[Translated article] The effect of showing preoperative photographs on patient satisfaction following forefoot surgery.

BACKGROUND: Postoperative outcome measurement typically relies on postoperative radiological results and clinical-functional scales; however, there is a growing interest in considering patient satisfaction (including subjective aspects) as part of the success of forefoot surgery. OBJECTIVE: To determine whether showing a preoperative photograph improves satisfaction in postoperative forefoot surgery patients. MATERIAL AND METHODS: An observational, cross-sectional, analytical study was conducted in the foot and ankle unit of our centre. We included 120 participants between 18 and 90 years old who underwent forefoot surgery. The degree of satisfaction was compared using the PSQ-10 questionnaire between a group of patients who received a preoperative foot appearance image at their 3-month postoperative follow-up and those who did not receive it. RESULTS: The overall satisfaction rate was 78.33% at 3 months after the intervention. The 93.6% of patients who received the photograph were satisfied at the postoperative follow-up, while in the control group, it was 86.2% with a p value of 0.218. CONCLUSION: The degree of satisfaction in patients undergoing forefoot surgery is not associated with the presentation of preoperative photographs.

The effect of showing preoperative photographs on patient satisfaction following forefoot surgery. / Influencia de la fotografía preoperatoria en el grado de satisfacción en pacientes postoperados de cirugía de antepié.

BACKGROUND: Postoperative outcome measurement typically relies on postoperative radiological results and clinical-functional scales; however, there is a growing interest in considering patient satisfaction (including subjective aspects) as part of the success of forefoot surgery. OBJECTIVE: To determine whether showing a preoperative photograph improves satisfaction in postoperative forefoot surgery patients. MATERIAL AND METHODS: An observational, cross-sectional, analytical study was conducted in the foot and ankle unit of our center. We included 120 participants between 18 and 90 years old who underwent forefoot surgery. The degree of satisfaction was compared using the PSQ-10 questionnaire between a group of patients who received a preoperative foot appearance image at their 3-month postoperative follow-up and those who did not receive it. RESULTS: The overall satisfaction rate was 78.33% at 3 months after the intervention. The 93.6% of patients who received the photograph were satisfied at the postoperative follow-up, while in the control group, it was 86.2% with a p-value of 0.218. CONCLUSION: The degree of satisfaction in patients undergoing forefoot surgery is not associated with the presentation of preoperative photographs.

Resultados funcionales en el tratamiento ortopédico de las roturas agudas del tendón de Aquiles / Functional results in the orthopedic treatment of acute ruptures of the Achilles tendon

Resumen: Objetivo: Analizar los resultados clínicos y funcionales de los pacientes con rotura aguda del cuerpo del tendón de Aquiles tratados de forma conservadora mediante bota ortopédica y carga precoz. Material y métodos: Estudio observacional prospectivo con 19 pacientes con rotura aguda de tendón de Aquiles tratados de forma ortopédica. Se analizaron las variables demográficas, la escala ATRS (Achilles tendon Total Rupture Score), la función mediante el test de puntillas, masa muscular gemelar y el equino en reposo residual. Los registros clínicos y funcionales se realizaron a las seis semanas, tres, seis y 12 meses. Se realizó un análisis estadístico mediante Stata 14. Resultados: A los 12 meses, 94% de los pacientes realizaban puntillas monopodales, la media de la atrofia gemelar fue de 1.03 cm ± 0.51 respecto a extremidad contralateral y la diferencia de equino residual respecto el lado sano era de 5.63 grados ± 4.17, 83.24% de los pacientes realizaban su práctica deportiva habitual previa a la rotura. La media de ATRS de la muestra era de 87.41 puntos ± 17.78. Se registraron dos rerroturas parciales (11%) a los tres meses de seguimiento que continuaron con tratamiento ortopédico. Conclusiones: El tratamiento ortopédico funcional mediante bota ortopédica y carga precoz presenta buenos resultados clínicos y funcionales, considerándolo un tratamiento válido para las roturas agudas del tendón de Aquiles.

Abstract: Objective: The purpose of this study is to assess the clinical and functional results of patients with acute middle third of Achilles tendon rupture treated conservatively by orthopedic boot and early weight-bearing. Material and methods: This is a prospective observational study with 19 patients with acute Achilles tendon rupture treated by conservative treatment. Demographic variables, ATRS score, function using heel-rise test, calf circumference and Achilles tendon resting angle were analyzed. The clinical and functional registration was performed at six weeks, three, six and 12 months of injury. A statistical analysis was performed. Results: At one year follow-up, the 94% of patients were capable of standing single heel rise, the mean of twin atrophy was 1.03 cm ± 0.51 compared to uninjured side and the difference of Achilles tendon resting angle was 5.63 degrees ± 4.17 compared to contralateral limb. The 83.24% of patients returned to play and the mean of ATRS score was 87.41 points ± 17.78. Two partial re-rupture (11%) were occurred at three months of follow-up, which continued with orthopedic treatment. Conclusions: Based on the results, functional orthopedic treatment using orthopedic boot and early weight-bearing presents good clinical and functional outcomes, considering it a valid treatment for acute Achilles tendon ruptures.

[Functional results in the orthopedic treatment of acute ruptures of the Achilles tendon]. / Resultados funcionales en el tratamiento ortopédico de las roturas agudas del tendón de Aquiles.

OBJECTIVE: The purpose of this study is to assess the clinical and functional results of patients with acute middle third of Achilles tendon rupture treated conservatively by orthopedic boot and early weight-bearing. MATERIAL AND METHODS: This is a prospective observational study with 19 patients with acute Achilles tendon rupture treated by conservative treatment. Demographic variables, ATRS score, function using heel-rise test, calf circumference and Achilles tendon resting angle were analyzed. The clinical and functional registration was performed at six weeks, three, six and 12 months of injury. A statistical analysis was performed. RESULTS: At one year follow-up, the 94% of patients were capable of standing single heel rise, the mean of twin atrophy was 1.03 cm ± 0.51 compared to uninjured side and the difference of Achilles tendon resting angle was 5.63 degrees ± 4.17 compared to contralateral limb. The 83.24% of patients returned to play and the mean of ATRS score was 87.41 points ± 17.78. Two partial re-rupture (11%) were occurred at three months of follow-up, which continued with orthopedic treatment. CONCLUSIONS: Based on the results, functional orthopedic treatment using orthopedic boot and early weight-bearing presents good clinical and functional outcomes, considering it a valid treatment for acute Achilles tendon ruptures.

OBJETIVO: Analizar los resultados clínicos y funcionales de los pacientes con rotura aguda del cuerpo del tendón de Aquiles tratados de forma conservadora mediante bota ortopédica y carga precoz. MATERIAL Y MÉTODOS: Estudio observacional prospectivo con 19 pacientes con rotura aguda de tendón de Aquiles tratados de forma ortopédica. Se analizaron las variables demográficas, la escala ATRS (Achilles tendon Total Rupture Score), la función mediante el test de puntillas, masa muscular gemelar y el equino en reposo residual. Los registros clínicos y funcionales se realizaron a las seis semanas, tres, seis y 12 meses. Se realizó un análisis estadístico mediante Stata 14. RESULTADOS: A los 12 meses, 94% de los pacientes realizaban puntillas monopodales, la media de la atrofia gemelar fue de 1.03 cm ± 0.51 respecto a extremidad contralateral y la diferencia de equino residual respecto el lado sano era de 5.63 grados ± 4.17, 83.24% de los pacientes realizaban su práctica deportiva habitual previa a la rotura. La media de ATRS de la muestra era de 87.41 puntos ± 17.78. Se registraron dos rerroturas parciales (11%) a los tres meses de seguimiento que continuaron con tratamiento ortopédico. CONCLUSIONES: El tratamiento ortopédico funcional mediante bota ortopédica y carga precoz presenta buenos resultados clínicos y funcionales, considerándolo un tratamiento válido para las roturas agudas del tendón de Aquiles.

Estudio y descripción anatómica de vías de abordaje del astrágalo / Anatomical study of surgical approaches to the talus

Estudio anatómico descriptivo de las diferentes vías de abordaje de astrágalo, con documentación fotográfica, utilizando técnica en 3 dimensiones. Este estudio tiene como objetivo evaluar puntos de referencia macroscópicos, planos anatómicos, estructuras en riesgo, campo de visualización y posible aplicabilidad de cada vía de abordaje para ayudar a la toma de decisiones en el momento de la planificación quirúrgica ante una fractura de astrágalo. Dieciocho especímenes frescos y 2 inyecciones con látex en la arteria poplítea fueron estudiados realizando 2 veces cada vía de abordaje con documentación fotográfica. Este estudio propone la necesidad de realizar una correcta planificación prequirúrgica para elegir la mejor vía de abordaje en cada caso y la importancia de realizar, en la gran mayoría de casos, la vía combinada para conseguir una reducción correcta

Descriptive anatomical study of the different surgical approaches to the talus with photographic documentation using a 3-dimensional technique. The objective of this study is to evaluate macroscopic reference points, anatomical planes, structures at risk, field of visualization and possible applicability of each approach to help decision-making at the time of surgical planning in the event of a fracture of the talus. Eighteen fresh specimens and two specimens injected with black latex through the popliteal artery were dissected, performing each surgical approach twice with photographic documentation. This study highlights the need for correct pre-surgical planning to choose the best approach in each case and the importance of a combined approach in the vast majority of cases to achieve a correct reduction

Anatomical study of surgical approaches to the talus. / Estudio y descripción anatómica de vías de abordaje del astrágalo.

Descriptive anatomical study of the different surgical approaches to the talus with photographic documentation using a 3-dimensional technique. The objective of this study is to evaluate macroscopic reference points, anatomical planes, structures at risk, field of visualization and possible applicability of each approach to help decision-making at the time of surgical planning in the event of a fracture of the talus. Eighteen fresh specimens and two specimens injected with black latex through the popliteal artery were dissected, performing each surgical approach twice with photographic documentation. This study highlights the need for correct pre-surgical planning to choose the best approach in each case and the importance of a combined approach in the vast majority of cases to achieve a correct reduction.

Osteotomía calcánea con cuña de sustracción dorsal como tratamiento quirúrgico en la tendinopatía insercional de Aquiles / Dorsal wedge calcaneal osteotomy as surgical treatment for insertional Achilles tendinopathy

OBJETIVO: La osteotomía calcánea con cuña de sustracción dorsal tiene como objetivo reducir la longitud del calcáneo, elevando la inserción del tendón de Aquiles, reduciendo así la tensión en su inserción por la verticalización del calcáneo. El objetivo del estudio es evaluar los resultados clínicos de esta osteotomía en pacientes con tendinopatía insercional de Aquiles y un ángulo de inclinación del calcáneo elevado. MATERIAL Y MÉTODOS: Estudio retrospectivo de 18 pacientes con diagnóstico de tendinopatía insercional del tendón de Aquiles. Realizamos una doble osteotomía calcánea en forma de cuña dorsal, exéresis de esta y síntesis con 2 tornillos canulados. Se evaluaron los resultados clínicos-funcionales mediante las escalas EVA, AOFAS, VISA-A y satisfacción del paciente pre- y posquirúrgicas. Los parámetros radiológicos analizados fueron el ángulo de inclinación del calcáneo, la longitud del calcáneo y ángulo de Fowler-Philips. Se realizó un análisis estadístico mediante Stata 15. La media de seguimiento fueron 18,3 meses (rango 14-36). RESULTADOS: Todos los pacientes presentaron mejoría objetiva de los síntomas y de las escalas EVA (de 8,25 a 2,16 puntos) y AOFAS (de 41,5 a 86,5 puntos) con significación estadística (p < 0,05). La persistencia de calcificaciones intratendinosas en las radiografías postoperatorias no influyó en la mejoría sintomática. CONCLUSIONES: Con los resultados obtenidos consideramos que la osteotomía calcánea con cuña de sustracción dorsal es una técnica alternativa válida en el tratamiento de la tendinopatía insercional de Aquiles, sobre todo en los casos con un ángulo de inclinación del calcáneo elevado

OBJECTIVE: The dorsal wedge calcaneal osteotomy aims to reduce the length of the calcaneus and elevate the insertion of the Achilles tendon, leading to a reduction of Achilles tension in its insertion. The purpose of this study is to assess the clinical and functional results of this osteotomy in patients with insertional Achilles tendinopathy and a high calcaneal inclination angle. MATERIAL AND METHODS: This is a retrospective study with 18 patients diagnosed with insertional Achilles tendinopathy, who were treated by dorsal wedge calcaneal osteotomy, excision of the wedge and fixation with 2 cannulated screws. The VAS, AOFAS ankle-hindfoot, VISA-A and patient satisfaction scales were performed preoperatively and postoperatively. The radiological parameters analysed were the calcaneal inclination angle, the calcaneal length and the Fowler-Philips angle. A statistical analysis was performed. The mean follow-up was 18.3 months (range 14-36). RESULTS: All patients reported relief from symptoms. The VAS scale improved from 8.25 to 2.16 points; and the AOFAS score rose from 41.5 to 86.5 points (P<.05). The presence of tendon spurs on postoperative x-rays was not related to the clinical improvement. CONCLUSIONS: Based on the results that we present, the dorsal wedge calcaneal osteotomy can be considered an alternative procedure for insertional Achilles tendinopathy in patients with a high calcaneal inclination angle. The symptomatic relief of all the patients might be secondary to the reduction of the tendon tension in its insertion

Dorsal wedge calcaneal osteotomy as surgical treatment for insertional Achilles tendinopathy. / Osteotomía calcánea con cuña de sustracción dorsal como tratamiento quirúrgico en la tendinopatía insercional de Aquiles.

OBJECTIVE: The dorsal wedge calcaneal osteotomy aims to reduce the length of the calcaneus and elevate the insertion of the Achilles tendon, leading to a reduction of Achilles tension in its insertion. The purpose of this study is to assess the clinical and functional results of this osteotomy in patients with insertional Achilles tendinopathy and a high calcaneal inclination angle. MATERIAL AND METHODS: This is a retrospective study with 18 patients diagnosed with insertional Achilles tendinopathy, who were treated by dorsal wedge calcaneal osteotomy, excision of the wedge and fixation with 2 cannulated screws. The VAS, AOFAS ankle-hindfoot, VISA-A and patient satisfaction scales were performed preoperatively and postoperatively. The radiological parameters analysed were the calcaneal inclination angle, the calcaneal length and the Fowler-Philips angle. A statistical analysis was performed. The mean follow-up was 18.3 months (range 14-36). RESULTS: All patients reported relief from symptoms. The VAS scale improved from 8.25 to 2.16 points; and the AOFAS score rose from 41.5 to 86.5 points (P<.05). The presence of tendon spurs on postoperative x-rays was not related to the clinical improvement. CONCLUSIONS: Based on the results that we present, the dorsal wedge calcaneal osteotomy can be considered an alternative procedure for insertional Achilles tendinopathy in patients with a high calcaneal inclination angle. The symptomatic relief of all the patients might be secondary to the reduction of the tendon tension in its insertion.

Tratamiento del pie de Charcot complejo mediante cirugía en un solo tiempo con fijador circular estático. Serie de casos / Treatment of complex Charcot foot by single stage surgery with static circular fixation. Case series report

Objetivo: Presentamos los resultados de una serie de casos de pie de Charcot tratados mediante cirugía en un solo tiempo con fijador circular estático. Material y método: Revisión retrospectiva de 10 casos tratados con fijación externa circular estática desde 2016, con los siguientes criterios de inclusión: 1) deformidad asociada a alguno de los siguientes signos: úlcera cutánea, osteomielitis o inestabilidad articular; 2) neuropatía periférica, y 3) fallo del tratamiento ortopédico previo. Criterios de exclusión: 1) obstrucción vascular periférica sin revascularizar; 2) incapacidad para cumplir el tratamiento; 3) pacientes no deambulantes, y 4) contraindicación médica para la cirugía. De los 10pacientes, 7 hombres y 3mujeres, 6tenían afectación del pie izquierdo y 4del derecho. La edad promedio de nuestros pacientes era de 58 años (rango 39-71). Valoramos además estadio de Eichenholtz, clasificación de Brodsky, presencia de úlceras cutáneas, osteomielitis e inestabilidad. Todos los pacientes fueron tratados con fijación circular con un seguimiento medio de 17 meses (rango 11-24 meses). Postoperatoriamente, valoramos la conservación de la extremidad, curación de la úlcera cutánea, estabilidad e índice de reulceraciones. Resultados: En todos los pacientes se consiguió un pie plantígrado funcional, curación de la úlcera cutánea sin recidiva de la misma. Cuatro casos presentaron infección cutánea en las agujas, resuelta con cuidados locales. Evidenciamos rotura de aguja en 2 casos, que no requirieron recambio. Todos los pacientes están satisfechos y optarían por la misma técnica, de ser necesario. Conclusiones: En el pie de Charcot los objetivos son evitar la amputación y conseguir un pie plantígrado funcional, sin úlcera cutánea. La cirugía en un solo tiempo con fijación externa circular estática es una técnica reproducible en nuestro medio, válida además para aquellos casos en que la fijación interna puede estar contraindicada

Objective: We present a case series report of patients with Charcot foot treated by single-stage surgery with static circular fixation. Material and method: Retrospective review of 10 cases treated with static circular external fixation since 2016, with the following inclusion criteria: 1) Deformity with any of the following: ulcers, osteoporosis, osteomyelitis or instability 2) peripheral neuropathy, 3) failed orthopaedic treatment. Exclusion criteria: 1) peripheral vascular obstruction without revascularization, 2) inability to comply with treatment, 3) non-ambulatory patients, 4) medical contraindication for surgery. Of the 10patients, 7men and 3women, 6had involvement of the left foot and 4of the right one. The average age of our patients was 58 years (range 39-71). We also evaluated Eichenholtz and Brodsky classification, presence of ulcers, osteomyelitis and instability. All were treated with circular external fixation with a medium follow up of 17 months (11-24 months). Postoperatively we evaluated limb salvation, ulcer healing, stability and re-ulcerations. Results: In all patients a functional plantigrade foot was achieved, cutaneous ulcer healed without recurrence. Four cases presented superficial pin infection, solved with local wound care. We had wire ruptures in 2 cases, which did not require replacement. We had a traumatic tibial fracture after frame removal, orthopedically solved. All patients were satisfied and would opt for the same technique, if necessary. Conclusions: of the study In Charcot foot, the objectives are to avoid amputation and achieve a functional plantigrade foot, without ulcer. Single-stage surgery with static circular external fixation is reproducible in our country, and also a valid technique for those cases in which internal fixation may not be the best option

Treatment of complex Charcot foot by single stage surgery with static circular fixation. Case series report. / Tratamiento del pie de Charcot complejo mediante cirugía en un solo tiempo con fijador circular estático. Serie de casos.

OBJECTIVE: We present a case series report of patients with Charcot foot treated by single-stage surgery with static circular fixation. MATERIAL AND METHOD: Retrospective review of 10 cases treated with static circular external fixation since 2016, with the following inclusion criteria: 1) Deformity with any of the following: ulcers, osteoporosis, osteomyelitis or instability 2) peripheral neuropathy, 3) failed orthopaedic treatment. EXCLUSION CRITERIA: 1) peripheral vascular obstruction without revascularization, 2) inability to comply with treatment, 3) non-ambulatory patients, 4) medical contraindication for surgery. Of the 10patients, 7men and 3women, 6had involvement of the left foot and 4of the right one. The average age of our patients was 58 years (range 39-71). We also evaluated Eichenholtz and Brodsky classification, presence of ulcers, osteomyelitis and instability. All were treated with circular external fixation with a medium follow up of 17 months (11-24 months). Postoperatively we evaluated limb salvation, ulcer healing, stability and re-ulcerations. RESULTS: In all patients a functional plantigrade foot was achieved, cutaneous ulcer healed without recurrence. Four cases presented superficial pin infection, solved with local wound care. We had wire ruptures in 2 cases, which did not require replacement. We had a traumatic tibial fracture after frame removal, orthopedically solved. All patients were satisfied and would opt for the same technique, if necessary. CONCLUSIONS: of the study In Charcot foot, the objectives are to avoid amputation and achieve a functional plantigrade foot, without ulcer. Single-stage surgery with static circular external fixation is reproducible in our country, and also a valid technique for those cases in which internal fixation may not be the best option.

Treatment algorithm for Charcot foot and surgical technique with circular external fixation.

BACKGROUND: Charcot neuroarthropathy (CNA), commonly known as Charcot foot, is one of the most debilitating complications of diabetes mellitus. Patients with plantar ulcer and osteomyelitis (OM) due to Charcot foot represent a high cost for health systems and society in general. The amputation risk for ulcerated Charcot patients is 12 times higher than general population under 65 years old. MATERIAL AND METHODS: In this article we present the CNA treatment protocol we use in our center. We also make a detailed description of the surgical technique «single stage surgery¼ with circular external fixation. RESULTS: Our CNA treatment protocol covers the most common presentations of this severe neuropathic complication. With the «single stage surgery¼ using circular external fi xation we achieve an ulcer-free foot, successful treatment of the OM, correction of the deformity, diminished the cost of treatment, avoided amputation and prevented recurrence of the ulcer. CONCLUSIONS: The use of a treatment algorithm based on the current literature, can be an invaluable tool in the treatment of these complex patients. The circular external fixation has proven to be the only reliable tool for treating complex Charcot foot in the context of poor bone stock, active ulcers, soft tissues problems and OM.

ANTECEDENTES: La neuroartropatía de Charcot, comúnmente llamado «pie de Charcot¼, es una de las complicaciones más incapacitantes de la diabetes mellitus. Los pacientes con úlceras plantares y osteomielitis representan un gasto elevado para los diferentes sistemas de salud y la sociedad en general. El riesgo de amputación en estos pacientes es 12 veces más elevado que en la población general menor de 65 años. MATERIAL Y MÉTODOS: En el presente trabajo mostramos el algoritmo de tratamiento de nuestro centro y también presentamos de manera detallada la técnica quirúrgica de un solo tiempo con fijación externa circular. RESULTADOS: Nuestro algoritmo de tratamiento cubre la mayor parte de las presentaciones clínicas de esta complicación. Con la cirugía en un solo tiempo y el uso de la fijación externa circular se ha logrado desaparecer las úlceras, tratar satisfactoriamente la osteomielitis, corregir la deformidad, disminuir costos, prevenir recurrencias y evitar las amputaciones. CONCLUSIONES: El uso de un algoritmo de tratamiento basado en la literatura actual es de suma utilidad para este grupo de pacientes. La fijación externa circular ha demostrado ser una herramienta confiable en el tratamiento integral de estos casos.

Treatment algorithm for Charcot foot and surgical technique with circular external fixation / Algoritmo de tratamiento para el pie de Charcot y técnica quirúrgica con fijación externa circular

Abstract: Background: Charcot neuroarthropathy (CNA), commonly known as Charcot foot, is one of the most debilitating complications of diabetes mellitus. Patients with plantar ulcer and osteomyelitis (OM) due to Charcot foot represent a high cost for health systems and society in general. The amputation risk for ulcerated Charcot patients is 12 times higher than general population under 65 years old. Material and methods: In this article we present the CNA treatment protocol we use in our center. We also make a detailed description of the surgical technique «single stage surgery¼ with circular external fixation. Results: Our CNA treatment protocol covers the most common presentations of this severe neuropathic complication. With the «single stage surgery¼ using circular external fixation we achieve an ulcer-free foot, successful treatment of the OM, correction of the deformity, diminished the cost of treatment, avoided amputation and prevented recurrence of the ulcer. Conclusions: The use of a treatment algorithm based on the current literature, can be an invaluable tool in the treatment of these complex patients. The circular external fixation has proven to be the only reliable tool for treating complex Charcot foot in the context of poor bone stock, active ulcers, soft tissues problems and OM.

Resumen: Antecedentes: La neuroartropatía de Charcot, comúnmente llamado «pie de Charcot¼, es una de las complicaciones más incapacitantes de la diabetes mellitus. Los pacientes con úlceras plantares y osteomielitis representan un gasto elevado para los diferentes sistemas de salud y la sociedad en general. El riesgo de amputación en estos pacientes es 12 veces más elevado que en la población general menor de 65 años. Material y métodos: En el presente trabajo mostramos el algoritmo de tratamiento de nuestro centro y también presentamos de manera detallada la técnica quirúrgica de un solo tiempo con fijación externa circular. Resultados: Nuestro algoritmo de tratamiento cubre la mayor parte de las presentaciones clínicas de esta complicación. Con la cirugía en un solo tiempo y el uso de la fijación externa circular se ha logrado desaparecer las úlceras, tratar satisfactoriamente la osteomielitis, corregir la deformidad, disminuir costos, prevenir recurrencias y evitar las amputaciones. Conclusiones: El uso de un algoritmo de tratamiento basado en la literatura actual es de suma utilidad para este grupo de pacientes. La fijación externa circular ha demostrado ser una herramienta confiable en el tratamiento integral de estos casos.

Resultados de la técnica de Regnauld para el tratamiento del hallux valgus y el hallux rigidus en 147 casos a los 3 años / Results at 3 years of Regnauld's technique for the treatment of hallux valgus and hallux rigidus in 147 cases

Objetivo: Evaluar los resultados radiológicos, clínicos y funcionales a los 3 años de evolución en pacientes intervenidos quirúrgicamente para la corrección del hallux valgus y el hallux rigidus mediante la técnica de Regnauld. Material y método: Estudio descriptivo retrospectivo de 131 pacientes (147 casos) intervenidos mediante la técnica de Regnauld entre los años 2003 y 2006. Se revisaron 101 mujeres, 30 varones, 16 bilaterales. Edad media de 70 años. Seguimiento medio de 3 años. Se asociaron otros gestos quirúrgicos en 73 casos. Antes y tras la cirugía se valoró el estado clínico y funcional con el test de la escala AOFAS (American Orthopaedic Foot & Ankle Society) y se midieron los ángulos metatarsofalángico (AMTF), intermetatarsal (IM) y DASA (distal articular set angle ‘ángulo articular distal’). Resultados: Corrección del AMTF: 16,6°, del IM: 2° y del DASA: 1,7°. La puntuación en la escala AOFAS mejoró de 39,6 a 85,4. Resultados: En la escala subjetiva, las valoraciones fueron excelentes (25%), buenas (68%), aceptables (5%) y malas (2%). Resultados En el 4,7% hubo recidivas; en el 2% hubo dolor moderado, sin casos de hallux rigidus, hallux varus ni infección; no hubo ninguna reintervención.ConclusionesLos resultados a medio plazo son satisfactorios, con un bajo porcentaje de complicaciones. La técnica permite acortar la primera falange, corregir rotaciones, reducir los AMTF y DASA, mantener la congruencia y la integridad articular y recuperar su funcionalidad (AU)

Purpose: To assess radiological, clinical and functional results at 3 years’ evolution of patients subjected to surgical correction of hallux valgus and hallux rigidus by means of the Regnauld technique. Materials and Methods: Descriptive retrospective study of 131 patients and 147 cases operated through the Regnauld technique between 2003 and 2006. One hundred and one females and 30 males were reviewed; 16 cases were bilateral. Mean age was 70 years. Mean follow-up was 3 years. Additional surgical maneuvers were used in 73 cases. Before and after surgery, an assessment was made of the patients’ clinical and functional status using both the AOFAS and a subjective scale; measurements were taken of the metatarsophalangeal (MTP), intermetatarsal (IM) and distal articular set angles (DASA). Results: The degrees of correction achieved were 16.6° for the MTP angle, 2° for the IM angle and 1.7° for the DASA angle. Scores on the AOFAS scale improved from 39.6 to 85.4 points. On the subjective scale, 25% of cases rated their result as excellent, 68% as good and 2% as poor. As far as complications were concerned, there were 4.7% recurrences, 2% instances of moderate pain with no cases of hallux rigidus, hallux varus or infection. There were no reoperations. Conclusions: The technique makes it possible to shorten the first phalanx, correct rotations, reduce the MTP and DASA angles, preserve the joint's congruence and integrity los AMTF y DASA and regain its function (AU)