Percutaneous Kirschner Wire Repair of Failed Digital Arthrodesis Using Pulsed Electromagnetic Field Therapy A Case Report.

A case of a repaired failed toe arthrodesis is presented. A novel and previously unreported approach using a percutaneously placed Kirschner wire coupled with a pulsed electromagnetic field achieved healing of a painful pseudoarthrosis at 54 days. With a percutaneous technique, open debridement of the failed arthrodesis site can be avoided.

Dedo en martillo agudo / Acute hammer toe

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[Diaphysectomy of the proximal phalanx in quintus varus supraductus and hammer toe in children]. / Diafisectomía de la falange proximal en el quinto dedo supraducto y dedo en martillo en niños.

The most frequent foot and ankle anatomical alterations in the pediatric population are found in the little toes. Several treatments are proposed for these conditions, ranging from total phalangeal resections, phalangeal osteotomies, osteosynthesis, and soft tissue management. We propose a surgical technique based on the diaphysectomy of the proximal phalanx and the release of soft tissues that are under tension. The purpose is to assess the functional foot results after surgical treatment consisting of proximal phalanx diaphysectomy and soft tissue release using the functional AOFAS scale in pediatric patients. A prospective, longitudinal, descriptive, non-comparative clinical study was conducted from March 2008 to December 2010, with a follow-up of up to six months. Twenty patients (35 toes) were included; 15 females and five males, with a mean age of 14.65 years. Fifteen (30 toes) had bilateral involvement; 88.56% had greater involvement of the fifth toe. The surgical indication was determined based on the degree of functional disability for gait and the type of footwear. The functional assessment was conducted using the AOFAS criteria and a subjective assessment scale with a total score of 100 to assess the metatarsophalangeal and the interphalangeal joints of the smallest toes. Scores were as follows: < 50 points, poor; 51-70 points, fair; 71-90, good, and > 91, excellent. The assessment was done preoperatively and at postoperative month six. The mean preoperative score was 73.55 and the mean postoperative score was 85.75, with a 12.2 point difference (p > 0.5). Results were: 11 excellent, seven good and two fair. There were four relapses, so a salvage procedure was performed with the Ruiz-Mora technique; excellent results were obtained in all four. One case had soft tissue infection. Proximal phalanx diaphysectomy and soft tissue release provides appropriate alignment of the affected toes and relief of soft tissues under tension, thus avoiding broad resections leading to both esthetic and functional alterations. This is a simple and effective technique for the treatment of little toe deformities as it improves function and alignment.

Enfermedad de Charcot-Marie-Tooth: consideraciones ortopédicas / Charcot-Marie-Tooth syndrome: orthopaedic considerations

La enfermedad de Charcot-Marie-Tooth es una enfermedad heredodegenerativa del sistema nervioso periférico. La alteración es progresiva, y provoca deformidades en pies y manos. La musculatura de la pierna y el pie es la más afectada. La forma de presentación es muy diversa debido a que la afectación muscular es diferente en cada paciente. El pie cavo-varo es la forma de presentación habitual. El tratamiento conservador consiste en férulas correctoras, plantillas y rehabilitación. La indicación quirúrgica se plantea cuando fracasa el tratamiento conservador. La deformidad y el dolor son los problemas principales. En las deformidades flexibles se plantean cirugías para preservar las articulaciones. Los dedos en garra se tratarán con transferencias tendinosas o artroplastias. La deformidad en garra del dedo gordo se produce por el descenso del primer metatarsiano y la hiperactividad del músculo extensor hallucis longus. El tratamiento de esta deformidad del dedo gordo se realiza mediante la técnica de Jones. El descenso del primer metatarsiano necesitará una osteotomía dorsiflexora en la base del primer metatarsiano. Para el varo de retropié se utiliza la osteotomía valguizante de calcáneo. La retracción de la fascia plantar, gastrocnemio y Aquiles se trata con elongación de las estructuras retraídas. Cuando las deformidades son rígidas, será necesario realizar una artrodesis de las articulaciones afectadas. La artrodesis más utilizada es la triple artrodesis (AU)

Charcot-Marie-Tooth disease is a degenerative hereditary disease of the peripheral nervous system. The change is progressive and causes deformities in the feet and hands. The musculature of the leg and foot are most affected. The form of presentation is very diverse owing to the muscle involvement being different in each patient. The high-arched foot is the most common form of presentation. Conservative treatment consists of correction splints, insoles and rehabilitation. Surgery may be indicated when conservative treatment fails. The deformity and pain are the main problems. In flexion deformities surgery is indicated to conserve the joints. Claw hammer toes should be treated with tendon transfers and arthroplasty. The claw deformity in the big toe is caused by the descent of the first metatarsal and hyperactivity of the hallucis longus extensor muscle. The Jones technique is performed as treatment for this deformity of the big toe. The descent of the first metatarsal requires a dorsiflexion osteotomy in the base of the first metatarsal. For the hind foot varus a calcaneal vagus osteotomy is used. The tightening of the plantar fascia, gastrocnemius and Achilles is treated with an extension of the muscle contractures. When the deformities are rigid, it will be necessary to perform an arthrodesis of the affected joints. The arthrodesis most used is the triple arthrodesis (AU)

[Continuous popliteal block with ropivacaine via a stimulant catheter for postoperative analgesia after foot surgery]. / Bloqueo poplíteo continuo con ropivacaína mediante catéter estimulante para analgesia postoperatoria tras cirugía del pie.

Three patients underwent foot surgery to correct hallux valgus and other toe deformities. Postoperative analgesia was provided by a sciatic nerve block in the popliteal fossa through a 21-gauge 64 mm needle and a 50 cm catheter connected to a nerve stimulator. Ropivacaine 0.125% was perfused continuously at a rate of 7 mL/h for 48 h. All 3 patients were very satisfied with the level of analgesia, given that the intensity of pain upon movement was never more than slight. Hallux valgus surgery causes intense postoperative pain that can be prevented by a peripheral nerve block. A continuous popliteal block through a catheter equipped with a nerve stimulator is an easy technique that provides very good pain management after this type of surgery, with few undesirable side effects.

Bloqueo poplíteo continuo con ropivacaína mediante catéter estimulante para analgesia postoperatoria tras cirugía del pie / Continuous popliteal block with ropivacaine through a stimulation catheter for postoperative anesthesia after foot surgery

Tres pacientes fueron intervenidas de hallux valgus y de dedos de los pies. La analgesia postoperatoria se consiguió mediante bloqueo del nervio ciático en la fosa poplítea realizado con una aguja 21G x 64 mm y un catéter de 50 cm conectados a un neuroestimulador. Por el catéter se administró ropivacaína 0,125 por ciento, en perfusión continua a 7 ml/h durante 48 h. Las tres pacientes valoraron muy satisfactoriamente la analgesia recibida dado que la intensidad del dolor no pasó en ningún momento de ser ligera con el movimiento .La cirugía del hallux valgus produce un intenso dolor postoperatorio que puede evitarse realizando técnicas de bloqueo nervioso periférico. El bloqueo poplíteo continuo con catéter estimulante es una técnica fácil que proporciona muy buena calidad analgésica en el tratamiento del dolor postoperatorio de esta cirugía con pocos efectos indeseables (AU)