Advertisement for orthosearch.org.uk
Results 1 - 20 of 31
Results per page:
Orthopaedic Proceedings
Vol. 86-B, Issue SUPP_II | Pages 133 - 133
1 Feb 2004
Ribau-Díez MA González-Ustes J Pisa J Siles E Felipe D Riera J Andolz M Novell J
Full Access

Introduction and Objectives: The aim of this report is to present the complications that occur with percutaneous surgery for hallux valgus. Percutaneous surgery is based on a series of combined surgical procedures designed to resolve a deformity. Materials and Methods: We have reviewed the first 200 cases of percutaneous surgery in our centre. In 136 cases, a diagnosis of hallux valgus was made in association with metatarsalgia and deformity of the toes. There were 40 cases of hallux valgus alone, 24 cases of metatarsal-gias with toe deformities, and 10 cases of toe deformities alone. Patients were treated between February 2001 and February 2002 with a mean follow-up time of 8 months. Complications were analysed clinically and radiographically. Results: We found the following complications: 4 cases of insufficient bunionectomy, 5 cases of dysesthesia of the first digit, 12 cases of transfer metatarsalgia, 10 cases of asymptomatic metatarsal non-union, 20 cases of superficial infections, 50% of cases with prolonged edema of the foot, and 90% of cases with pain on the dorsum of the foot lasting 3–4 months in cases of meta-tarsalgia. Other less common complications included the following: 1 case of deep vein thrombosis, 1 case of cutaneous necrosis in the area of the anaesthetic block, and 1 case of anterior tibial dysesthesia at the level of the anesthetic block. Repeat treatment was required by 10% of patients. Discussion and Conclusions: Percutaneous surgery is an alternative to conventional surgery. Advantages included decreased postoperative pain, a rapid return to daily activities, weight-bearing ability in the immediate postoperative period, and the fact that is it a standing surgery. However, it should be remembered that this method is not without its possible complications, which may require repeat treatment


Orthopaedic Proceedings
Vol. 91-B, Issue SUPP_II | Pages 325 - 325
1 May 2009
Izquierdo O Gonzalez X Parals F Novell J
Full Access

Introduction: We present 34 patients diagnosed with hallux rigidus treated by percutaneous surgery. We analyzed the surgical techniques used and the functional results achieved. Materials and methods: We retrospectively collected 34 patients (24 women). Patients were stratified by means of parametric x-rays (Hanft classification from 1 to 4). Treatment consisted in a double osteotomy, also known as Keller’s technique, using percutaneous procedures. The postoperative protocol consisted of walking, use of orthopedic footware, and early mobilization. Results: Mean age was 68.78 years and mean follow-up was 31.45 months. Mean time from first clinical visit to surgery was 4.38 years; most patients had received conservative treatment. The mean degree of hallux rigidus according to the standard classification was 2.5. The mean value of the metacarpophalangeal joint arc and interphalangeal joint arc was 40.35°and 52.14° respectively. Return to work activities was achieved in 90.9%. The mean value according on the VAS (visual analogue scale) (0–10) was 3.14. The mean value on the AOFAS scale was 62.57 (0–100). Conclusions: Percutaneous surgery is a satisfactory method for the treatment of hallux rigidus, enabling the patient to quickly return to work. This procedure avoids the use of osteosynthesis materials and minimizes the complications seen in open surgery


The Bone & Joint Journal
Vol. 107-B, Issue 1 | Pages 10 - 18
1 Jan 2025
Lewis TL Barakat A Mangwani J Ramasamy A Ray R

Hallux valgus (HV) presents as a common forefoot deformity that causes problems with pain, mobility, footwear, and quality of life. The most common open correction used in the UK is the Scarf and Akin osteotomy, which has good clinical and radiological outcomes and high levels of patient satisfaction when used to treat a varying degrees of deformity. However, there are concerns regarding recurrence rates and long-term outcomes. Minimally invasive or percutaneous surgery (MIS) has gained popularity, offering the potential for similar clinical and radiological outcomes with reduced postoperative pain and smaller scars. Despite this, MIS techniques vary widely, hindering comparison and standardization. This review evaluates the evidence for both open Scarf and Akin osteotomy and newer-generation MIS techniques. Fourth-generation MIS emphasizes multiplanar rotational deformity correction through stable fixation. While MIS techniques show promise, their evidence mainly comprises single-surgeon case series. Comparative studies between open and MIS techniques suggest similar clinical and radiological outcomes, although MIS may offer advantages in scar length and less early postoperative pain. MIS may afford superior correction in severe deformity and lower recurrence rates due to correcting the bony deformity rather than soft-tissue correction. Recurrence remains a challenge in HV surgery, necessitating long-term follow-up and standardized outcome measures for assessment. Any comparison between the techniques requires comparative studies. Surgeons must weigh the advantages and risks of both open and MIS approaches in collaboration with patients to determine the most suitable treatment. Cite this article: Bone Joint J 2025;107-B(1):10–18


Orthopaedic Proceedings
Vol. 93-B, Issue SUPP_II | Pages 216 - 217
1 May 2011
Martins R Marinheiro J Paulo C Alves J Ferreira N Lopes D Correia J Araújo S
Full Access

The Achilles tendon is formed by the fusion of gastrocnemius and soleus muscle, and is one of the strongest of the human body. Acute ruptures occur mostly in men between 30 and 50 years of age, with irregular sports activity. Rupture generally occurs in a low perfusion area, between 2 and 6 cm above the calcaneal tuberosity. We reviewed and examined 45 patients with Achilles tendon rupture submitted to surgical correction, between January 2004 and December 2008 (5 years), in our Hospital. For each patient was determined the injury type, time until diagnosis, time between diagnosis and surgery, surgical technique employed, immobilization period, rehabilitation program, occurrence of complications and rerupture, follow-up period and clinical outcome (AOFAS score). The most frequent cause of rupture was professional activity (46%), followed by soccer practice (38%). The diagnosis was made in the first medical observation in 71% of patients. The mean surgical period until surgery was of 0.7 days, and the mean time of admission was of 3.56 days. The used surgical techniques were open surgery (25 cases), open surgery augmented with gastrocnemius fascia (5 cases), and percutaneous surgery with the Achillon system (15 cases). The mean AOFAS score was of 92.42 (84–100), was of 100 in the Achillon group, 92 in the open surgery group and 91 in the augmented surgery group. The complications all occurred in the open surgery group, with one infection, one surgical incision healing delay and one case of sural nerve injury. The mean follow-up was of 4.4 months and the main complain was of local tenderness in the surgical wound, with all patients having returned to their normal level of activity. This series complications rate is low, and the AOFAS score and satisfaction rate is higher in the percutaneous group, following the tendency expressed in the international literature. Reflecting the growing tendency for information in our patients, one important cause of dissatisfaction in the open surgery group is not to have had the opportunity of a percutaneous surgery. The results of percutaneous surgery are excellent, with a lower rate of complications, less surgical wound complaints. The possibility raised by other studies of a higher rerupture rate in the percutaneous group was not confirmed in this group. Currently all Achilles ruptures are treated percutaneously in our Hospital, if the rupture meets the indications criteria for this type of surgery


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXXVII | Pages 388 - 388
1 Sep 2012
Sanchis Amat R Crespo Gonzalez D Juando Amores C Espi Esciva F Balaguer Andres J
Full Access

INTRODUCTION. Percutaneous surgery is an increasingly accepted technic for the treatment of Hallux valgus but it has some limitations when the intermetatarsal angle ismoderate to severe, having high risk of recurrence. The mini tight-rope used as a complement for precutaneous surgery avoids complications of open surgery osteotomies (delays consolidation, pain, screws protusion, infection) and it allows us continue with the recurrent trend towards minimal invasive surgery. MATERIAL AND METHOD. Between 2007 and 2009, 60 patients with severe Hallux valgus were treated in our Hospital using the percutaneous mini tight-rope. The mean age of patients was 62, 5 patients were man and 55 were woman. The mean follow-up was 18 months. RESULTS. Patients had clinical assessment using AOFAS score, radiological assessment and a subjective satisfaction degree assessment at 2,6 weeks and 4-6-12 months postoperative. As complications we found four technical failures due to learning curve, one infection and one second metatarsal fracture. CONCLUSION. mini tight-rope is a good option as a supplement in the treatment of severe hallux valgus by percutaneous technique because it avoids complications of open surgery, obtaining satisfactory results in 76% of cases according to the AOFAS scale


Orthopaedic Proceedings
Vol. 91-B, Issue SUPP_II | Pages 323 - 323
1 May 2009
Lajara F Salinas JE Ruiz M
Full Access

Introduction and purpose: Many techniques for the treatment of metatarsalgia have been described. Weil’s osteotomy causes loss of movement of the metatarsophalangeal (MTP) joint. Some authors associate this deficiency with a hypertrophic soft tissue scar on the dorsal part of the MTP joint. The purpose of this study is to assess the results of distal osteotomy of the small metatarsals carried out by means of a mini-invasive (MIS) technique.

Materials and methods: We retrospectively reviewed 43 feet, 111 osteotomies performed between 2002 and 2006. The mean age of the patients was 51.8 years. In 45.45% of cases there were associated hallux pathological conditions and in 57.5% there were alterations of the smaller toes. Patients underwent clinical and functional assessment. Radiologically it was possible to determine the metatarsal formula, the rate of consolidation and metatarsal shortening.

Results: The follow-up period was 15 months. From the functional and cosmetic point of view 97% of the patients considered their results were excellent or good. Radiologically there was an average shortening of 2.88 mm; in 20% of cases there was a change to a more physiological metatarsal formula and union was achieved in all cases without significant delays. Complications seen: one case of cellulitis and 3 transfer metatarsalgias.

Conclusions: MIS seems an appropriate surgical technique for the treatment of metatarsalgias of the smaller toes associated or not with forefoot surgery. Good clinical and cosmetic outcomes are seen in more than 95% of cases.


Orthopaedic Proceedings
Vol. 95-B, Issue SUPP_14 | Pages 17 - 17
1 Mar 2013
Mostert P Snyckers C
Full Access

Purpose of the study

Percutanous acetabular surgery is a new and developing technique in fixation of acetabulum fractures. The most common screw used is the anterior column screw that traverses anterograde or retrograde through the anterior column of the acetabulum. Standard height and width calculations derived from CT scans do not take the trajectory of the screw into consideration. They have been shown to exaggerate the available safe bone corridor for screw passage. Posterior column screws can be placed in a retrograde fashion via the ischial tuberosity to fixate posterior column. Limited international data is available and no studies to date have been conducted on the South African population. This study assesses the anterior and posterior acetabular columns of South African individuals and ascertains the safe bone corridor sizes.

Methods

Pelvic CT-scans of 100 randomly selected patients were reviewed. Specific computer software was used to virtually place anterior screws through the anterior acetabular column, in its clinical trajectory. Specific entry points inferior to the pubic tubercles significantly changed the relation of the screw trajectory to the mid- column isthmus and were incorporated in the measurement of the anterior column. All the available lengths and diameters were measured and averages were calculated for males and females.


Orthopaedic Proceedings
Vol. 106-B, Issue SUPP_18 | Pages 87 - 87
14 Nov 2024
Savaş S Konya M Yılmaz BK Kağa S Kağa E Demirel HH
Full Access

Introduction. The Achilles tendon is the thickest and strongest tendon in the human body. Even though the tendon is so strong, it is one of the most frequently injured tendons. Treatment of patients after rupture is planned conservatively and surgically. Conservative treatment is generally applied to elderly patients with sedentary lives. If the treatment is surgical, it can be planned as open surgery or percutaneous surgery. In our study with rabbits, we wrapped a membrane made of plga (polylactic-co-glycolic acid) nanotubes impregnated with type 1 collagen around the tendon in rabbits that underwent open Achilles tendon repair surgery. After surgery, biomechanical and histological tests were performed on the tendons. Method. In the study consisting of 24 rabbits, 2 groups were created by random distribution. In the study group, after the Achilles tendon rupture was created, a type 1 collagen-impregnated plga-based membrane was placed around the tendon after the repair of 1 modified Kesslerr suture. In the control group, after the Achilles tendon rupture was created, 1 modified Kessler suture and Tendon repair was performed with the application of 3 primary sutures. At the end of the 6th week of the study, the rabbits in 2 groups were randomly distributed and histological examination was performed. Additionally, biomechanical testing was performed. Bonar and Movın scoring were used in histological examinations. Result. As a result of biomechanical tests, it was seen that the resistance of the tendon against rupture was higher in the study group than in the control group. In addition, it was observed that the tendon rupture time was longer in the study group than in the control group. Histological examinations gave supportive results from biomechanical tests. Conclusion. We think that the use of collagen-impregnated plga-based nanotubes in the surgical treatment of Achilles tendon ruptures has a positive healing effect. Although we think that the return to normal life after surgery may be faster, we believe that more clinical studies are needed


Full Access

Hallux valgus surgery can result in moderate to severe post-operative pain requiring the use of narcotic medication. The percutaneous distal metatarsal osteotomy is a minimally invasive approach which offers many advantages including minimal scarring, immediate weight bearing and decreased post-operative pain. The goal of this study is to determine whether the use of narcotics can be eliminated using an approach combining multimodal analgesia, ankle block anesthesia and a minimally invasive surgical approach. Following ethics board approval, a total of 160 ambulatory patients between the ages of 18-70 with BMI ≤ 40 undergoing percutaneous hallux valgus surgery are to be recruited and randomized into Narcotic-free (NF) or Standard (S) groups. To date, 72 patients have been recruited (38 NF and 34 S). The NF group received acetaminophen, naproxen, pregabalin 75mg and 100mg Ralivia (tramadol extended release) before surgery and acetaminophen, naproxen, pregabalin 150mg one dose and Ralivia 100mg BID for five days, as well as a rescue narcotic (hydromorphone, 1mg pills) after surgery. The S group received acetaminophen and naproxen prior to surgery and acetaminophen, naproxen and hydromorphone (1mg pills) post-operatively, our current standard. Visual analog scales (VAS) were used to assess pain and narcotic consumption was recorded at 6, 12, 24, 36, 48, 72 hours and seven days post-operatively. Patients wore a smart watch to record the number of daily steps and sleep hours. A two-sided t-test was used to compare the VAS scores and narcotic consumption. During the first post-operative week, the NF group consumed in total an average of 6.5 pills while the S group consumed in total an average of 16 pills and this difference was statistically significant (p-value=0.001). Importantly, 19 patients (50%) in the NF group and four patients (12%) in the S group did not consume any narcotics post-operatively. For the VAS scores at 24, 48, 72 hours and seven days the NF group's average scores were 2.17, 3.17, 2.92, 2.06 respectively and the S group's average scores were 3.97, 4.2, 3.23, 1.97. There was a statistically significant difference between the groups at 24 and 48hours (the NF group scored lower on the VAS) with a p-value of 0.0008 and 0.04 respectively, but this difference is not considered clinically significant as the minimal clinically important difference reported in the literature is a two-point differential. The NF group walked an average of 1985.75 steps/day and slept an average of 8h01 minute/night, while the S group walked an average of 1898.26 steps/day and slept an average of 8h26 minutes/night in the first post-operative week. Hallux valgus remains a common orthopedic foot problem for which surgical treatment results in moderate to severe post-operative pain. This study demonstrates that with the use of multimodal analgesia, ultrasound guided ankle blocks and a percutaneous surgical technique, narcotic requirements decreased post-operatively. The use of long-acting tramadol further decreased the need for narcotic consumption. Despite decreased use of narcotics, this combined novel approach to hallux valgus surgery allows for early mobilization and excellent pain control


Orthopaedic Proceedings
Vol. 87-B, Issue SUPP_III | Pages 383 - 383
1 Sep 2005
Tenenbaum S Segal A Driengel N Israeli A Chechick A
Full Access

Background: 75% of Achilles tendon ruptures are related to physical activities. The best method of treatment for acute Achilles tendon rupture is still debated. Treatment options can be classified as Nonoperative based on cast immobilization, open surgery, and percutaneous surgery based on passing sutures through several stab incisions. Common complications include re-ruptures, infection, wound problems and sural nerve injury. Recent reports of percutaneous surgery show good functional outcome, low incidence of re-ruptures, fewer wound healing problems and prompt recovery. Objective: Assessment of percutaneous operative treatment outcome. Methods: 73 patients treated for acute Achilles tendon rupture with percutaneous surgery in the past eight years are followed. Evaluations were preformed at an average of 34.6 months postoperatively (range, 17 to 54 months). Outcome was evaluated by analyzing Epidemiologic, subjective and objective parameters. Results: The patients demonstrated good functional outcome, with none – to mild limitations in recreational activities. Ankle range of motion was not statistically different between both ankles. Evaluation of strength and power with the Cybex II dynamometer revealed a difference at 240 deg/sec for plantar flexion power between the injured and healthy leg, but no difference at 30 and 90 deg/sec, or in dorsiflexion power and strength. Complication rate was low: sural nerve injury (1 patient), superficial wound infection (2 patients), suture granuloma (4 patients) and re-rupture (1 patient). Conclusions: In our series, percutaneous operative treatment was found to be simple, fast and can be done under local anesthesia. Our low complication rate and excellent functional results make this treatment an appealing alternative to either conservative or open surgical suture


Orthopaedic Proceedings
Vol. 96-B, Issue SUPP_16 | Pages 47 - 47
1 Oct 2014
Ruatti S Merloz P Moreau-Gaudry A Chipon E Dubois C Tonetti J Milaire M Kerschbaumer G
Full Access

In recent years internal fixation of the spine by using posterior approach with minimally invasive and percutaneous technique were increasingly used in trauma. The percutaneous surgery lose information and navigation is supposed to provide better data because the lost information is found again. We hypothesise that a percutaneous minimal invasive dorsal procedure by using 3D intra-operative imaging for vertebral fractures allows short operating times with correct screw positioning and does not increase radiation exposure. 59 patients were included in this prospective, monocentric and randomised study. 29 patients (108 implants) were operated on by using conventional surgical procedure (CP) and 30 patients (72 implants) were operated on by using a 3D fluoroscopy-based navigation system (3D fluo). In the two groups, a percutaneous approach was performed for transpedicular vertebroplasty or percutaneous pedicle screws insertion. In the two groups surgery was done from T4 level to L5 levels. Patients (54 years old on average) suffered trauma fractures, fragility fractures or degenerative instabilities. Evaluation of screw placement was done by using post-operative CT with two independent radiologists that used Youkilis criteria. Operative and radiation running time were also evaluated. With percutaneous surgery, the 3D fluo technique was less accurate with 13.88% of misplaced pedicle screws (10/72) compared with 11.11% (12/108) observed with CP. The radiation running time for each vertebra level (two screws) reached on average 0.56 mSv with 3D fluo group compared to 1.57 mSv with the CP group. The time required for instrumentation (one vertebra, two screws) with 3D fluo was 19.75 minutes compared with CP group 9.19 minutes. The results were statistically significant in terms of radiation dose and operative running time (p < 0.05), but not in terms of accuracy (p= 0.24). With percutaneous procedures, 3D fluoroscopy-based navigation (3D fluo) system has no superiority in terms of operative running time and to a lesser degree in terms of accuracy, as compared to 2D conventional procedure (CP), but the benefit in terms of radiation dose is important. Other advantages of the 3D fluo system are twofold: up-to-date image data of patient anatomy and immediate availability to assess the anatomical position of the implanted screws


The Bone & Joint Journal
Vol. 98-B, Issue 3 | Pages 365 - 373
1 Mar 2016
Lucas y Hernandez J Golanó† P Roshan-Zamir S Darcel V Chauveaux D Laffenêtre O

Aims. The aim of this study was to report a single surgeon series of consecutive patients with moderate hallux valgus managed with a percutaneous extra-articular reverse-L chevron (PERC) osteotomy. . Patients and Methods. A total of 38 patients underwent 45 procedures. There were 35 women and three men. The mean age of the patients was 48 years (17 to 69). An additional percutaneous Akin osteotomy was performed in 37 feet and percutaneous lateral capsular release was performed in 22 feet. Clinical and radiological assessments included the type of forefoot, range of movement, the American Orthopedic Foot and Ankle (AOFAS) score, a subjective rating and radiological parameters. . The mean follow-up was 59.1 months (45.9 to 75.2). No patients were lost to follow-up. Results. The mean AOFAS score increased from 62.5 (30 to 80) pre-operatively to 97.1 (75 to 100) post-operatively. A total of 37 patients (97%) were satisfied. At the last follow up there was a statistically significant decrease in the hallux valgus angle, the intermetatarsal angle and the proximal articular set angle. The range of movement of the first metatarsophalangeal joint improved significantly.. There was more improvement in the range of movement in patients who had fixation of the osteotomy of the proximal phalanx. Conclusion. Preliminary results of this percutaneous approach are promising. This technique is reliable and reproducible. Its main asset is that it maintains an excellent range of movement. Take home message: The PERC osteotomy procedure is an effective approach for surgical management of moderate hallux valgus which combines the benefits of percutaneous surgery with the versatility of the chevron osteotomy whilst maintaining excellent first MTPJ range of motion. Cite this article: Bone Joint J 2016;98-B:365–73


Bone & Joint 360
Vol. 12, Issue 6 | Pages 36 - 39
1 Dec 2023

The December 2023 Trauma Roundup360 looks at: Distal femoral arthroplasty: medical risks under the spotlight; Quads repair: tunnels or anchors?; Complex trade-offs in treating severe tibial fractures: limb salvage versus primary amputation; Middle-sized posterior malleolus fractures – to fix?; Bone transport through induced membrane: a randomized controlled trial; Displaced geriatric femoral neck fractures; Risk factors for reoperation to promote union in 1,111 distal femur fractures; New versus old – reliability of the OTA/AO classification for trochanteric hip fractures; Risk factors for fracture-related infection after ankle fracture surgery.


Orthopaedic Proceedings
Vol. 92-B, Issue SUPP_I | Pages 132 - 133
1 Mar 2010
Tonetti J Merloz P Vouaillat H Eid A
Full Access

Following orthopaedic reconstruction and cranial neurosurgery, spine surgery is now entering its low invasive period. When, in 90’s, computer went routinely available in the surgical field, the main goal was to help surgeons operate on with more accuracy some difficult but standard procedures. The surgery was “computer aided”. The displayed tools on 2D or 3D images allowed surgeons to avoid permanent intra operative landmarks. Once patient personal anatomy was capture into the machine and the tools calibrated, the surgeon was able to plan and optimised ideal trajectories without direct vision to check tools position. “Navigation” starts to be more obvious to describe this intra operative control. Anyway, we still needed large exposure to get the full bone surface in order to build a 3D surface based model. This model optically localised was matched using rigid or elastic algorithm with preoperative CT scan model or bone morphing. ®. Ultrasound recognition of the soft tissue/bone interface let think about trans cutaneous palpation. However, automatic segmentation of the bone surface never lead to commercially available soft. Only X-ray is commonly use during surgery to help surgeon to see tools and bone without surgical exposure. Fluoroscopy allows percutaneous trajectory as iliosacral screwing, vertebroplasty, fracture nailing et caetera. Radiation exposition could therefore be an issue for patient but also for surgeon. Fluoronavigation is a good response to percutaneous surgery. In spine no transversal view could be available. Surgeons should make mental reconstruction of the volume to perform the right trajectory. Industrial proposed intra operative tomography on C-arm with 3D reconstruction. It works well for limbs, but in thoracic and lumbar spine the large amount of surrounding soft tissues leads to low quality images. Flat panel X-ray receptor are a path to get more accurate images. Other perspectives are circular intra CT scan. The cost and the volume of machines stops the spread of such device. Robots are used by knee surgeons but abandoned by hip surgeons. In spine tool holder robot are available in order to place a pedicular drill guide. Matching with bone is based on fluoroscopy. Spine navigation could be useful to e-leaning and simulators too. The training of percutaneous surgery is long, because of mental matching between fluoroscopic 2D projections and the vertebra volume. We need a simulator allowing 3D virtual trajectory checked on AP and lateral view to short the learning curve


Orthopaedic Proceedings
Vol. 98-B, Issue SUPP_5 | Pages 11 - 11
1 Feb 2016
Merloz P Ruatti S Dubois C Chipon E Kerschbaumer G Milaire M Moreau-Gaudry A Tonetti J Dao Lena S
Full Access

Introduction. We report a single-centre, prospective, randomised study for pedicle screw insertion, by using a Computer Assisted Surgery (CAS) technique with three dimension (3D) intra-operative images intensifier versus conventional surgical procedure. Methods. 143 patients (68 women and 75 men) were included in this study. 72 patients underwent conventional surgery (C = conventional). 71 patients were operated on with the help of a 3D intra-operative imaging system (N = navigated). We performed 34 percutaneous surgeries in group N and 37 in group C; 25 open surgeries in group N and 35 in group C. 382 screws were implanted in group C and 174 in group N. We measured the pedicle screw running-time, and surgeon's radiation exposure. All pedicle runs were assessed according to Heary's classification by two independent radiologists on a post-operative CT. Results. 3D Fluoro-navigation appeared less accurate with percutaneous procedures (24% of misplaced pedicle screws versus 5% in Group C) (p=0,007), but more accurate in opened surgeries (5% of misplaced pedicle screws versus 17% in Group C) (p=0,025). In this study, 3D-fluoroscopy navigation increases the instrumentation time, with a strongly higher radiation rate. Conclusion. Therefore, our work hypotheses are partially confirmed according to the type of analysed criteria


Orthopaedic Proceedings
Vol. 96-B, Issue SUPP_1 | Pages 16 - 16
1 Jan 2014
Uglow M
Full Access

Purpose of the Study. A cooled, side cutting burr designed for use in adult foot surgery has been used as a primary bone cutting device in children to facilitate a truly percutaneous method of performing osteotomies. Stabilisation of the femur was using a percutaneous locked nail and for the tibia percutaneous K-wires. The author describes the advantages and disadvantages of this method with results from the first cohort of patients treated. Method. Patients under going osteotomy of the femur, tibia and fibula using a 2 mm × 20 mm side cutting burr were followed prospectively and assessed for scar size, bone healing time and complications. Results. Thirty six osteotomies were performed in the femur and tibia in 25 patients. A fibula osteotomy was always performed with a tibial osteotomy. Scar size for the femoral osteotomy was <15 mm and for the nail insertion <25 mm. For the tibia & fibula the scar size was <10 mm. Healing time was by 6 weeks in the tibia and in the femur was within 16 weeks in non-lengthening cases in all but 1 case of non-union (associated with Vitamin D insufficiency). Three burr bits broke during the learning curve including 2 in tibial osteotomies and 1 in the femur. Cortical thickness and slow burr speeds were associated with burr breakage. All wounds healed without infection. The optimum speed for the burr at 50 Nm of torque was established as 200 rpm in children under the age of 13 yrs. The initial recommended speed of 300 rpm increases healing time when performing osteotomies in children. Conclusion. Truly percutaneous surgery can be performed to osteotomise the femur and tibia using a cooled, side cutting burr with a locked femoral nail and crossed tibial wires with excellent cosmetic results and minimal complications. Level of Evidence IV


The Journal of Bone & Joint Surgery British Volume
Vol. 89-B, Issue 2 | Pages 145 - 154
1 Feb 2007
Giannoudis PV Tzioupis CC Pape H Roberts CS

With the development of systems of trauma care the management of pelvic disruption has evolved and has become increasingly refined. The goal is to achieve an anatomical reduction and stable fixation of the fracture. This requires adequate visualisation for reduction of the fracture and the placement of fixation. Despite the advances in surgical approach and technique, the functional outcomes do not always produce the desired result. New methods of percutaneous treatment in conjunction with innovative computer-based imaging have evolved in an attempt to overcome the existing difficulties. This paper presents an overview of the technical aspects of percutaneous surgery of the pelvis and acetabulum


Orthopaedic Proceedings
Vol. 93-B, Issue SUPP_IV | Pages 540 - 540
1 Nov 2011
Bauer T Lortat-Jacob A Hardy P
Full Access

Purpose of the study: Different metatarsal osteotomies performed via a percutaneous approach can be used to correct hallux valgus. The purpose of this work was to analyse the clinical and radiographic results of percutaneous treatment of hallux valgus using a distal wedge osteotomy of the metatarsal. Material and methods: This was a consecutive prospective series of 125 cases of hallux valgus treated by the same surgical technique, distal wedge osteotomy of the metatarsal without fixation. Percutaneous lateral arthrolysis and percutaneous varus correction of the first phalanx were associated. The AOFAS function score for the forefoot was determined preoperatively and at last follow-up. Time to normal shoe wearing and to resumption of occupational activities were also noted. Angle correction was determined on the anteroposterior weight-bearing image. All patients were reviewed at mean 20 months (range 12–40). Results: The AOFAS forefoot function score was 46/100 preoperatively and 87/100 at last follow-up. Mean motion of the metatarsophalangeal joint was 95 preoperatively and 80 postoperatively. Mean metatarsophalangeal valgus was 30 preoperatively and 12 at last follow-up. The mean intermetatarsal angle improved from 13 to 8 and the orientation of the joint surface of the first metatarsal (DMAA) improved from 11 to 7. The metatarsophalangeal joint of the first ray was congruent in 45% of the feet preoperatively and in 88% postoperatively. Mean time to wearing normal shoes was seven weeks for the treatment of hallux valgus alone and three months for surgery of the first ray and lateral rays. Discussion: Percutaneous treatment of mild to moderate hallux valgus by distal wedge osteotomy of the metatarsal enables good clinical and radiographic improvement. The surgical technique requires experience with percutaneous surgery of the forefoot to avoid the main complications: secondary displacement in elevates and excessive shortening of the first metatarsal. This technique restores metatarsophalangeal congruence of the first ray compared with Isham-Reverdin osteotomy


Orthopaedic Proceedings
Vol. 90-B, Issue SUPP_II | Pages 337 - 337
1 Jul 2008
Bhattacharyya M Gerber B
Full Access

Background: Acute rupture of Tendo achillis can be treated by open, percutaneous surgery and minimally invasive technique. Open method reported to have high complication. Objective: We report the outcome and length of hospital stay with minimally invasive technique with achillion. Design: Non randomised prospective observational study form October 2002 to December 2005. Materials and Methods: 9 male non professional athletes of mean age 38 years (range 23-73) presented with closed rupture were treated surgically using achillon technique were treated with same preoperative cast, post operative orthosis and rehabilitation protocol. All the patients had suture removed at 10 days after the surgery and followed up at 3 weeks, 8 weeks, 12 weeks and 6 months and yearly. Results: The average operating time is 38 mins [range 27-58mins]. Mean length of incision is 3.4cm. No patient had clinical DVT, sural nerve disturbance and failure of repair and no bed stay. Summary: Achillion Method helps to repair tendon under direct visualization, preserving its vascularity. We found no complication in wound healing. This surgical technique reduces financial burden in terms of bed use and wound care to the care provider. Randomised control studies may be necessary to highlight potential cost effectiveness


Orthopaedic Proceedings
Vol. 93-B, Issue SUPP_IV | Pages 539 - 540
1 Nov 2011
Laffenêtre O Larrach H Darcel V Villet L Grecmip DC
Full Access

Purpose of the study: Minimally invasive techniques are gaining popularity. We report our experience with the treatment of hallux valgus using a hybrid technique combining wedge osteotomy of M1 and other procedures (arthrolysis, phalangeal osteotomy) performed percutaneously. Material and methods: This was a prospective consecutive series of 172 operated feet in 139 patients, mean age 2005 to 2007. All procedures were performed by the same operator and reviwed by an independent observer at mean maximum follow-up of 18 months. The same operative technique was used; the only variable was Akin osteotomy performed (in 67%) or not, fixed (one out of three) or not. Assessment compared pre and postoperative values for the angles M1M2, M1P1, DMAA and DM2AA, joint range of motion, Kitaoka score and morbidity. Results: At maximum follow-up, the independent observer noted: 40.6% and 71% improvement in M1M2 and M1P1 angles, 42.3% in DMAA and 122% in DM2AA, 32.3% in the P1P2 angle, and 71.8% in the Kitaoka score. Dorsiflexion was diminished 4.2%, plantar flexion 19.6%. Material was removed in 7%, and complication rate was 2.9%; there were no deep infections. The procedure was achieved in an outpatient setting from 57% of patients. Excepting one patient who was disappointed, all other patients were satisfied or very satisfied with their operation. Discussion: Wedge osteotomy is an attractive first-intention procedure for the treatment of moderate hallux valgus. It is even more so when combined with the academic percutaneous surgery imported in France by GRECMIP indicated in a still limited number of situations. All parameters are significantly improved with a perfectly controlled morbidity. The absence of deep infection despite (or thanks to) refection 15 days after the first dressing is particularly noteworthy. This method has the approval of nearly 100% of patients and presents many advantages: absence of pain related to unwonted mobilization during wound care, maximal protection of the operated foot in the dressing which is humid at first then hardens forming a shock absorber without extra cost for the postoperative care. Conclusion: We validate this concept which constitutes a fundamental progress in forefoot surgery, particularly in phase with the current concern for cost containment