Introduction and Objectives: The aim of this report is to present the complications that occur with
Introduction: We present 34 patients diagnosed with hallux rigidus treated by
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
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
INTRODUCTION.
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. 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.Purpose of the study
Methods
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
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
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
In recent years internal fixation of the spine by using posterior approach with minimally invasive and percutaneous technique were increasingly used in trauma. The
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
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.
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
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
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
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
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
Background: Acute rupture of Tendo achillis can be treated by open,
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