Minimally Invasive Arthrodesis of the Equine Proximal Interphalangeal Joint: A Biomechanical Comparison of Three 5.5-mm Cortical Screws Inserted in Lag Fashion and Two 7.0-mm Headless Cannulated Dual-Pitch Compression Screws.

OBJECTIVE: The aim of this study was to compare the biomechanical properties of two minimally invasive arthrodesis techniques of the equine proximal interphalangeal (PIP) joint (three transarticular 5.5-mm cortical screws [AO-3TLS] vs. two transarticular 7.0-mm headless cannulated multi-use compression screws [MUC-2TS]) in dynamic non-destructive testing and compression testing to failure. STUDY DESIGN: The experimental study included six pairs of cadaveric adult equine forelimbs; one limb from each horse was randomly assigned to one of the treatments, and the contralateral limb was submitted to the remaining treatment. The dynamic test was performed alternating non-destructive compression tests at a displacement rate of 5 mm/min up to 5,000 N and sinusoidal compressive cyclic tests at 6 Hz, using a 3,600-N amplitude for 8,550 cycles. Construct stiffness and maximum sagittal plane rotation about the PIP joint markers were determined during the dynamic test. After the dynamic test reached 136,800 cycles, the monotonic compressive test until failure was performed on each construct: load, displacement and sagittal plane rotation about the PIP joint marker at failure were analysed. RESULTS: The evaluated biomechanical properties showed no statistical difference between the AO-3TLS and MUC-2TS treatment groups in any of the ramps of the dynamic non-destructive test and in the compression loading until failure test. CONCLUSION: The MUC-2TS treatment produced biomechanical properties equivalent to the AO-3TLS treatment for PIP joint arthrodesis.

Plasma rico em plaquetas e células tronco no tratamento de desmopatia dos ligamentos colaterais distais em equino / Platelet-rich plasma and stem cells in the treatment of desmopathy of the distal collateral ligaments in equine

Os equinos são animais muito utilizados em eventos esportivos, sendo, desta forma, propensos a sofrer acidentes que podem levar a lesões articulares e ósseas. Na rotina clínica, artifícios como o uso de raio X e ultrassonografia são de grande importância para que o correto diagnóstico seja feito e a conduta clínica possa ser melhor planejada. Além disso, alguns biomateriais, como o plasma rico em plaquetas (PRP) e células-tronco mesenquimais (CTMs), têm se inserido nos protocolos terapêuticos, demonstrando grande efetividade no tratamento desse tipo de lesão, devido à grande quantidade de fatores de crescimento presentes em ambos os biomateriais. O PRP é um derivado sanguíneo, caracterizado pela alta concentração plaquetária. Foi produzido a partir de duas centrifugações, a primeira para separar o plasma das hemácias e a segunda para concentrar as plaquetas. As CTMs foram isoladas de tecido adiposo, cultivadas, transportadas e aplicadas de forma autóloga, assim como o PRP. No presente relato, um equino, fêmea, Brasileiro de Hipismo com 8 anos, foi diagnosticado com desmopatia nos ligamentos colaterais da articulação interfalângica distal e foi tratado com PRP e CTMs, de forma associada e sequencial. Foi encontrada uma melhora do quadro clínico, significativa, em comparação aos dados encontrados na literatura, demonstrando grande potencialidade do uso associado de PRP e CTMs no tratamento de lesões ligamentares.

Horses are animals widely used in sporting events and are therefore prone to accidents that can lead to joint and bone injuries. In the clinical routine, devices such as the use of X-ray and ultrasound are of great importance for the correct diagnosis to be made and the clinical conduct can be better planned. In addition, some biomaterials such as platelet-rich plasma (PRP) and mesenchymal stem cells (MSCs) have been included in the therapeutic protocols, demonstrating great effectiveness in the treatment of this type of injury due to the large amount of growth factors present in both biomaterials. PRP is a blood derivative, characterized by high platelet concentration. It is produced from two centrifugations, the first to separate plasma from red blood cells and the second to concentrate platelets. MSCs were isolated from adipose tissue, cultured, transported and applied autologously, as well as PRP. In the present report, an 8-year-old female Brazilian equestrian horse was diagnosed with desmopathy in the collateral ligaments of the distal interphalangeal joint and was treated with PRP and MSCs in an associated and sequential manner. A significant improvement in the clinical picture was found in comparison to the data found in the literature, demonstrating great potential of the associated use of PRP and MSCs in the treatment of ligament injuries.

Informe de caso: Resultado clínico de TOE conservado después de un evento traumático de pie / Case report: Clinical outcome of TOE preserved after Traumatic event of foot

Introduction: Decision making in determining management of post-trauma patient is very important, especially for traumatic in the small bones, fingers and toes. The global predictor to determine the management of retaining or amputating the limb is using the Mangled Extrimity Severity Score (MESS) scoring system, values above 7 are the indication for amputation. The decision maker have to pay attention for the end result of the actions which were performed in the initial management. Material and Methods: One case is reported from Orthopaedic emergency department Hospital in Makassar, South Sulawesi, Indonesia. A 39-year old male with motor vehicle accident trauma at left foot region since 6 hours before admitted to hospital, later was diagnosed with open comminutive fracture shaft proximal phalang of left 5th toe, the Mangled Extrimity Severity Score (MESS) was 8. Patient underwent emergency debridement and retained the toe by performed Open Reduction Internal Fixation (ORIF) K-Wire. Results: This patient has a good clinical outcome by following up 2 weeks and 8 months after surgery by retain the affected side with debridement and Open Reduction Internal Fixation (ORIF) K-Wire. Patient can ambulate normally with full weight bearing, and there is no difficulty to wearing shoe or sandal. Conclusions: Determination of action by retaining the traumatized limb needs to be considered for the good of the patient, but it is necessary to provide informed consent to the patient and family that there will be a possibility of tissue death with the worst possibility of limb amputation

Comparison of a 3-hole 4.5-mm Dynamic Compression Plate and a 7-hole 5.5-mm Y Locking Compression Plate for Arthrodesis of the Proximal Interphalangeal Joint in Horses-an Ex Vivo Biomechanical Study.

The objective of this study was to compare the biomechanical properties in a single cycle axial loading test and the types of failures in two constructs (a 3-hole 4.5-mm dynamic compression plate (DCP) and 7-hole 5.5-mm Y locking compression plate (Y-LCP)) in equine proximal interphalangeal joint (PIJ) arthrodesis. One limb in each pair was randomly assigned to PIJ arthrodesis using a 3-hole 4.5-mm DCP combined with two transarticular 5.5-mm cortical screws, whereas the contralateral limb was submitted to PIJ arthrodesis using a 7-hole Y-shaped 5.0-mm LCP in conjunction with one transarticular 4.5-mm cortical screw inserted through the central plate hole. Cortical screws were inserted in lag fashion. Constructs were submitted to a single axial load cycle to failure. Construct stiffness, load, and deformation were analyzed. Dynamic compression plate and Y-LCP arthrodesis constructs did not differ significantly and were equally resistant to axial loading under the conditions studied (DCP and Y-LCP group stiffness, 5685.22 N/mm and 6591.10 N/mm, respectively). Arthrodesis of the PIJ using a DCP and two transarticular 5.5-mm cortical screws or a Y-LCP yielded biomechanically equivalent outcomes under the test conditions considered. However, Y-LCP provides less impact in the palmar/plantar bone. Application of Y-LCP with unicortical screws has equivalent biomechanical characteristics of DCP and may be a safe option for PIJ arthrodesis, where potential trauma secondary to applying bicortical screws in the palmar/plantar aspect of the pastern can be avoided.

Use of platelet-rich plasma in the treatment of desmitis of distal interphalangeal joint collateral ligament in a horse

Background: Platelet-rich plasma (PRP) has been increasingly used to hasten healing of tendonitis and desmitis, allowinghorse athletes to go back to practicing sports in a shorter period of time. However, its use has rarely been reported in thetreatment of desmitis of the collateral ligaments of the distal interphalangeal joint (CL-DIP), which is based on the useof horseshoes and rest for at least six months. This paper describes the use of PRP as an aid in the treatment of CL-DIPin a horse athlete.Case: A male Criollo horse, 450 kg, about 15-year-old, used for paleteada. The animal had a month-long history of lameness, and a visual inspection revealed an increase in volume in the lateral dorsal region of the limb proximal to the coronaryband of the hoof. A specific examination of the locomotive system showed Grade III, Category 5 claudication, which became evident the beginning of the exercise and ceased after a short period. A radiographic evaluation of the distal phalanxrevealed no clinically relevant changes. Therefore, and in view of the location of the increased volume, an ultrasound scanwas performed, which showed an image compatible with an extensive hematoma in the region underlying the periopliccorium, while the CL-DIP presented swelling with large areas of hypoechogenicity. Considering the findings of the image,the physical examination and the history of the horse, desmitis of the collateral ligaments of the distal interphalangeal jointwas diagnosed. The treatment plan consisted of rest, application of a therapeutic horseshoe, and infiltration of the lesionwith platelet-rich plasma (PRP). First, however, warm compresses were applied to reduce the swelling. The PRP wasobtained by collecting whole blood from the external jugular vein, subjecting it to double centrifugation, and separatingthe supernatant blood plasma. The end product was applied to the lesion by ultrasound-guided infiltration. The horseshoewas a model...(AU)

Structural interaction between bone and implants due to arthroplasty of the first metatarsophalangeal joint.

BACKGROUND: Currently, the metatarsophalangeal joint replacement through a restorative arthroplasty, where implants are used, is a viable invasive surgical medical procedure in the treatment of severe cases of osteoarthritis in this joint, better known as hallux rigidus. However, few things are known about the postoperative complications that implants can cause on the joint, like Swanson and Tornier implants.Research in this field can provide a valuable information that would help the specialist surgeon in the decision-making during the selection of the more suitable joint implant in each patient, as well as the redesign of the devices, to make them more efficient, durable and biocompatible with the human body. METHODS: The aim of this work is to perform a structural biomechanical analysis of a restorative arthroplasty of the first metatarsophalangeal joint, and to analyze the interaction between bone and medical grade silicone implants. For that, a simulation of a foot with Swanson and Tornier joint implants were performed to evaluate the stress/strain distribution during a critical stage (toe-off). RESULTS AND CONCLUSIONS: Principal stresses obtained for the first metatarsal with both implants suggest that failure is induced in this bone because, values exceed (up to 136.84% for Swanson model) the tensile strength reported for phalange trabecular bone, which may be related to osteolysis. Stress and strain values obtained in this work suggest that arthroplasty surgery with Swanson implant is more likely to cause postoperative complications versus Tornier implant.

Use of platelet-rich plasma in the treatment of desmitis of distal interphalangeal joint collateral ligament in a horse

Background: Platelet-rich plasma (PRP) has been increasingly used to hasten healing of tendonitis and desmitis, allowinghorse athletes to go back to practicing sports in a shorter period of time. However, its use has rarely been reported in thetreatment of desmitis of the collateral ligaments of the distal interphalangeal joint (CL-DIP), which is based on the useof horseshoes and rest for at least six months. This paper describes the use of PRP as an aid in the treatment of CL-DIPin a horse athlete.Case: A male Criollo horse, 450 kg, about 15-year-old, used for paleteada. The animal had a month-long history of lameness, and a visual inspection revealed an increase in volume in the lateral dorsal region of the limb proximal to the coronaryband of the hoof. A specific examination of the locomotive system showed Grade III, Category 5 claudication, which became evident the beginning of the exercise and ceased after a short period. A radiographic evaluation of the distal phalanxrevealed no clinically relevant changes. Therefore, and in view of the location of the increased volume, an ultrasound scanwas performed, which showed an image compatible with an extensive hematoma in the region underlying the periopliccorium, while the CL-DIP presented swelling with large areas of hypoechogenicity. Considering the findings of the image,the physical examination and the history of the horse, desmitis of the collateral ligaments of the distal interphalangeal jointwas diagnosed. The treatment plan consisted of rest, application of a therapeutic horseshoe, and infiltration of the lesionwith platelet-rich plasma (PRP). First, however, warm compresses were applied to reduce the swelling. The PRP wasobtained by collecting whole blood from the external jugular vein, subjecting it to double centrifugation, and separatingthe supernatant blood plasma. The end product was applied to the lesion by ultrasound-guided infiltration. The horseshoewas a model...

Digital mucous cyst: surgical closure technique based on self-grafting using skin overlying the lesion.

BACKGROUND: Digital mucous cysts or myxoid cysts are relatively common, benign pseudocysts of the digits typically located at the distal interphalangeal joints or in the proximal nail fold. There are several therapeutic modalities for its treatment ranging from conservative to surgical procedures; however, there is no consensus about the best approach. MATERIAL AND METHODS: We describe a surgical technique based on the excision of the digital mucous cyst and reconstruction using a self-grafting from the overlying skin lesion. RESULTS: The use of the cyst's overlying skin as a partial cutaneous graft followed by a long-term Brown's dressing, in this case, provided a satisfactory functional and esthetic result. CONCLUSIONS: This technique is a new option for the reconstruction of digital mucous cyst defects that decreases the surgical time and avoids a graft removal of healthy skin and consequently a new scar.

Dual-Component Intramedullary Implant Versus Kirschner Wire for Proximal Interphalangeal Joint Fusion: A Randomized Controlled Clinical Trial.

We undertook a multicenter, parallel treatment arm, randomized controlled trial to compare the outcomes after surgery for the treatment of lesser digital hammertoe using either a Kirschner wire or a 2-piece intramedullary, stainless steel implant for fixation of the proximal interphalangeal joint. Our primary aim was to compare the incidence of arthrodesis and complications, and our secondary aim was to compare the subjective foot-related outcomes measured using the Bristol Foot Score and the Foot Function Index, stratified by fixation group. We hypothesized that the use of the dual-component implant would result in greater patient satisfaction, a greater incidence of radiographic arthrodesis, and fewer complications after hammertoe repair. The overall mean age of the participants was 58.72 ± 13.48 (range 18 to 84) years, their mean body mass index was 30.14 ± 6.55 (range 20.7 to 46.98) kg/m(2), and no statistically significant differences in the demographic variables were present between the treatment groups at baseline or during the follow-up period. Of the 91 participants, 46 (50.55%) were randomly allocated to the Kirschner wire group and 45 (49.45%) to the intramedullary implant group. No statistically significant differences were observed between the 2 fixation groups in the incidence of complications; however, the 2-piece intramedullary implant group was associated with a greater mean Bristol Foot Score and Foot Function Index score and a greater incidence of fusion.

Lesser toes proximal interphalangeal joint fusion in rigid claw toes.

Treatment of rigid claw toe is still subject to discussion and evolution. Arthrodesis or arthroplasty of the PIPJ is apparently the most reliable procedure. K wire seems be the most reliable way to solve this clinical issue, but different implants specifically created to treat PIPJ deformities are being developed, and still have to be tested clinically. The use of screws to fix the PIPJ is a valid alternative, although some problems remain to be solved, specifically pain in relation to the tip of the screw. Longer follow-up studies are needed to increase our knowledge of the treatment of this specific deformity.

Joint and tendon subclinical involvement suggestive of gouty arthritis in asymptomatic hyperuricemia: an ultrasound controlled study.

INTRODUCTION: In this study, we aimed to investigate ultrasonographic (US) changes suggestive of gouty arthritis in the hyaline cartilage, joints and tendons from asymptomatic individuals with hyperuricemia. METHODS: We conducted a cross-sectional, controlled study including US examinations of the knees and first metatarsal-phalangeal joints (first MTPJs), as well as of the tendons and enthesis of the lower limbs. Differences were estimated by χ² or unpaired t-tests as appropriate. Associations were calculated using the Spearman's correlation coefficient rank test. RESULTS: Fifty asymptomatic individuals with hyperuricemia and 52 normouricemic subjects were included. Hyperechoic enhancement of the superficial margin of the hyaline cartilage (double contour sign) was found in 25% of the first MTPJs from hyperuricemic individuals, in contrast to none in the control group (P < 0.0001). Similar results were found on the femoral cartilage (17% versus 0; P < 0.0001). Patellar enthesopathy (12% versus 2.9%; P = 0.01) and tophi (6% versus 0; P = 0.01) as well as Achilles enthesopathy (15% versus 1.9%; P = 0.0007) were more frequent in hyperuricemic than in normouricemic individuals. Intra-articular tophi were found in eight hyperuricemic individuals but in none of the normouricemic subjects (P = 0.003). CONCLUSIONS: These data demonstrate that morphostructural changes suggestive of gouty arthritis induced by chronic hyperuricemia frequently occur in both intra- and extra-articular structures of clinically asymptomatic individuals.

Arthrodesis of the equine proximal interphalangeal joint: a biomechanical comparison of 3-hole 4.5 mm locking compression plate and 3-hole 4.5 mm narrow dynamic compression plate, with two transarticular 5.5 mm cortex screws.

OBJECTIVES: To compare the biomechanical characteristics of 2 arthrodesis techniques for the equine proximal interphalangeal joint (PIP) using either a 3-hole 4.5 mm locking compression plate (LCP) or 3-hole 4.5 mm narrow dynamic compression plate (DCP), both with 2 transarticular 5.5 mm cortex screws. STUDY DESIGN: Experimental. SAMPLE POPULATION: Cadaveric adult equine forelimbs (*n=6 pairs). METHODS: For each forelimb pair, 1 limb was randomly assigned to 1 of 2 treatment groups and the contralateral limb by default to the other treatment group. Construct stiffness, gap formation across the PIP joint, and rotation about the PIP joint were determined for each construct before cyclic axial loading and after each of four, 5000 cycle loading regimens. After the 20,000 cycle axial loading regimen, each construct was loaded to failure. RESULTS: There were no significant differences in construct stiffness, gap formation, or sagittal plane rotation between the LCP and DCP treatment groups at any of the measured time points. CONCLUSION: Biomechanically, fixation of the equine PIP joint with a 3-hole 4.5 mm LCP is equivalent to fixation with a 3-hole 4.5 mm narrow DCP under the test conditions used.

Luxación interfalángica del hallux: presentación de ocho casos y revisión de la bibliografía / Interphalangeal dislocation of the hallux

Introducción: La luxación de la articulación interfalángica del hallux (LIFH) es una patología poco frecuente y en la bibliografía mundial se describen sólo algunos casos. Miki estableció una clasificación que la divide en dos tipos según su aspecto clínico y radiográfico. En ambos tipos la placa volar se encuentra avulsionada de sus inserciones óseas permitiendo su migración intraarticular e impidiendo la reducción por métodos ortopédicos, lo que obliga a recurrir a la reducción quirúrgica. Materiales y métodos: Entre 1995 y 2008 se evaluaron 8 pacientes, todos varones, de entre 21 y 46 años. En todos los casos se intentó la reducción ortopédica bajo anestesia local sin lograr resultados satisfactorios, por lo cual se debió recurrir al tratamiento quirúrgico para restaurar la congruencia articular. Resultados: En todos los casos se obtuvo la reducción de la articulación en forma completa. La movilidad articular en el posoperatorio alejado fue nula en 6 casos y en los 2 restantes varió entre 10º Y 20º de flexión, sin relación con la vía de abordaje utilizada. Conclusiones: La LIFH es una patología poco frecuente, que en la mayoría de los casos exige maniobras quirúrgicas para lograr la reducción. El resultado es independiente de la vía de aborda

Diagnosis of chronic gout: evaluating the american college of rheumatology proposal, European league against rheumatism recommendations, and clinical judgment.

OBJECTIVE: Observation of monosodium urate (MSU) crystal is the gold standard for diagnosis of gout, but is rarely performed in daily clinical practice, and diagnosis is based on clinical judgment. Our aim was to identify clinical and paraclinical data included in the European League Against Rheumatism recommendations (EULARr) and American College of Rheumatology proposed criteria (ACRp) for diagnosis of gout in patients with chronic gout according to their attending rheumatologists. METHODS: This cross-sectional and multicenter study included consecutive patients from outpatient clinics with a diagnosis of gout by their attending rheumatologists according to their expertise. The frequency of each item from the ACRp and EULARr was determined. Possible combinations of the items that were frequent, clinically relevant, and simple to evaluate in daily practice were determined. RESULTS: We studied 549 patients (96% men), mean age 50 +/- 14 years. Analysis of MSU crystals was performed in 15%. We selected 7 clinical criteria and 1 laboratory measure because of their frequency, importance, and simplicity to obtain: current or past history of: > 1 attack of acute arthritis (93%); mono or oligoarthritis attacks (74%); rapid progression of pain and swelling (< 24 hours; 74%); podagra (70%); erythema (56%); unilateral tarsitis (33%); tophi (52%); and hyperuricemia (93%). The chronic gout diagnosis (CGD) proposal comprised >or= 4/8 of these; 88% of patients had the criteria of the CGD proposal while 75% had 6/11 ACRp criteria (p = 0.001). When analysis of MSU crystals was added, 90.1% (CGD) and 83.9% (ACRp) met the criteria (p = 0.004). CONCLUSION: Current or past history of >or= 4/8 CGD parameters is highly suggestive of chronic gout.

Luxación interfalángica del hallux: presentación de ocho casos y revisión de la bibliografía / Interphalangeal dislocation of the hallux

Introducción: La luxación de la articulación interfalángica del hallux (LIFH) es una patología poco frecuente y en la bibliografía mundial se describen sólo algunos casos. Miki estableció una clasificación que la divide en dos tipos según su aspecto clínico y radiográfico. En ambos tipos la placa volar se encuentra avulsionada de sus inserciones óseas permitiendo su migración intraarticular e impidiendo la reducción por métodos ortopédicos, lo que obliga a recurrir a la reducción quirúrgica. Materiales y métodos: Entre 1995 y 2008 se evaluaron 8 pacientes, todos varones, de entre 21 y 46 años. En todos los casos se intentó la reducción ortopédica bajo anestesia local sin lograr resultados satisfactorios, por lo cual se debió recurrir al tratamiento quirúrgico para restaurar la congruencia articular. Resultados: En todos los casos se obtuvo la reducción de la articulación en forma completa. La movilidad articular en el posoperatorio alejado fue nula en 6 casos y en los 2 restantes varió entre 10° Y 20° de flexión, sin relación con la vía de abordaje utilizada. Conclusiones: La LIFH es una patología poco frecuente, que en la mayoría de los casos exige maniobras quirúrgicas para lograr la reducción. El resultado es independiente de la vía de abordaje utilizada.

Floating-toe deformity as a complication of the Weil osteotomy.

BACKGROUND: The Weil osteotomy for treatment of central metatarsalgia is an oblique osteotomy of the metatarsal neck and shaft parallel to the ground that provides controlled shortening of the metatarsal without additional depression. It offers many advantages over more traditional osteotomies, including stability and a large area of bone-to-bone contact. However, a floating-toe deformity appears to be a common complication after this osteotomy. METHODS: Between February, 2000 and February, 2003, 70 Weil osteotomies (in 26 patients) were done at one institution. Follow-up averaged 18.3 (6 to 36) months. Weightbearing radiographs were examined for shortening, subluxation, and for evidence of nonunion or malunion of the metatarsal head. Floating-toe deformity and mild recurrent tenderness were noted in the history and physical examination. The American Orthopaedic Foot and Ankle Society (AOFAS) Lesser Metatarsophalangeal-Interphalangeal Scale (LMIS) was used for outcome rating. At final follow-up, nonunion and malunion also were evaluated. RESULTS: The median score of the AOFAS scale was 81 (19 to 95) points. Fifty-four percent of the osteotomies were done with a proximal interphalangeal (PIP) joint arthrodesis of the same ray, and we observed a higher occurrence of floating-toe deformity in this group of patients. CONCLUSION: Although it may be associated with some complications, the Weil osteotomy is an effective and safe procedure for the treatment of central metatarsalgia. We conclude that floating-toe deformity is a common complication associated with PIP joint arthrodesis. Although it appears not to cause a functional impairment, concurrent PIP arthrodesis should be avoided to reduce the occurrence of floating toes.

Role of flaps and skin grafts in the management of neuropathic plantar ulcers

In the neurologically impaired foot pressure ulcers are common. Pressure point reduction must always be addressed. Most ulcers, perhaps with the exception of huge heel ulcers, will heal by secondary intention if treated conservatively in the right manner. However, conservative treatment can be very time consuming and might sometimes leave unstable scars. For those with recurrent ulcers, the time taken off work to heal these ulcers can be economically debilitating. Skin grafting and flep coverage can be rewarding in selected cases. Follow up with proper footwear is of uttermost importance. Soft tissue coverage can only occur when all signs of infection have resolved and the foot has an adequate blood supply.

Avaliaçäo radiológica, em amostra populacional, do ângulo cuneiforme medial/1º metatarso / Radiographic evaluation of a populational sample of the 1º metatarsophalangeal joint

Quarenta indivíduos, com idade entre 17 e 64 anos, foram submetidos a radiografias padronizadas na incidência ântero-posterior em ortostase. Em suas radiografias foram avaliados os seguintes ângulos: entre o 1° e 2º metatarsos; entre o cuneiforme medial e o 1º metatarso; entre o cuneiforme medial e o 2° metatarso; e entre o 1º metatarso e a falange proximal do primeiro raio. Foi também avaliado o grau de deslocamento lateral dos sesamóides. Estes parâmetros foram apurados e correlacionados, o que permitiu confirmar a influência que tem a presença de acentuada inclinaçäo da articulaçäo cuneiforme medial/1° metatarso na gênese do metatarso primo varo

Avaliação radiográfica do hálux valgo: estudo populacional de novos parâmetros angulares / Radiographic evaluation of the hallux valgus: population study of new angular parameters

Estimulados pelo crescente interesse, pelos fatores intrínsecos na gênese da deformidade do hálux valgo, os autores estudaram os ângulos articulares distal do primeiro metatársico (AADM), articular proximal (AAPFP) e articular distal da falange proximal do hálux (AADFP). Para isso, avaliaram as radiografias na incidência AP em ortostase de 70 indivíduos brasileiros adultos e normais (140 pés), com idades variando de 18 a 55 anos (média de 29 anos), distribuídos entre 40 indivíduos do sexo feminino (57,1 por cento) e 30 do masculino (42,9 por cento). A análise estatística a que se submeteram os dados indicaram como limites superiores da normalidade para a população estudada os valores de 8 graus para o AADN, 8 graus para o AAPFP e 10 graus para o AADFP.