Introduction

Acromioclavicular dislocation (ACD) is frequent, at 8% of all shoulder traumas. Management in grade III lesions remains controversial. The present study assessed objective and subjective results at medium-term follow-up (mean, 60 months; range, 12—120 mo) in 27 patients managed by Ligastic® ligament reconstruction for acute dislocation.

Purpose of the study: Scarf osteotomy is currently the gold standard treatment for hallux valgus. The purpose of our work was to search for anatomic and clinical factors affecting the outcome.

Material and methods: This retrospective review concerned 125 osteotomies performed in 105 patients (101 women and 4 men, mean age 48 years, age range 16–75 years). For 55 cases, Scarf osteotomy was associated with osteotomy of the proximal phalanx. Osteotomies to reduce the lateral metatarsals were performed in 32 cases. Clinical outcome was assessed in terms of pain, hallux function and motion using the AOFAS and Groulier systems. AP and lateral weight-bearing views were used to assess the metatarsophalangeal, intermetatarsal, interphalangeal, PPAA, DMAA, and Djian angles and metatarsal slope.

Results: Mean follow-up was 45 months (range 24–95). The Kiaoka and Groulier score improved respectively from 50 to 84/100 points and 38 to 68/100 points (p< 0.0001). Pain relief was total or nearly total in 95% of patients. MPJ stiffness was related to gastrocnemius retraction, osteoarthritic degeneration, and residual deformation (p< 0.05). Subjectively, 72% of patients were satisfied or very satisfied, corresponding to 73% good or very good results. At last follow-up M1P1, M1M2 and DMAA had decreased significantly (p< 0.001) respectively improving from 33° to 18°, 14° to 9.5° and 13.2° to 9.4°. Conversely, mean P1P2 and PAA increased significantly (p< 0.05) because certain inter- and intraphalangeal deformations, radiographically masked by the preoperative hallux pronation, were not corrected. There were 29 recurrences (MP angle > 25°) statistically related to under correction of the intermetatarsal angles (p< 0.0001), M1M5, DMAA (p< 0.05), persistent hallomegaly (p=0.015), and presence of an oblique cuenometatarsal space (p=0.02). Recurrence was more frequent in patients with flat foot (p=0.04); greater calcanceal valgus was associated with wider MP angle (p=0.02).

Discussion and conclusion: Scarf osteotomy enabled complee correction of 80% of the deformations. To improve the final outcome, displacement of the first metatarsal should correct the metatarsus varus and the DMAA. Careful radioclinical analysis pre- and intra-operatively should held detect posterior (flat foot) and anterior (hallomegaly, inter- and intraphalangeal crossover) of the MPJ because they significantly influence persistence or recurrence of the deformation.

Purpose: Mediotarsal arthrodesis can correct the deformation and relieve pain in adults with reducible talipes planovalgus. We assess clinical and radiological outcome.

Material and methods: This retrospective analysis involved 22 cases of reducible talipes planovalgus (Johson stage 2) in 19 patients (eleven men and eight women), mean age 43 years (15–75). Clinical assessment was based on pain, function and motion (AOFAS and Mann). AP and lateral weight-bearing radiographs with Meary cerclage were used to determine the Djian angle, talometatarsal alignment, talar tilt, calcaneal valgus, and stage of osteoarthritis in adjacent joints.

Results: Mean follow-up was 88 months (6–243). Two non-unions evolved favourably after cancellous graft. The Kitaoka score was 73.5 points/94 (53–94). Pain and function improved respectively from 2.8 to 1.1/4 points and 3.5 to 1.6/4 points on the de Mann scale. Flexion-extension remained unchanged. The foot was well aligned in 68% of the cases (7.5 points). Mean talar tilt and talocalcaneal divergence were normalised but defective Djian angle persisted with a broken de Meary line in 98% and 41% of cases respectively. Calcaneal valgus was reduced 6.6° (16.6 to 10°) and podoscopy showed that flat foot persisted in 86% of the cases. In 50%, neighbouring joints presented progressive osteoarthritic degeneration with clinical impact in only one patient (4.5%). Subjectively, 73% of the patients were satisfied or very satisfied and none of the patients were disappointed. The objective outcome was excellent or good in 68% of cases.

Discussion: Pain, function, motion, complications and rate of satisfaction were comparable with data in the literature (Mann, Baxter, Steinhäuser). Mediotarsal arthrodesis is effective against pain and allows satisfactory recovery of function without morbidity greater than talonavicular arthrodesis (Harper). However, while the foot is well aligned in the majority of the cases, the plantar vault is poorly restored clinically and radiologically. Compensatory over-motion of the adjacent joints probably leads to bone remodelling and moderate asymptomatic osteoarthritis seven years after the procedure.