Bösch technique for hallux valgus surgery in a tropical setting.

OBJECTIVES: To evaluate the early clinical and radiological results using the Bösch technique to treat hallux valgus. MATERIAL AND METHODS: We reviewed retrospectively four patients with 6 feet undergoing the Bösch technique for mild and moderate hallux valgus from 2009 to 2012 with an average follow-up of 10.8 months. All patients complained of pain around the first metatarsophalangeal joint. They had cosmetic concerns, and difficulty in wearing shoes. At final follow-up patients were asked about the improvement of pain, cosmetic appearance of the foot, problems with wearing shoes, the ability to walk, and their satisfaction with the operation. Complications encountered were also recorded. The radiographic evaluation considered osteotomy site union, the hallux valgus angle, and the intermetatarsal angle. RESULTS: All patients complained of mild or no pain. They had a satisfactory cosmetic result, wore normal shoes without problems with no limitation of walking ability. They were satisfied with the procedure. One case of superficial infection was noticed. All osteotomies healed primarily within three months. The average hallux valgus angle improved from 32.7° preoperatively to 14.8° at final follow-up and the average intermetatarsal angle from 17.5° to 9.2°. CONCLUSION: The Bösch technique is a cost effective procedure that yields good clinical and radiological results while correcting mild and moderate symptomatic hallux valgus with reduced risk of surgery related complications.

Avulsion fracture of the tibial tubercle associated with patellar ligament avulsion treated by staples.

We present a case of combined avulsion fracture of the tibial tubercle (AFTT) and avulsion of the patellar ligament in a 15-year-old boy. This injury was treated by open reduction and fixation of both lesions using staples with satisfactory results. This constellation of injury is rare but a high index of suspicion is needed when faced with a displaced AFTT. Open reduction and internal fixation should be the treatment of choice.

[Aortic failure neglected in surgery of mitral or mitro-tricuspid valve diseases]. / Insuffisances aortiques negligees au cours de la chirurgie des valvulopathies mitrales ou mitro-tricuspidiennes.

The objective of this study was to determine the outcome of neglected minimal or moderate aortic regurgitation during mitral or mitro-tricuspid valve surgery. 42 patients were included in this survey between 1985 and 2002. There were 17 men and 25 women aged 9-54 years (mean age: 22 +/- 10 years). Etiology was dominated by acute rheumatic fever (91%). Associated lesions were observed: mitral valve incompetence 11 cases, mitral valve stenosis 9 cases, mitral valve incompetence plus mitral valve stenosis in 8 pateints and mitro-tricuspid valve disease in 14 others. All the patients were symptomatic (NYHA class II 79%, NYHA class III or IV 20%). 90% of patients had a radiological cardiomegaly: mean cardio-thoracic was 0.62. At electrocardiogram, 79% of patients were in sinus rhythm and 57% presented a left ventricular hypertrophy. Minimal or moderate aortic regurgitation has been confirmed by echocardiography and angiocardiography in all patients. Surgical treatment was a mitral valve replacement (n = 35.83%), a mitral valvuloplasty (n = 5.12%), a mitral valve replacement and a tricuspid valve annuloplasty according to DE VEGA technique (n = 2.5%). The operative mortality was 4.7% (2 deaths) due to an acute cardiac failure (1 case) and prosthetic valve endocarditis (1 case). 19 patients have been followed up from a mean 1 month to13 years (mean follow-up: 5 years). The follow-up has been marked by a regression or a stability of the neglected aortic incompetence , a regression of the mean cardio-thoracic ratio from 0.62 preoperatively to 0.56 postoperatively, an improvement of the functional status (84% of cases). We conclude that the neglected aortic incompetence during mitral or mitro-tricuspid valve surgery do not tend to aggravate during follow-up.