Rates of revision surgery using Chevron-Austin osteotomy, Lapidus arthrodesis, and closing base wedge osteotomy for correction of hallux valgus deformity.

To identify complications that necessitated revision surgery after the primary operation, a multicenter retrospective chart review was conducted for 646 patients who received either a modified chevron-Austin osteotomy (270 patients), modified Lapidus arthrodesis (342 patients), or closing base wedge osteotomy (34 patients) to correct hallux valgus deformity. Revision surgery for complications was calculated and compared. All surgery was performed by 1 of 5 staff foot and ankle surgeons at Kaiser Permanente medical centers. Complications included recurrent hallux valgus, iatrogenic hallux varus, painful retained hardware, nonunion, postoperative infection, and capital fragment dislocation. The rates of revision surgery after Lapidus arthrodesis, closing base wedge osteotomy and chevron-Austin osteotomy were similar with no statistical difference between them. The total rate for re-operation was 5.56% among patients who received chevron-Austin osteotomy, 8.82% among those who had a closing base wedge osteotomy, and 8.19% for patients who received modified Lapidus arthrodesis. Among patients who had the chevron-Austin osteotomy procedure, rates of re-operation were 1.85% for recurrent hallux valgus and 1.48% for hallux varus. Among patients who had the modified Lapidus arthrodesis, rates of re-operation were 2.92% for recurrent hallux valgus and 0.29% for hallux varus. Among patients who had the closing base wedge osteotomy, rates of reoperation were 2.94% for recurrent hallux valgus and 2.94% for hallux varus. The collected comparative complication rates should serve to provide adjunctive information for foot and ankle surgeons and patients regarding hallux valgus surgery.

Breaking the cycle of mistrust: wise interventions to provide critical feedback across the racial divide.

Three double-blind randomized field experiments examined the effects of a strategy to restore trust on minority adolescents' responses to critical feedback. In Studies 1 and 2, 7th-grade students received critical feedback from their teacher that, in the treatment condition, was designed to assuage mistrust by emphasizing the teacher's high standards and belief that the student was capable of meeting those standards--a strategy known as wise feedback. Wise feedback increased students' likelihood of submitting a revision of an essay (Study 1) and improved the quality of their final drafts (Study 2). Effects were generally stronger among African American students than among White students, and particularly strong among African Americans who felt more mistrusting of school. Indeed, among this latter group of students, the 2-year decline in trust evident in the control condition was, in the wise feedback condition, halted. Study 3, undertaken in a low-income public high school, used attributional retraining to teach students to attribute critical feedback in school to their teachers' high standards and belief in their potential. It raised African Americans' grades, reducing the achievement gap. Discussion centers on the roles of trust and recursive social processes in adolescent development.