Purpose of the study: Minimally invasive techniques are gaining popularity. We report our experience with the treatment of hallux valgus using a hybrid technique combining wedge osteotomy of M1 and other procedures (arthrolysis, phalangeal osteotomy) performed percutaneously.

Material and methods: This was a prospective consecutive series of 172 operated feet in 139 patients, mean age 2005 to 2007. All procedures were performed by the same operator and reviwed by an independent observer at mean maximum follow-up of 18 months. The same operative technique was used; the only variable was Akin osteotomy performed (in 67%) or not, fixed (one out of three) or not. Assessment compared pre and postoperative values for the angles M1M2, M1P1, DMAA and DM2AA, joint range of motion, Kitaoka score and morbidity.

Results: At maximum follow-up, the independent observer noted: 40.6% and 71% improvement in M1M2 and M1P1 angles, 42.3% in DMAA and 122% in DM2AA, 32.3% in the P1P2 angle, and 71.8% in the Kitaoka score. Dorsiflexion was diminished 4.2%, plantar flexion 19.6%. Material was removed in 7%, and complication rate was 2.9%; there were no deep infections. The procedure was achieved in an outpatient setting from 57% of patients. Excepting one patient who was disappointed, all other patients were satisfied or very satisfied with their operation.

Discussion: Wedge osteotomy is an attractive first-intention procedure for the treatment of moderate hallux valgus. It is even more so when combined with the academic percutaneous surgery imported in France by GRECMIP indicated in a still limited number of situations. All parameters are significantly improved with a perfectly controlled morbidity. The absence of deep infection despite (or thanks to) refection 15 days after the first dressing is particularly noteworthy. This method has the approval of nearly 100% of patients and presents many advantages: absence of pain related to unwonted mobilization during wound care, maximal protection of the operated foot in the dressing which is humid at first then hardens forming a shock absorber without extra cost for the postoperative care.

Conclusion: We validate this concept which constitutes a fundamental progress in forefoot surgery, particularly in phase with the current concern for cost containment.

Purpose: The purpose of this work was to demonstrate the usefulness of osteoplasty block for the treatment of primary hip osteochondritis.

Material and methods: Eighteen children underwent surgery between 1992 and 2001. Mean age at diagnosis was eight years five months (5–13 years). Preoperatively, mean motion limitation was −25 in abduction and internal rotation. Radiologically the series included: Catterall II Herring B with signs of high-risk head (n=2), III B (n=7), III C (n=1), IV B (n=1), IV C (n=2), and sequelar stage (n=2). Mean excentration was 6.5 mm and mean lateral overhang was 10.2 mm. Surgery was indicated because of an aggravation of the excentration with revascularisation. An iliac graft was encrusted in a limbic rail and covered with rectus femoris tendon left continuous to provide elastic support. A bermuda cast was used for 17 children with immediate weight bearing for eleven. Hospital stay was 36 hours for all children.

Results: Sixteen children were reviewed at mean follow-up of three years two months. There were no complications. Clinically, there all patients were pain free, but three developed persistent limping. Ten had a moderate limitation of hip movement and three had severe joint stiffness. Radiologically, there was good head coverage in fifteen hips and joint congruency in fifteen, including eleven with concentric congruency. The intervention was considered useful for twelve children, and not useful for one who developed complete lysis of a poorly positioned graft. Usefulness was uncertain for three children, including the two with a sequelar-stage hip at diagnosis.

Discussion: Femoral osteotomy to correct the valgus and pelvic osteotomy to reorient or widen the acetabulum are effective treatments but have many disadvantages (limited abduction movement, leg length discrepancy, re-intervention to remove material). The excellent integration of the plasty block at mid term is a sign of effective head-acetabulum adaptation. Clinical and radiological results have been similar to those obtained with other methods. Joint stiffness and postoperative limping are observed in very severe cases. Joint prognosis depends on the severity of the disease.

Conclusion: This series of paediatric patients who have not yet reached bone maturity shows that the plasty block meets expectations for the treatment of early-stage primary hip osteochondritis. Treatment time is short and there are no complications.