ABSTRACT
El Hallux Varus Iatrogénico es una complicación de la cirugía correctiva del Hallux Valgus muy poco frecuente. El tratamiento incluye la intervención de los tejidos blandos, y óseos. El propósito de este trabajo es mostrar los resultados clínico-radiológicos del tratamiento quirúrgico del Hallux Varus Iatrogénico Flexible Severo empleando la combinación de técnicas de reconstrucción alternativas en una paciente femenina de 59 años de edad. Se realizó liberación medial de la capsula articular MTF y abductor, osteotomía de Chevron reverso, artrodesis interfalángica izquierda, transferencia tendinosa del extensor largo de Hallux hacia plantar con botón artesanal. De acuerdo a la Escala AOFAS aumentó de 30 a 90 puntos. Se logró la corrección estable de la deformidad en varo y la consolidación de la osteotomía. El Hallux Varus Iatrogénico es una complicación poco frecuente considerada una deformidad mal tolerada, con pocos casos reportados y pocos reportes. Se debe hacer un enfoque de tratamiento paso a paso para abordar todos los elementos involucrados en el Hallux Varus iatrogénico. La corrección quirúrgica del Hallux Varus iatrogénico severo con técnicas de reconstrucción no convencionales tipo Chevron reverso y transferencia tendinosa con botón plantar, es una excelente opción terapéutica de acuerdo a los resultados obtenidos en este caso(AU)
Iatrogenic Hallux Varus is a very rare complication of Hallux Valgus corrective surgery. The treatment includes the intervention of soft tissues and bones. The purpose of this paper is to show the clinical-radiological results of the surgical treatment of Severe Flexible Iatrogenic Hallux Varus using the combination of alternative reconstruction techniques in a 59-year-old female patient. Medial release of the MTF and abductor joint capsule, reverse Chevron osteotomy, left interphalangeal arthrodesis, tendon transfer of the long extensor of Hallux to plantar with artisanal button was performed. According to the AOFAS Scale, it increased from 30 to 90 points. Stable correction of the varus deformity and consolidation of the osteotomy were achieved. Iatrogenic Hallux Varus is a rare complication considered a poorly tolerated deformity, with few reported cases and few reports. A step-by-step treatment approach must be taken to address all the elements involved in iatrogenic Hallux Varus. Surgical correction of severe iatrogenic Hallux Varus with unconventional reconstruction techniques such as reverse Chevron and plantar button tendon transfer is an excellent therapeutic option according to the results obtained in this case(AU)
Subject(s)
Humans , Female , Middle Aged , Osteotomy , Surgical Procedures, Operative , Hallux Varus/surgery , Bone Malalignment , Toe PhalangesABSTRACT
Objective To investigate the effect of free toe transplantation in finger reconstruction.Methods Free toe transplantations were performed in 164 patients (185 fingers) suffering from finger defection.There were 134 males and 30 females,aged at 12-83 years [mean (44.8 ± 11.2)years].Finger deletion severity was classified as grade Ⅰ in one case,grade Ⅱ in 18,grade Ⅲ in 23,grade Ⅳ in 49,grade Ⅴ in 54,and grade Ⅵ in 19.According to Gilbert standards,dorsal metatarsal arteries were classified as type Ⅰ in 68 cases,type Ⅱ in 84,and type Ⅲ in 12.Survival ratio of the transplanted fingers and hand function rehabilitation were observed.Results The transplanted toe survived in 160 cases (173 fingers).They composed of all the cases of grade Ⅰ-Ⅴ finger deletion and 15 cases of grade Ⅵ finger deletion; all the cases of type Ⅰ dorsal metatarsal arteries,83 cases of type Ⅱ dorsal metatarsal arteries and nine case of type Ⅲ dorsal metatarsal arteries.Transplantation failed in four cases (12 fingers) of grade Ⅵ finger defection including one case of Gilbert Ⅱ dorsal metatarsal arteries and three cases of Gilbert Ⅱ dorsal metatarsal arteries.Postoperative results were excellent in 110 cases and good in 50.Conclusions Toe transplantation is helpful to restore the finger shape and function and the outcome is satisfactory.Anatomic deformation of dorsal metatarsal arteries is the main cause for the failure of finger reconstruction.
ABSTRACT
PURPOSE: The second toe PIP joint free flap is a method of reconstruction used for abnormalities of the PIP joint of the finger. We report the results of the additional tenolysis in patients with a difference between passive ROM and active ROM after second toe PIP joint free flap. METHODS: From March 2001 to July 2008, tenolysis was performed in patients with a difference in their active and passive ROM after second toe PIP joint free transfer, performed on 14 fingers. We performed a retrospective analysis of the medical records, noting the clinical and radiological findings. In addition, we measured the preoperative and postoperative range of motion of the PIP joint. RESULTS: The average active ROM was 22.5degrees in three months after the joint transfer surgery, and was 38degrees after additional tenolysis from five months to twelve months after the joint transfer. CONCLUSIONS: Additional tenolysis, after the second toe PIP joint free flap, might be a good option with an improved results in patients with difference in active and passive ROM of a transferred PIP joint.