RESUMEN
Displaced ulnar collateral ligament injuries of the metacarpophalangeal joint of the thumb, also known as Stener lesions, are a well-recognized clinical entity, requiring surgical intervention because of the trapped location of the torn lateral collateral ligament superficial to the adductor aponeurosis of the thumb. We report a similar lesion located at the first metatarsophalangeal joint, to our knowledge the first ever described in the literature. In our patient, magnetic resonance imaging showed a full-thickness tear of the lateral collateral ligament of the first metatarsophalangeal joint, as well as a full-thickness tear of the extensor hood, with dislocation of the proximal part of the ruptured lateral collateral ligament to a position superficial to the extensor hood. Analogous to true Stener lesions, we are convinced these patients also need early surgical repair. Therefore, we would like to raise awareness about their existence to ensure adequate management of these lesions, in order to prevent possible long-term complications like chronic pain, instability, and joint degeneration.
Asunto(s)
Ligamentos Laterales del Tobillo/diagnóstico por imagen , Ligamentos Laterales del Tobillo/lesiones , Imagen por Resonancia Magnética/métodos , Artes Marciales/lesiones , Articulación Metatarsofalángica/diagnóstico por imagen , Articulación Metatarsofalángica/lesiones , Adolescente , Terapia Combinada , Femenino , Humanos , Ligamentos Laterales del Tobillo/cirugía , Articulación Metatarsofalángica/cirugía , Modalidades de Fisioterapia , RoturaRESUMEN
The surgical principles of management of chronic osteomyelitis of metatarsal bone of the foot have remained unchanged, but the debridement tools and level of precision have improved. This study reports the use of the Versajet system to achieve accurate, effective wound debridement during an elective orthopedic surgery in the difficult and confined geometric and anatomical area of the metatarsophalangeal joint of the foot. The patient experienced minimum blood loss and tissue resection during the procedure and healed well without complications.
Asunto(s)
Artritis Infecciosa/cirugía , Hidroterapia/métodos , Articulación Metatarsofalángica/cirugía , Osteomielitis/cirugía , Adolescente , Antibacterianos/uso terapéutico , Artritis Infecciosa/diagnóstico por imagen , Artritis Infecciosa/terapia , Enfermedad Crónica , Desbridamiento/instrumentación , Desbridamiento/métodos , Femenino , Floxacilina/uso terapéutico , Humanos , Hidroterapia/instrumentación , Articulación Metatarsofalángica/diagnóstico por imagen , Articulación Metatarsofalángica/patología , Osteomielitis/diagnóstico por imagen , Osteomielitis/terapia , RadiografíaRESUMEN
There is a paucity of objective information in the literature about first metatarsophalangeal (MTP) hemiarthroplasty. The authors postulate that it is a reasonable treatment option for severe hallux rigidus in selected patients. Twenty-two elective first MTP hemiarthroplasties were performed on 20 patients that met the inclusion criteria. Pre- and postoperative evaluations were done using the American Orthopaedic Foot and Ankle Society (AOFAS) forefoot score, visual analogue scale (VAS) pain score, range of motion (ROM) measurements, and radiographs. Average ROM and dorsiflexion improved by 15° and 8°, respectively. VAS pain scores improved from 5 to 2.5 after six weeks. Painless ambulation occurred after six weeks, with maximum improvement by six months. After 24 months, two patients had pain at the surgical site interfering with function, leading to an unsatisfactory result that required conversion to arthrodesis. First MTP hemiarthroplasty for severe hallux rigidus can be considered an alternative to fusion in properly selected patients who wish to maintain a functional range of motion.
Asunto(s)
Artroplastia de Reemplazo/métodos , Hallux Rigidus/cirugía , Hallux/cirugía , Articulación Metatarsofalángica/cirugía , Anciano , Anciano de 80 o más Años , Artroplastia de Reemplazo/instrumentación , Femenino , Hallux/diagnóstico por imagen , Hallux/fisiopatología , Hallux Rigidus/diagnóstico por imagen , Hallux Rigidus/fisiopatología , Humanos , Prótesis Articulares , Masculino , Articulación Metatarsofalángica/diagnóstico por imagen , Persona de Mediana Edad , Dimensión del Dolor , Radiografía , Rango del Movimiento Articular , Recuperación de la Función , Perfil de Impacto de Enfermedad , Resultado del TratamientoRESUMEN
BACKGROUND: Treatment options are limited for young and active patients with hallux rigidus of the first metatarsophalangeal (MTP) joint. Soft-tissue interpositional arthroplasty is a promising alternative. METHODS: The surgical technique for interpositional arthroplasty utilizing a human acellular dermal regenerative tissue matrix as a spacer is described. A retrospective review of a consecutive series of the first nine patients with Coughlin grade 3 halux rigidus who underwent this procedure is presented. Five patients were female and four were male, with a mean age of 53.3 years, a mean body mass index of 28.6, and a mean duration of symptoms of 3.1 years. RESULTS: The mean length of followup was 12.7 months, with no reported complications or failures. The mean total AOFAS score and pain sub-score were significantly higher at the most recent followup (87.9 and 34.4, respectively) versus preoperatively (63.9 and 17.8, respectively). CONCLUSIONS: These excellent early results and lack of complications may be due to the minimal bone resection associated with the procedure. This technique does not require autograft harvesting, is bone-sparing by preserving the plantar plate, and maintains the natural intrinsics of the joint by preserving its associated tendons and the FHB insertion. The sesamoid articulation also is resurfaced. Although further followup is needed, this technique may offer the young and active patient with advanced hallux rigidus an opportunity to maintain an active lifestyle, while retaining the possibility for more surgical options should the condition progress.
Asunto(s)
Artroplastia , Materiales Biocompatibles , Hallux Rigidus/cirugía , Articulación Metatarsofalángica/cirugía , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Dimensión del Dolor , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Ingeniería de Tejidos , Resultado del TratamientoAsunto(s)
Hallux Valgus/diagnóstico , Hallux Valgus/cirugía , Articulación Metatarsofalángica/cirugía , Vías Clínicas , Hallux/diagnóstico por imagen , Hallux/cirugía , Hallux Valgus/terapia , Humanos , Huesos Metatarsianos/diagnóstico por imagen , Huesos Metatarsianos/cirugía , Articulación Metatarsofalángica/diagnóstico por imagen , RadiografíaAsunto(s)
Deformidades del Pie/diagnóstico , Deformidades del Pie/cirugía , Hallux/cirugía , Articulación Metatarsofalángica/cirugía , Vías Clínicas , Huesos del Pie/cirugía , Deformidades del Pie/etiología , Hallux/diagnóstico por imagen , Humanos , Articulación Metatarsofalángica/diagnóstico por imagen , Osteotomía/métodos , RadiografíaRESUMEN
Older patients taking NSAIDs or high-dose aspirin should have complete laboratory evaluations of blood count, urinalysis, BUN/creatine, potassium, and serum transaminases several times yearly; more often if the clinical picture warrants. The use of aspirin, NSAIDs, and other medications should be reviewed in detail with the patient, particularly the rationale. The physician should stress the need to take the medications regularly, not "as needed." Physicians should also take time to warn patients against unorthodox medications and "treatments."