Prospective randomized comparative study on V-Y and pants-over-vest capsulorraphy in chevron and scarf osteotomy.

The contribution of capsulorraphy techniques at hallux valgus surgery to sustain the longevity of the achieved correction is not well documented. This study aims to evaluate the outcome of two different capsulorraphies (V-Y and pants-over-vest). 88 feet were prospectively included and followed for 2 years. Capsulorraphy type was determined by randomisation. Primary outcome was the correction of the intermetatarsal angle (IMA) and the metatarso-phalangeal angle (MPA). Secondary endpoints were the Kitaoka-MTP1-score and the SF-36. A linear model for repeated measures was used for statistical analysis. VY and PV showed a comparable evolution for IMA (p = 0.42) and MPA (p = 0.36). However, a tendency to loss of MPA correction was noted in the scarf group for PV as compared to VY (p = 0.037). Secondary outcomes showed no significant differences between PV and VY in evolution over time for SF-36 total (p = 0.45) nor for the Kitaoka score (p = 0.15). We observed a complication rate comparable with those previously reported. The 2 year follow up did not reveal significant loss of correction of the IMA, regardless of the capsulorraphy used. The SF-36 and Kitaoka score results were stable over the study period.

Patient positioning for microdiscectomy nearly fatal because of iatrogenic obstruction to inferior cardiac inflow caused by hepatic hernia.

A routine microdiscectomy was complicated by an inferior cardiac inflow obstruction caused by compression of the inferior vena cava. This was due to further upward migration of an existing hepatic hernia through a right-sided diaphragmatic defect. Understanding the pathogenesis of this problem allowed the surgical team to adjust the positioning of the patient. After installing the patient on a different frame, the prone position was well tolerated and the microdiscectomy could be performed without the need to repair the diaphragmatic hernia.