis or paraplegia. Problems still exist with treatment for spinal junction tuberculosis. This study investigated the surgical approach and clinical outcomes of junction spinal tuberculosis.Methods
From June 1998 to July 2014, 77 patients with tuberculous spondylitis were enrolled. All patients received 2–3?weeks of anti-tuberculous treatment preoperatively; treatment was prolonged for 2–3?months when active pulmonary tuberculosis was present. The patients underwent anterior debridement and were followed up for an average of 29.4?months clinically and radiologically.Results
The cervicothoracic junction spine (C7-T3) was involved in 15 patients. The thoracolumbar junction spine (T11-L2) was involved in 39 patients. The lumbosacral junction spine (L4-S1) was involved in 23 patients. Two patients with recurrence underwent reoperation; the drugs were adjusted, and all patients achieved bone fusion. The preoperative cervicothoracic and thoracolumbar kyphosis angle and lumbosacral angle were 31.4?±?10.9°, 32.9?±?9.2°, and 19.3?±?3.7°, respectively, and the corresponding postoperative angles were ameliorated significantly to 9.1?±?3.2°, 8.5?±?2.9°, and 30.3?±?2.8°. The preoperative ESR and C-reactive protein level of all patients were 48.1?±?11.3?mm/h and 65.5?±?16.2?mg/L which decreased to 12.3?±?4.3?mm/h and 8.6?±?3.7?mg/L at the final follow-up, respectively. All patients that had neurological symptoms achieved function status improvement at different degrees.Conclusion
For spinal tuberculosis of spinal junctions, anterior debridement, internal fixation, and fusion can be preferred and achieved. If multiple segment lesions are too long or difficult for operation of anterior internal fixation, combining posterior pedicle screw fixation is appropriate.15.
Background
Ankle valgus is a common deformity in patients with multiple hereditary exostoses (MHE) and a potential risk factor for early degenerative arthritis. In children, medial hemiepiphysiodesis of the distal tibia is a relatively simple surgical technique used to correct this deformity. We present here the first results of applying this procedure using the eight-Plate guided growth system (eight-Plate) for growth guidance.Methods
Between 2006 and 2011 we performed hemiepiphysiodesis of the distal medial tibia in 30 ankles of 18 children with MHE using the eight-Plate. Weight-bearing total leg radiographs were obtained preoperatively, during follow-up and at the time of implant removal or when the distal tibial physis had closed. The lateral distal tibia angle (LDTA) was measured and fibular shortening assessed using the Malhotra classification. To evaluate the effect of hemiepiphysiodesis, we correlated the LDTA with age.Results
The mean age at time of surgery was 12.6 (range 9.5–15.0) years, and the mean preoperative LDTA was 76.9° (range 68.5°–83.5°). During follow-up, the implant was removed in 12 extremities and the physis had closed in 18 extremities. The mean LDTA at the time of implant removal or at closure of the physis was 83.6° (range 76.5°–90.0°). Mean correction of LDTA was 6.9° after a mean follow-up period of 22 (range 3–43) months. During follow-up, no changes in the Malhotra classification were found in any of the patients. Correction of the valgus deformity of the ankle was significantly correlated (r = ?0.506) (p = 0.004) with age in all patients.Conclusion
Temporary medial hemiepiphyseodesis of the distal tibia seems to be an effective strategy for correcting ankle valgus in children with MHE. Timing of the intervention is, however, of importance. Hemiepiphyseodesis alone has no effect on the Malhotra classification.Level of evidence
IV, retrospective review.16.
Background
Minimally invasive techniques have been used successfully in mild to moderate hallux valgus (HV) deformity, while controversy exists for their use in cases with more severe involvement. The purpose of this prospective study was to evaluate the outcomes of a modified less invasive technique for management of severe HV deformity.Patients and methods
Between January 2010 and 2013, a total of 15 active patients (20 ft) met our selection criteria for symptomatic severe HV deformity and treated by a modified double metatarsal osteotomy technique. The procedure implied simple transverse-osteotomy, with lateral translation, of the first metatarsal both distally and proximally combined with selective distal soft-tissue procedure. Average patient’s age was 43.9 years. Radiologically, HV angle, intermetatarsal angle, distal metatarsal articular angle, tibial sesamoid position, and joint congruity were assessed preoperatively and at the final follow-up. Clinically, the American Orthopedic Foot and Ankle Society scale and the subjective patient’s satisfaction were also evaluated. All data were statistically analyzed, and the complications were reported.Results
The average follow-up was 22.6 months (range 16–30 months). Union was achieved in all osteotomies in a mean of 6.22?±?0.79 weeks. Each clinical and radiological parameter showed a statistically significant improvement (P?<?0.001), with a negligible first-ray shortening (P?=?0.617) and a few complications. At final follow-up, none of the patient was dissatisfied.Conclusions
The modified double metatarsal osteotomy technique provides a simple, reproducible, and effective alternative for correction of all components of severe HV deformity in a less invasive manner.17.
Introduction
External fixation is associated with the risk of pin loosening and pin infection potentially associated to thermal bone necrosis during pin insertion.Objective
This study aims to investigate if the use of external fixator systems with unicortical pins reduces the heat production during pin insertion compared to fixators with bicortical pins.Methods
Porcine bone specimens were employed to determine bone temperatures during insertion of fixator pins. Two thermographic cameras were used for a simultaneous temperature measurement on the bone surface (top view) and a bone cross-section (front view). Self-drilling unicortical and bicortical pins were inserted at different rotational speeds: (30–600) rpm. Maximum and mean temperatures of the emerging bone debris, bone surface and bone cross-section were analyzed.Results
Maximum temperatures of up to 77?±?26 °C were measured during pin insertion in the emerging debris and up to 42?±?2 °C on the bone surface. Temperatures of the emerging debris increased with increasing rotational speeds. Bicortical pin insertion generated significantly higher temperatures at low insertion speed (30 rpm)Conclusion
The insertion of external fixator pins can generate a considerable amount of heat around the pins, primarily emerging from bone debris and at higher insertion speeds. Our findings suggest that unicortical, self-drilling fixator pins have a decreased risk for thermal damage, both to the surrounding tissue and to the bone itself.18.
Pietro Manuel Ferraro Matteo Vittori Giuseppe Macis Alessandro D’Addessi Gianmarco Lombardi Claudia Palmisano Jacopo Gervasoni Aniello Primiano Pier Francesco Bassi Giovanni Gambaro 《BMC urology》2018,18(1):101
Background
Previous studies have shown that, compared with non-stone formers, stone formers have a higher papillary density measured with computer tomography (CT) scan. The effect of increased hydration on such papillary density in idiopathic calcium stone formers is not known.Methods
Patients with recurrent calcium oxalate stones undergoing endourological procedures for renal stones at our Institution from June 2013 to June 2014 were considered eligible for enrolment. Enrolled patients underwent a baseline unenhanced CT scan before the urological procedure; after endoscopic removal of their stones, the patients were instructed to drink at least 2 L/day of a hypotonic, oligomineral water low in sodium and minerals (fixed residue at 180 °C?<?200 mg/L) for at least 12 months. Finally, the patients underwent a follow-up unenhanced CT scan during hydration regimen.Results
Twenty-five patients were prospectively enrolled and underwent baseline and follow-up CT scans. At baseline, mean papillary density was 43.2?±?6.6 Hounsfield Units (HU) (43.2?±?6.7 for the left kidney and 42.8?±?7.1 HU for the right kidney). At follow-up and after at least 12 months of hydration regimen, mean papillary density was significantly reduced at 35.4?±?4.2 HU (35.8?±?5.0 for the left kidney and 35.1?±?4.2 HU for the right kidney); the mean difference between baseline and follow-up was ??7.8 HU (95% confidence interval???10.6 to ??5.1 HU, p?<?0.001).Conclusions
Increased fluid intake in patients with recurrent calcium oxalate stones was associated with a significant reduction in renal papillary density.Trial registration
NCT03343743, 15/11/2017 (Retrospectively registered).19.
Introduction
The primary objective of the study is to make an inventory of malpractice in hallux valgus surgery in an ambulatory setting and to identify the patient characteristics for a higher risk of malpractice. The secondary objective is creating a methodology for analyzing the medicolegal aspects of a surgery in day case comparing with hospitalization.Materials and methods
The database of the Branchet insurance company was used. A total of 11,000 claims for a period of 11 years (2002–2013) have been investigated. The files of the patients with hallux valgus surgery were isolated from the insurer’s database using CCAM codes. The medical director, a medical officer, the legal expert and finally the judge had already analyzed all these cases. The authors reviewed the various documents with a specific questionnaire.Results
We identified 14 cases of claims in relation with hallux valgus 1-day surgery among a total of 138 claims for hallux valgus including all techniques (10%). All patients were female. The mean age was 42.6 years (19–64) in ambulatory patients (AG group) in comparison with 49.5 years (19–73) in hospitalized patients (HG group). Percutaneous techniques were significantly more represented in the AG group (p = 0.002) and scarfs osteotomies in the HG group (p = 0.004). The use of tourniquet seemed to be lower in the AG group, but it was a not significant trend (p = 0.085). In term of anesthesia procedures, no significant differences were seen between the two groups. The comparison of the complications common to both groups showed no significant difference except for insufficient results which were more frequent in the AG group (p = 0.026). The rate of insufficient informed consent seemed to be higher in the AG group, but it was a not significant trend (p = 0.084).Discussion and conclusion
No specific data regarding claims in relation with hallux valgus 1-day surgery are available to our knowledge in the literature. We did not identify in our study specific complications related to ambulatory procedures except for insufficient results. Hallux valgus 1-day surgery does not seem to expose surgeons to higher medicolegal problems than classical hospitalization. Nevertheless, a specific consent form for ambulatory patients is required to limit claims regarding information.20.
Arata Nakajima Masato Sonobe Yorikazu Akatsu Yasuchika Aoki Hiroshi Takahashi Toru Suguro Koichi Nakagawa 《Journal of orthopaedic surgery and research》2018,13(1):320