Modified lapidus procedure for the treatment of hypermobile hallux valgus.

The intermediate outcome of patients who underwent a modified Lapidus procedure for the treatment of hallux valgus secondary to a hypermobile first ray was evaluated with an outcome tool to determine if their pain and functional status were improved. We evaluated 31 feet in 26 patients who underwent a modified Lapidus procedure. All working patients (100%) returned to full-time work. Six patients were retired and one was unemployed prior to surgery. There was an average of eight months until sports or unlimited activities were performed, and an average 16 weeks until conventional shoes could be worn. All patients but one (96%) were satisfied with the surgery and knowing their results would have the surgery again. Postoperative pain relief satisfaction was totally satisfied in 19 patients, satisfied with reservations in six patients, and not satisfied in one patient. Postoperative appearance satisfaction was totally satisfied in 21 patients and satisfied with reservations in five patients. Postoperative joint motion was no noticeable stiffness in 22 patients, noticeable stiffness but not bothersome in three patients, and stiffness that impairs activity in one patient (two feet). In the radiographic measurements, there was an average improvement of 10 degrees in the hallux valgus angle, 10 degrees in the intermetatarsal angle, two degrees in the lateral metatarsal-floor angle and two grades in the sesamoid position. Complications experienced were five recurrent deformities, two metatarsalgias, and one deep vein thrombosis. One of the five recurrences became symptomatic and required a revision.

Triple arthrodesis in adults using rigid internal fixation: an assessment of outcome.

The intermediate outcome of patients who underwent a triple arthrodesis for the treatment of adult foot disorders was evaluated with an outcome tool to determine if their pain and functional status were improved. We evaluated 63 feet in 57 patients who underwent a triple arthrodesis using rigid internal fixation for the treatment of hindfoot deformities associated with symptomatic arthrosis. Twenty-four men and thirty-three women, with an average age of 54 years, were evaluated. The average follow-up was 30 months. Multiple diagnoses contributed to hindfoot deformities with secondary arthrosis. Iliac crest bone graft was used in 56 of 63 cases (89%). Percutaneous heel cord lengthening was done in 53 of 63 cases (84%). Twenty-four of the thirty patients (80%) returned to work. Twenty-five patients were retired and two were unemployed before surgery. All patients except two (97%) were satisfied with the surgery and would have the surgery again. The average American Orthopaedic Foot and Ankle Society Ankle-Hindfoot preoperative score was 28 points, and the average postoperative score was 81 points (P < 0.0001). In the radiographic measurements, there was an average improvement of 12 degrees in the lateral talometatarsal angle, 7 degrees in the lateral talocalcaneal angle, and 10 degrees in the AP talometatarsal angle (P < 0.0001). Complications experienced included two varus malunions, two valgus malunions, two nonunions, two deep vein thromboses, one distal fibula stress fracture, and one wound infection. Of the 26 feet in 22 patients with mortise views available, 10 feet (38%) had evidence of ankle arthrosis and 19 feet (73%) had some degree of talar tilt postoperatively.

The prognostic value of quantitative bone scan in knee osteochondritis dissecans. A preliminary experience.

We reviewed the records of 12 patients ages 9 to 16 years with knee osteochondritis dissecans. All patients had clinical histories and examinations, four radiographic views of the knee, and technetium-99m diphosphonate quantitative bone scans. Scan results (symmetric, increased, or decreased activity), clinical course, healing time, and final outcome were correlated to determine the prognostic value of the scan. We divided the patients into those with open physes (distal femoral and proximal tibial) and those with closed physes. Four of the six patients with open physes had increased activity on the bone scan. All four of these knees healed with nonsurgical treatment. The other two patients had decreased activity on bone scan, and both required surgical treatment after nonsurgical treatment failed. Of the six patients with closed physes, all had increased activity on the bone scan, but only two patients had healing of the osteochondral lesion without surgery. Quantitative bone scanning had a 100% predictive value for the prognosis in osteochondritis dissecans patients with open physes, but for those with closed physes the predictive value was less. Because the natural history in the adolescent group is less predictable, it is in this group that the quantitative scan would be most helpful. In this small group of patients, quantitative bone scanning had limited prognostic value.

Subtalar distraction bone block fusion: an assessment of outcome.

Twenty-nine feet in 28 patients who underwent subtalar distraction bone block fusion for the treatment of subtalar deformities associated with symptomatic arthrosis were evaluated. All patients were assessed with the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale score. Eighteen men and 10 women with a mean age of 44 years were evaluated. The mean follow-up was 33 months. Subtalar arthrosis was secondary to trauma in 27 of 29 feet (93%) with os calcis fractures in 19, subtalar dislocations in 5, and talus fractures in 3. Eighteen of the 28 patients (64%) returned to either full- or part-time work. The change in the mean AOFAS Ankle-Hindfoot Scale score from 25 preoperatively to 75 postoperatively was statistically significant (P < 0.0001). The radiographic analysis of the pre- and postoperative standing lateral radiographs showed an average increase of 8 mm in hindfoot height, 9 degrees in lateral talocalcaneal angle, and 11 degrees in lateral talar declination angle that were statistically significant (P < 0.0001). All patients but one (96%) were satisfied. Complications included four nonunions, two varus malunions, one metatarsal stress fracture, and one medial plantar nerve paresthesia. Each nonunion occurred in patients who smoked.