A new minimally extended distal Chevron osteotomy (MEDCO) with percutaneous soft tissue release (PSTR) for treatment of moderate hallux valgus.

PURPOSE: Surgical treatment of moderate hallux valgus (HV) onwards by Chevron osteotomy and all variants described to date including the recent extended distal Chevron osteotomy (EDCO), yields improvable outcome but with recurrence rate. A new modification of this technique is needed to achieve better results. METHODS: 34 consecutive female patients suffering from moderate HV underwent a new minimally extended distal Chevron osteotomy (MEDCO) with percutaneous soft tissue release (PSTR). Outcome was assessed using pre-post operative VAS-Pain, AOFAS Hallux Score and radiological measurements. Mean age was 53.7 years, follow-up 2.7 years and satisfaction score 8. RESULTS: VAS improved from 7 to 1 (p < 0.001) and AOFAS score from 64 to 90.7 (p < 0.001). Comparing postoperative HV and intermetatarsal (IM) angles of previous studies (either employing a Chevron osteotomy alone or a double Chevron-Akin) with our results, an improvement from 15.6/14.8 to 9.1 and 8.2 /8.8 to 5.6 respectively (p < 0.05) was achieved. Complication and recurrence rates were both 5.8%, lower than the documented rates of other techniques. CONCLUSION: The modified technique in the present study was found to be a more effective and reliable method of correcting hallux valgus when compared to other previous procedures. It provides a higher level of satisfaction and excellent outcomes with low complication and recurrence rates. Furthermore, the percutaneous lateral incision improved the cosmetic results by avoiding formation of a dorsal first web space scar. Medial incision is also shorter than the one used for EDCO. LEVEL OF EVIDENCE: Level IV, case series.

Treatment of distal-third clavicular fractures (Neer type ii-b) with a triple button device. / Tratamiento de fracturas de tercio distal de clavícula (tipo ii-b de Neer) con sistema de triple botón.

OBJECTIVE: The purpose of this study is to describe the outcomes of using a triple button device for the treatment of displaced distal-third clavicle fractures (Neer, type ii-b). MATERIAL AND METHOD: A retrospective review was conducted on a series of patients between November 2011 and December 2014. Fourteen patients initially met the inclusion criteria, but 2 were excluded, leaving 12 patients (83.3% male; mean age 32.2 years) for the final analysis at a mean follow-up of 26±11.24 months (range, 12-48). Post-operative follow-up was performed at 2 weeks (two first months), and monthly thereafter, until was achieving clinically and radiological healing. The functional outcome was evaluated using the Constant score, and DASH score in the last follow-up. RESULTS: The mean Constant Score was 95.5±5.2 points (range, 85-100), with a mean DASH score of 3.3±4.4 points (range, 0-12.5). The mean time to clinical healing was10.3±3.1 weeks (range, 8-16), and the mean time to radiological healing was 13.6±2.6 weeks (range, 12-20). There were no major complications. There were 5 minor complications without clinical impact: 2 coracoclavicular calcifications, 1 hypertrophic scar, 1 patient with discomfort due to the device, and 1 superficial wound infection. All patients returned their previous activity. CONCLUSION: Good clinical results can be achieved with the triple button device in unstable distal fractures of the clavicle, without the need to remove the hardware.

[Preiser's disease. A case study]. / Enfermedad de Preiser. A propósito de un caso.

The idiopathic avascular necrosis of the scaphoid or Preiser's disease is condition about which few cases have been described. In the majority of cases, it is debatable whether it is actually a spontaneous osteonecrosis, or a pathological process secondary to a systematic disease, or a result of chemotherapy treatment, or associated with taking steroids. We present the case of a 20-year old woman, with no previous trauma, with pain in her right wrist, which progressed over a period of four years. It was wrongly diagnosed as a tendinitis, and was treated conservatively without any improvement. A simple X-ray was requested that showed an abnormality of the proximal pole of the scaphoid that was beginning to fragment; a fact which was confirmed later by performing a CT scan. This was followed by nuclear magnetic resonance spectroscopy (NMR), which showed signs of ischaemia, mainly in the proximal pole. There were signs of viability in the distal fragment in the NMR using paramagnetic contrast. After the imaging tests, idiopathic avascular necrosis of the scaphoid was diagnosed. The surgical treatment consisted of the removal of necrotic fragments of the proximal pole and removal of the posterior interosseous-nerve. Two years after the intervention, the patient is asymptomatic and with a complete range of movement in the operated wrist.