Secuelas graves de la cirugía del hallux valgus: opciones quirúrgicas para su tratamiento / Serious sequellae of the hallux valgus surgery: More options for its surgical treatment

Objetivo. Se expone un procedimiento para tratar las secuelas originadas por fracaso de técnicas correctoras del hallux valgus, que producen grave acortamiento del primer radio con metatarsalgia severa y dificultad para realizar el tercer rocker. Material y métodos. El trabajo, realizado en 2 hospitales de Madrid y Barcelona, analiza los resultados clínicos y radiológicos de 40 casos, en los que predomina el sexo femenino en un 97,5%. Técnicamente consiste en realizar una artrodesis metatarsofalángica, previa distracción ósea con un minifijador externo, y posteriormente interponer un injerto óseo de cresta ilíaca, estabilizándolo con una placa o con el mismo minifijador. Resultados. El acortamiento medio preoperatoriamente fue de 2,5 cm y el alargamiento obtenido osciló entre 1,5 y 3,0 cm. La integración ósea clínica y radiológica se consiguió a los 2-4 meses, manteniéndose esta al año de seguimiento. Para valorar los resultados, se aplicaron los criterios de Blauth y Falliner en periodos intermedios y al año de la cirugía, mediante la Escala Visual Analógica (VAS score/dolor, escala 1-10) que fueron favorables en un 80%, sin modificarse en el tiempo. La tasa de fracasos fue del 7,5%; cabe destacar la no integración del injerto y la infección, que requirieron cirugía adicional. Discusión. Hay escasas publicaciones sobre graves secuelas de la cirugía del hallux valgus, tampoco hay pautas establecidas al respecto, salvo la artrodesis convencional. El problema se plantea cuando el paciente presenta grave acortamiento con metatarsalgia severa y una artrodesis metatarsofalángica directa que agravaría el problema al acortar más el primer radio. En dichos casos nuestros procedimientos están indicados (AU)

Objective. The purpose of this study is to present a method for treating the serious consequences that result from failure of corrective techniques used for hallux valgus, which produces severe shortening of the first ray, and makes it difficult to perform the third rocker. Material and methods. In this study, conducted in 2 hospitals in Madrid and Barcelona, an assessment was made of the clinical and radiological results of 40 cases, of which 97.5% were female. Technically it involves making a metatarsophalangeal arthrodesis after bone distraction with an external mini-fixation, and then inserting an iliac crest bone graft, stabilising it with a plate or the mini-fixator. Results. The pre-operative shortening was 2.5 cm. and elongation obtained was between 1.5 and 3.0 cm. Clinical and radiological bone graft integration was achieved at 2-4 months, although full integration occurred after one year. Falliner and Blauth criteria were used to evaluate the results at 6 and 12 months follow-up, and using Visual Analogue Scale (VAS score/pain, scale 1-10), being favourable in 80%, and not changing over time. The failure rate was 7.5%, which included the non-integration of the graft and infection, requiring additional surgery. Discussion. There are not many publications on the number and type of complication for hallux valgus surgery, or guidelines established, only the treatment by conventional fusion. The problem arises when the patient presents a severe shortening of the ray, and direct fusion would aggravate the insufficiency of the first ray and the transference metatarsalgia. In these cases, these procedures would be indicated (AU)

Serious sequellae of the hallux valgus surgery: More options for its surgical treatment. / Secuelas graves de la cirugía del hallux valgus: opciones quirúrgicas para su tratamiento.

OBJECTIVE: The purpose of this study is to present a method for treating the serious consequences that result from failure of corrective techniques used for hallux valgus, which produces severe shortening of the first ray, and makes it difficult to perform the third rocker. MATERIAL AND METHODS: In this study, conducted in 2 hospitals in Madrid and Barcelona, an assessment was made of the clinical and radiological results of 40 cases, of which 97.5% were female. Technically it involves making a metatarsophalangeal arthrodesis after bone distraction with an external mini-fixation, and then inserting an iliac crest bone graft, stabilising it with a plate or the mini-fixator. RESULTS: The pre-operative shortening was 2.5cm. and elongation obtained was between 1.5 and 3.0cm. Clinical and radiological bone graft integration was achieved at 2-4 months, although full integration occurred after one year. Falliner and Blauth criteria were used to evaluate the results at 6 and 12 months follow-up, and using Visual Analogue Scale (VAS score/pain, scale 1-10), being favourable in 80%, and not changing over time. The failure rate was 7.5%, which included the non-integration of the graft and infection, requiring additional surgery. DISCUSSION: There are not many publications on the number and type of complication for hallux valgus surgery, or guidelines established, only the treatment by conventional fusion. The problem arises when the patient presents a severe shortening of the ray, and direct fusion would aggravate the insufficiency of the first ray and the transference metatarsalgia. In these cases, these procedures would be indicated.

Infecciones de tobillo y pie / Foot and ankle infection

Los principios básicos del manejo de la infección del tobillo y pie son los mismos que existen ante cualquier infección ósea. Es fundamental lograr el diagnóstico de infección, el aislamiento e identificación del germen, el manejo general del paciente, el tratamiento antibiótico y las diferentes técnicas quirúrgicas. Sin embargo, algunas enfermedades sistémicas, como la insuficiencia arterial de las extremidades o la neuropatía diabética, tienen graves repercusiones en el pie. También es necesario recordar que el pie es fundamental en la bipedestación y deambulación. Todas estas características le confieren aspectos específicos y técnicas quirúrgicas propias como la calcanectomía y la amputación de un radio

Principles of management of foot and ankle infection are the same that any bony infection. It is very important to diagnose the infection, bacteria isolation and identification, the general management of the patient, antibiotic therapy and surgical procedures. However, it is necessary to know that some illness like arterial insufficiency of the limb and diabetic neurophaty have severe repercussions on the foot. It is also necessary to remember that the foot is basic in walking and weigthbearing. All these topics make that foot infections have some specific characteristics and some particular surgical procedures like calcanectomy and the amputation of a ra

El pie en reumatología

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Sepsis due to group G Streptococcus after a total hip arthroplasty. A case report.

A patient with a total hip arthroplasty developed an aggressive infection with group G Streptococcus. Very few similar cases have been reported, but they all resolved with antibiotics or drainage. A Girdlestone resection was necessary in our case because of loosening and extensive bony destruction. The true incidence may be greater than that reported and the prognosis may be worse.

[Resection arthroplasty in the treatment of hallux valgus]. / Die Resektionsarthroplastik zur Behandlung des Hallux valgus.

Sixty-six feet operated on for hallux valgus in 1984 were reviewed. Keller-Brandes' operation was performed in all cases, together with Lelièvre's "fibrous cerclage" and flexor hallucis longus tendon anchoring to the sesamoid pad, as described by A. Viladot. In most cases, satisfactory clinical correction was achieved and the patients could wear standard shoes. More than half of the cases presented partial limitation of movement at the first metatarsophalangeal joint; however, flexion power of the big toe was preserved, and the range of motion was wide enough to allow a painless and limp-free gait. Radiologically, good correction of the angle between the first and second metatarsals and the metatarsophalangeal angle was obtained, but all cases presented proximal displacement of sesamoid bones. A baropodometric study showed that the toe-off phase of the gait does not change after this operation. In our series, central metatarsalgia was present in 17 feet; however, it did not compromise the functional result and was easily relieved with orthopaedic devices. Four feet showed radiographic images, suggesting necrosis of the first metatarsal head; all four were asymptomatic. The only case that required reoperation was the one that developed hallux varus deformity. The Keller-Brandes-Lelièvre-Viladot procedure is still a simple and effective method for the surgical treatment of hallux valgus in elderly people with osteoarthritis at the first metatarsophalangeal joint.

Congenital flat foot: different clinical forms.

Using standard lateral x rays of 32 congenital flat feet (CFF) treated in our institutions, we studied the alignment in the sagittal plane of the tarsal and metatarsal bones. All feet presented with a complete dislocation of the talonavicular joint and a vertical talus. In some cases, however, the alignment of the calcaneocuboid joint was abnormal. In these, both the talus and the calcaneus appeared verticalized with no apparent subtalar joint subluxation (type I). Other cases, by contrast, had a normally aligned calcaneus thus implying subluxation of the subtalar joint (type II). Between the two types, a spectrum of clinical forms combining features from both categories exists. Recognition of the different varieties of CFF is of importance when planning surgery. Type I CFF requires reduction and stabilization of the whole midtarsal joint, while in type II CFF attention must be given to both the subtalar and calcaneocuboid joints.

Gluteal fibrosis.

After reviewing the literature the authors discuss the aetiology and pathogenesis of gluteal fibrosis. We believe that the condition occurs more frequently than is thought. If this is borne in mind when dealing with children from four to six years old, presenting with abnormal gaits, an early diagnosis can be made. As regards treatment, we agree with those authors who maintain that if diagnosed early the lesion can be treated successfully by physiotherapy alone. In more advanced cases, Z lengthening of the tendon is indicated.