Distal osteotomy of the first metatarsal bone for the correction of hallux valgus: comparison of the sagittal stability of two percutaneous techniques-a cadaveric study.

BACKGROUND: Distal first metatarsal osteotomy is used to correct mild or moderate hallux valgus (HV). We designed a cadaveric study to compare the resistance to axial load between two percutaneous distal first metatarsal osteotomies: Bösch osteotomy and percutaneous chevron. The first aim of this study was to develop a systematic technique for measuring the sagittal displacement on lateral foot X-rays. Our second objective was to measure the resistance to axial load for both of these osteotomies. METHODS: Ten pairs of freshly frozen cadaveric feet were randomly assigned to one of the two techniques investigated. Pre- and post-operative lateral X-rays were obtained. After surgery, the feet were placed under progressive axial loads up to 60 kg. Metaphyseo-diaphyseal angle (MDA) and the distance between bone fragments were measured, and the differences between the two techniques were statistically assessed. RESULTS: The MDA decreased in both surgical techniques. The mean plantar tilt was -6.90 degrees (SD = 10.251) for chevron osteotomy and -5.34 degrees (SD = 16.621) for Bösch osteotomy. There was no significant difference between the techniques (p = 0.41). Regarding the distance between the bone fragments, the Bösch osteotomy produced more plantar displacement than the chevron osteotomy, which was statistically significant for the 10 and 20 kg loads (p = 0.031 and 0.04, respectively). At loads ≥ 30 kg, the bone fragment distance did not differ significantly between the techniques (p = 0.114). CONCLUSIONS: Although the chevron technique confers higher stability regarding fragment displacement during axial loading, both techniques increase the plantar angulation of the metatarsal head. LEVEL OF EVIDENCE: Cadaveric study.

Radioguided localization of nonpalpable breast cancer lesions: randomized comparison with wire localization in patients undergoing conservative surgery and sentinel node biopsy.

OBJECTIVE: The aim of this investigation was to determine whether radioguided occult lesion localization and routine wire localization differ in respect to the effectiveness of complete excision of nonpalpable breast cancer lesions. SUBJECTS AND METHODS: This prospective randomized study included patients with breast cancer scheduled for conservative tumor excision and sentinel node biopsy. Patients were randomized to either radioguided localization or wire localization. Comparative radiologic, surgical, and pathologic data were collected and analyzed to establish the duration, ease of use, and accuracy of the two techniques for occult lesion localization. The effectiveness of sentinel node biopsy also was assessed. One radiologist and two surgeons participated in the study. RESULTS: Among 134 patients, 68 were treated with wire localization and 66 with radioguided localization. The mean duration of radiologic localization was significantly shorter for radioguided localization (p < 0.001). No statistical differences were found for the other parameters studied. Radiography of the surgical specimen showed 100% lesion excision with both techniques. Complete tumor excision with tumor-free margins was achieved in 89.4% of patients who underwent radioguided localization group and 82.4% of patients who underwent wire localization. Pathologic examination showed the excised tissue volume was slightly larger (p = 0.371) and lesion concentricity slightly less (p = 0.730) with radioguided localization. The sentinel node detection rate was 91% with radioguided localization and 84% with wire localization. CONCLUSION: The radioguided technique is as effective as the standard wire technique for localization and excision of nonpalpable breast cancer lesions and is somewhat faster and simpler to perform than wire localization.

Can ultrasound help to define orthopedic surgical complications?

This article aims to describe and illustrate the usefulness of ultrasound in detecting complications of orthopedic implants, metal fixation devices, and other surgical material, with an emphasis on soft-tissue pathology.

Sonographic findings of mesenteric panniculitis: correlation with CT and literature review.

PURPOSE: To evaluate the sonographic findings of mesenteric panniculitis (MP) and correlate them with CT findings. METHODS: We retrospectively evaluated the clinical, CT, and sonographic findings in 26 cases of MP in our hospital between January 1997 and July 2003. We also reviewed the sonographic features of MP previously described in the literature. RESULTS: The sonographic findings were well correlated to CT in 24 of 26 patients (92%). In these 24 cases, abdominal sonographic examination revealed a hyperechogenic, well-defined fatty mass (corresponding to the pseudocapsule CT sign) in the root of the mesentery, displacing the bowel loops. We found a clear interface between MP and normal intra abdominal fat. Examination with color Doppler sonography revealed the nondeviated mesenteric vessels within the mass. The persence of MP improved sonographic transmission in 9 obese patients and enabled the retroperitoneal vessels to be clearly visualized. Sonography was unable to demonstrate the preservation of the fat nearest the mesenteric vessels corresponding to the "fatty halo" sign on CT. CONCLUSIONS: Sonography is useful in the diagnostic workup for MP. The characteristic sonographic features of MP (well-defined mass, homogeneous hyperechogenicity of the mass, nondeviated vessels within the mass, and displaced bowel loops) correlate well with CT findings.