RESUMO
BACKGROUND: Opening wedge proximal metatarsal osteotomy combined with first metatarsophalangeal arthroplasty can be used to correct first metatarsus primus varus with a high intermetatarsal angle and a short first metatarsal. METHODS: 147 feet in 138 patients with degenerative first metatarsophalangeal arthrosis, >or=15 degrees of metatarsus primus varus and, a short first metatarsal were included. Preoperative and postoperative clinical, radiographic, and subjective outcome measurements were taken (Scale AOFAS). RESULTS: The mean first intermetatarsal angle decrease was 7.79+/-1.43 degrees and the mean increase in first metatarsal length was 2.88+/-0.45 mm. The pre-intervention mean values were 52.6 points in the AOFAS scale, and an overall result of 92.95 obtained after surgery (P<0.001). CONCLUSIONS: The opening proximal first metatarsal osteotomy without internal fixation and with first metatarsophalangeal resection arthroplasty can correct severe hallux valgus with an intermetatarsal angle >or=15 degrees and a short first metatarsal, achieving low rate of complications.
Assuntos
Artroplastia/métodos , Hallux Valgus/cirurgia , Articulação Metatarsofalângica/cirurgia , Osteotomia/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Hallux Valgus/diagnóstico por imagem , Hallux Valgus/fisiopatologia , Humanos , Masculino , Articulação Metatarsofalângica/diagnóstico por imagem , Articulação Metatarsofalângica/fisiopatologia , Pessoa de Meia-Idade , Satisfação do Paciente , Radiografia , Amplitude de Movimento Articular , Estudos Retrospectivos , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do TratamentoRESUMO
OBJECTIVE: The purpose of proximal tarso-metatarsal joint resection is to provide early weight-loading for biomechanical realignment and correct weight imbalance across the MTP joint. Therefore, its main indications are all those metatarsalgia in which previous orthopaedic treatment has failed. MATERIAL AND METHODS: We report our experience in metatarsalgia management with proximal metatarsal resection. This is a retrospective study between April 1997 and December 2005. 40 feet underwent this procedure (36 patients), with a total report of 86 osteotomies. Clinical results were evaluated with American Orthopaedic Foot and Ankle Society Lesser Metatarsophalangeal-Interphalangeal Scale Score (maximum score: 100 points). RESULTS: A 10-15-grade correction was achieved with a mean resection of 2mm. Assessment with AOFAS' scale disclosed previous average 35.75+/-4.2 with a final score reported of 88.4+/-6.9 (range 65-100). An overall mean increase of 52.65 points was achieved. No case had major complications that required further surgery. Pain improved in 39 patients (97.5%), and persisted in one patient. CONCLUSIONS: Proximal metatarsal resection is a simple technique that provides adequate correction of the abnormal pressure distribution across the MTP joint without internal fixation.
Assuntos
Ossos do Metatarso/cirurgia , Metatarsalgia/cirurgia , Procedimentos Ortopédicos/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Pessoa de Meia-Idade , Medição da Dor , Estudos Retrospectivos , Resultado do TratamentoRESUMO
Between 1997 and 2006, radiographs of 66 scaphoid fractures were retrospectively reviewed to evaluate ulnar variance. Twenty-one (31.8%) patients had an 'ulna neutral' wrist, six (9.1%) had an 'ulna plus' and 39 (59.1%) had an 'ulna minus' wrist. The mean ulnar variance was -1.3 (SD 1.8) mm (range -5.5, 2.5). We observed a significant difference in the distribution of ulnar variance (P < 0.00001) and in the proportion of cases with ulna minus (OR = 5.0; 95% CI: 2.7, 9.3) compared to previous publications.