Abstract. INTRODUCTION. Fracture neck of femur is aptly called as “the fracture of necessity” owing to the various factors responsible for its non-union. Pauwel's inter-trochantric valgus osteotomy is a useful approach to deal with such fractures. AIM. The aim of this study is to evaluate the functional outcome of valgus osteotomy in treatment of neglected and non-union fracture neck of femur using Harris Hip Scoring system (HHS). MATERIAL AND METHODS. This observational study included 25 patients of the age between 25 years and 50 years with more than 3 weeks since injury and the patients with failed primary fixation.
Hallux
Aim: We report radiological outcome following percutaneous minimally invasive corrention of Hallux
The aim of the study was to assess the clinical, radiological and paedobarographic outcome following modified Silver’s McBride’s procedure, in the treatment of Hallux
Abstract. OBJECTIVES.
INTRODUCTION. Hallux
Background. Authors sought to determine the degree of lateral condylar hypoplasia of distal femur was related to degree of valgus malalignment of lower extremity in patients who underwent TKA. Authors also examined the relationships between degree of valgus malalignment and degree of femoral anteversion or tibial torsion. Methods. This retrospective study included 211 patients (422 lower extremities). Alignment of lower extremity was determined using mechanical tibiofemoral angle (mTFA) measured from standing full-limb AP radiography. mTFA was described positive value when it was valgus. Patients were divided into three groups by mTFA; more than 3 degrees of valgus (valgus group, n = 31), between 3 degrees of valgus to 3 degrees of varus (neutral group, n = 78), and more than 3 degrees of varus (varus group, n = 313). Condylar twisting angle (CTA) was used to measure degree of the lateral femoral condylar hypoplasia. CTA was defined as the angle between clinical transepicondylar axis (TEA) and posterior condylar axis (PCA). Femoral anteversion was measured by two methods. One was the angle formed between the line intersecting femoral neck and the PCA (pFeAV). The other was the angle formed between the line intersecting femoral neck and clinical TEA (tFeAV). Tibial torsion was defined as a degree of torsion of distal tibia relative to proximal tibia. It was determined by the angle formed between the line connecting posterior cortices of proximal tibial condyles and the line connecting the most prominent points of lateral and medial malleolus. Positive values represented relative external rotation. Negative values represented relative internal rotation. Results. Greater lateral femoral condylar hypoplasia was related to increased valgus alignment of lower extremity. Correlation coefficient between mTFA and CTA was 0.253 (p < 0.001).
Introduction.
The aetiology of hallux valgus is well published and largely debated. Hypermobility at the TMTJ was initially described by Morton, but it was not till Lapidus that its association with hallux valgus was hypothesized. However, little has been published on the anatomy of the tarsometatarsal joint. Our aim was to determine whether there was an anatomical basis for the coronal hypermobility in hallux valgus. Method. Anatomical dissection was completed on 42 feet from 23 bodies. Presence of hallux valgus was noted (displacement of sesamoids). Measurements and photographs were taken of the first tarsometatarsal joint and all differences noted. Observations. The TMTJ articular morphology is variable. There were 3 separate subtypes identified of the metatarsal articular surface. Results. The articular subtypes identified were called called A, B and C. Type A, was uni-facet with a single flat articular surface, Type B was bi-facet with two distinct flat articular surfaces, and Type C was tri-facet, with the presence of a lateral eminence on inferolateral surface of metatarsal. Type A was found exclusively in bodies with Hallux
Background and Purpose of Study. The Valgus knee in total knee Arthroplasty, is considered a more demanding procedure, often with ligament balance a greater challenge than seen with neutral or Varus knees. It has also frequently been suggested that prostheses with higher levels of constraint be used to avoid late-onset instability. Various lateral release techniques have also been suggested in the literature. This study is aimed at assessing the outcomes of an unconstrained, rotating platform designed prosthesis, the LCS, using our technique, in the management of severe valgus deformity. Methods. 44 knees in 42 patients with a pre-operative valgus deformity of more than 10 degrees were included in our retrospective series. We analyzed the radiographs for the degree of correction, the angle of tibial tray implantation, and femoral implantation angle, tibial slope, as well as the presence (or degree) of lift off and any complications were noted. In this group, 7 had a
Introduction: We present the long term results in 204 cases of Hallux
Introduction: We present the long term results in 204 cases of Hallux
Purpose of the study: To evaluate the medium-term results of
Valgus knees present a surgically demanding challenge. Dissimilar bone and soft-tissue deformities compared to varus knees complicate restoration of proper alignment, positioning of components, and attainment of joint stability. Our study examined the relationship between tourniquet time and valgus deformity. A prospective study of all valgus knees were implanted over a 30 month period with Emotion Ortho-pilot version 4.2 Navigation system (BBraun Aesculap, Tutlingen). They were done by a single knee surgeon. Tourniquet times (TT) were recorded digitally with fixed timing criteria. The software recorded all pre- and post-operative deformities. We performed the lateral parapatella approach for all valgus knees. No patella resurfacing was done but all tibiae were cemented. There were a total of 56 valgus knees (1° to 22°, Mean 5.9°, SD 4.9). The TT varied from 42 min to 121 min (mean 72 min, SD 17.4). There was a statistically significant relationship between TT and
Short scarf osteotomy (SSO) retains the versatility of standard scarf in treating moderate and severe hallux valgus deformity with the added benefit of less invasiveness translated into less soft-tissue stripping, reduced exposure, less metalwork, less operative time and reduced cost. We present our medium-term clinical, radiographic and patient satisfaction results. All patients who underwent SSO between January 2015 and December 2017 were eligible (98). Exclusion criteria were: follow up less than a year, additional 1st ray procedures, inflammatory arthropathy, infection, peripheral vascular disease and hallux rigidus. Eighty-four patients (94 feet) were included: 80 females / 4 males with average age of 51-year-old (24–81). Minimum follow up was 12 months (12–28). Weight-bearing x-rays and AOFAS score were compared pre- and postoperatively. Non-parametric Mann-Whitney U test assessed statistical significance of our results. Hallux valgus angle (HVA) improved from preoperative mean of 30.8° (17.4°–46.8°) to 12° (4°–30°) postoperatively (p=0.0001). Intermetatarsal angle (IMA) improved from preoperative mean of 15.1° (10.3°–21.1°) to 7.1° (4°–15.1°) postoperatively (p=0.0001). Average sesamoid coverage according to Reynold's tibial sesamoid position improved from average grade 2.18 (1–3) to 0.57 (0–2) (p=0.0001). Average AOFAS score improved from 51.26 (32–88) to 91.1 (72–100) (p=0.0001). Ninety percent of patients were satisfied and 83% wound recommend the surgery. No troughing phenomenon or fractures. Four overcorrections were found 3 of which did not require surgery. One recurrence at 18 months was treated with standard scarf. We believe that this technique offers a safer, quicker and equally versatile way of dealing with Hallux
Management of a knee with valgus deformities has always been considered a major challenge. Total knee arthroplasty requires not only correction of this deformity but also meticulous soft tissue balancing and achievement of a balanced rectangular gap. Bony deformities such as hypoplastic lateral condyle, tibial bone loss, and malaligned/malpositioned patella also need to be addressed. In addition, external rotation of the tibia and adaptive metaphyseal remodeling offers a challenge in obtaining the correct rotational alignment of the components. Various techniques for soft tissue balancing have been described in the literature and use of different implant options reported. These options include use of cruciate retaining, sacrificing, substituting and constrained implants. Purpose. This presentation describes options to correct a severe valgus deformity (severe being defined as a femorotibial angle of greater than 15 degrees) and their long term results. Methods. 34 women (50 knees) and 19 men (28 knees) aged 39 to 84 (mean 74) years with severe valgus knees underwent primary TKA by a senior surgeon. A valgus knee was defined as one having a preoperative valgus alignment greater than 15 degrees on a standing anteroposterior radiograph. The authors recommend a medial approach to correct the deformity, a minimal medial release and a distal femoral valgus resection of angle of 3 degrees. We recommend a sequential release of the lateral structures starting anteriorly from the attachment of ITB to the Gerdy's tubercle and going all the way back to the posterolaetral corner and capsule. Correctability of the deformity is checked sequentially after each release. After adequate posterolateral release, if the tibial tubercle could be rotated past the mid-coronal plate medially in both flexion and extension, it indicated appropriate soft tissue release and balance. Fine tuning in terms of final piecrusting of the ITB and or popliteus was carried out after using the trial components.
Background. In the adolescent population, operative management of hallux-valgus is controversial. Operations may be less successful than in adults and post-operative recurrence is more common before full skeletal maturity. This study assesses the radiographic, functional and qualitative outcomes of surgical Hallux
To assess the outcome of Wilson’s osteotomy of the first metatarsal to correct Hallux
Aim: To evaluate results of fully congruent Mobile bearing knee arthroplasty for valgus arthritic knees using lateral capsular approach and realignment of vastus lateralis. Material and Method: We reviewed results of 50 mobile bearing total knee arthroplasties performed consecutively between 2001 and 2006 for
Aims: Surgical treatment of forefoot deformities is a common procedure. The vast majority comprising surgery for Hallux
Failed Hallux
We studied, clinically and radiologically, the growth and remodelling of 21 hips after valgus femoral osteotomy with both rotational and sagittal correction for hinge abduction in 21 patients (mean age, 9.7 years) with Perthes’ disease. The exact type of osteotomy performed was based on the pre-operative clinical and radiological assessment and the results of intra-operative dynamic arthrography. The mean IOWA hip score was 66 (34 to 76) before surgery and 92 (80 to 100) at a mean follow-up of 7.1 years (3.0 to 15.0). Radiological measurements revealed favourable remodelling of the femoral head and improved hip joint mechanics.
In moderate and severe Hallux
The purpose of this retrospective study was to report the results using scarf, first metatarsal osteotomies, in correcting Hallux
Background:. Varus or
The effect of hallux valgus (HV) on health-related quality of life (HRQOL) and the relationship between radiographic severity of deformity and patient reported outcome measures (PROMs) is poorly understood. The aim of this study was to compare the HRQOL of female patients with HV to the UK population. The secondary aim was to assess the correlation between PROMs, including HRQOL, with radiographic severity of deformity. Weight bearing radiographic data (hallux valgus (HVA) angle; intermetatarsal (IM) angle) were measured in consecutive female patients presenting with HV. Each patient prospectively completed the Euroqol EQ-5D-5L questionnaire (EQ-5D), Visual Analogue Scale for Pain (VAS-Pain) and Manchester Oxford Foot Questionnaire (MOXFQ). Data were stratified into age ranges and compared with an EQ-5D United Kingdom general population reference dataset. Pearson R correlation values were calculated for the PROMs and radiographic deformity.Background
Methods
Femoral head deformity with flattening and lateral protrusion can occur secondary to epiphyseal dysplasia or avascular necrosis of any aetiology in childhood. This causes painful impingement of the lateral femoral head on the acetabular lip, a phenomenon known as hinge abduction. We aimed to review our experience of valgus extension osteotomy in the treatment of hinge abduction in children and young adults with avascular necrosis. Twenty patients undergoing valgus osteotomy for hinge abduction performed by a single specialist were clinically and radiologically reviewed. The aetiology was Perthes disease in 16 patients and treatment of DDH in 4 patients. The indication for the procedure was pain and limited abduction. The mean follow-up was 4.5 years. Patients were assessed using modified Iowa hip scores at final follow-up. The procedure corrected some leg shortening and improved the abduction range of the affected hip. Overall 80 % of patients did well. The mean Iowa hip score in Perthes group was 84 at final follow-up. Four patients preoperatively had cysts/ defects in their femoral head. These were seen to fill up during their postoperative follow-up. Poorer outcome was associated with preoperative hip stiffness and surgery before stabilisation of the avascular process. Conclusion:
Stickler’s syndrome, also called Hereditary Progressive Arthro-Ophthalmopathy, is an autosomal dominant connective tissue disorder with strong expressivity, characterised by ocular, orofacial, skeletal, cardiac, and auditory features. We describe a case of valgus slipped capital femoral epiphysis in a 13 year-old boy with Stickler’s syndrome. He presented at routine rheumatology clinic follow-up with a 1-month history of progressively worsening right hip pain, which radiated to the knee. He underwent insitu cannulated screw fixation of the right slipped capital femoral epiphysis. Joint pains are a common manifestation in Stickler’s syndrome and this might delay the diagnosis of slipped capital femoral epiphysis.
Eighteen children between the ages of 6 and 12 years with unilateral non-united femoral neck fractures were treated by valgus intertrochanteric osteotomy with bone grafting between January 1995 and December 2000. Twelve fractures were judged as Pauwel 3, and 6 as Pauwel 2, and 5 children had avascular necrosis in addition to non-union. The initial treatment included internal fixation in 14 fractures, conservative treatment in 2 fractures, and no treatment in 2. The average interval from injury to osteotomy was 10 months (8-14 months). In each case we used a 90° child or adolescent hip plate modified by making an angle of 120 0 between the blade and shaft portions to simulate an adult Osteotomy plate. All fractures healed after osteotomy and bone grafting; the average time to radiological union was 12 weeks (8-24 weeks). At an average follow-up of 3.5 years (2-6 years), 15 cases were rated good, 2 fair, and 1 poor based on Ratliff’s criteria.
A significant number of hallux valgus is associated with valgus deviation of 2nd, 3rd and 4th toes. We recommend correction of the valgus deformity of all four rays simultaneously., because recurrence of the hallux valgus is very frequent if only the first ray is realigned. From 1978 to 1990 a series of 236 feet were operated upon for hallux valgus deformity using a distal osteotomy of the first rnetatarsal. These cases were followed up for a mean of 6, 1 years and showed that the recurrence rate was as high as 28%. Our observation was that, in the majority’ of cases, recurrence of the deformity occurred in those feet in which hallux valgus was combined with valgus deformity of the lesser toes due to varus deviation of the corresponded metatarsals. From 1990 to 1998, another series of 386 feet were operated for hallux valgus. In more than one third of them (142 feet in 96 patients) hallux valgus was associated by valgus deformity of the 2nd, 3rd, and 4th toes. These cases were operated using a distal osteotomy of the first rnetatarsal combined with osteotomies of lesser metatarsals aiming not only to face metatarsalgia, but to correct valgus deformity of the lesser toes simultaneously. These patients were followed up for a mean of 4.8 years. The results were excellent in 73 feet, good in 47, fair in 17 and poor in 5. The recurrence rate dropped to 7%. If hallux valgus is combined with valgus deformity of the lesser toes, correction of only the first ray creates a gap between first and second toe. Consequently there is no blocking effect toward valgus deviation of the great toe due to the gap remaining between the first and second toe. The above combined procedure seems to give better results with low recurrence rate in comparison with the results of single correction of the first ray.
Recurrence after surgical correction of hallux valgus may be related to coronal rotation of the first metatarsal. The scarf osteotomy is a commonly used procedure for correcting hallux valgus but has limited ability to correct rotation. Using weightbearing computed tomography (WBCT), we aimed to measure the coronal rotation of the first metatarsal before and after a scarf osteotomy, and correlate these to clinical outcome scores. We retrospectively analyzed 16 feet (15 patients) who had a WBCT before and after scarf osteotomy for hallux valgus correction. On both scans, hallux valgus angle (HVA), intermetatarsal angle, and anteroposterior/lateral talus-first metatarsal angle were measured using digitally reconstructed radiographs. Metatarsal pronation (MPA), alpha angle, sesamoid rotation angle and sesamoid position was measured on standardized coronal CT slices. Preoperative and postoperative(12 months) clinical outcome scores(MOxFQ and VAS) were captured.Introduction
Methods
We evaluated growth and remodeling of the 21 hips after valgus osteotomy with rotational and sagittal components for hinge abduction in 21 patients (mean, 9.7 years) with Legg-Calvé-Perthes disease (LCPD) both clinically and radiologically. The type of osteotomy was determined by assessing the hinge movement three-dimensionally using preoperative gait assessment, 2-dimensional/3-dimensional computed tomography (2D/3D-CT), and intraoperative dynamic arthrography. The Iowa hip score averaged 66 (34 to 76) before operation and 92 (80 to 100) at a mean follow-up of 7.1 years (3.0 to 15.0). Radiographic measurements revealed favorable remodeling of the femoral head and improved hip joint mechanics.
Introduction. Hallux
Preoperative talar valgus deformity increases the technical difficulty of total ankle replacement (TAR) and is associated with an increased failure rate. Deformity of ≥15° has been reported to be a contraindication to arthroplasty. The goal of the present study was to determine whether the operative procedures and clinical outcomes of TAR for treatment of end-stage ankle arthritis were comparable for patients with preoperative talar valgus deformity of ≥15° as compared to those with <15°. We will describe the evolving surgical technique being utilized to tackle these challenging cases. Fifty ankles with preoperative coronal-plane tibiotalar valgus deformity of ≥15° “valgus” group) and 50 ankles with valgus deformity of <15° (“control” group) underwent TAR. The cohorts were similar with respect to demographics and components used. All TARs were performed by a single surgeon. The mean duration of clinical follow-up was 5.5 years (minimum two years). Preoperative and postoperative radiographic measurements of coronal-plane deformity, Ankle Osteoarthritis Scale (AOS) scores and Short Form (SF)-36 scores were prospectively recorded. All ancillary (intraoperative) and secondary procedures, complications and measurements were collected. The AOS pain and disability subscale scores decreased significantly in both groups. The improvement in AOS and SF-36 scores did not differ significantly between the groups at the time of the final follow-up. The valgus group underwent more ancillary procedures during the index surgery (80% vs 26%). Tibio-talar deformity improved significantly toward a normal weight-bearing axis in the valgus group. Secondary postoperative procedures were more common in the valgus group (36%) than the controls (20%). Overall, re-operation was not associated with poorer patient outcome scores. Metal component revision surgery occurred in seven patients (three valgus and four controls). These revisions included two deep infections (2%), one in each group, which were converted to hindfoot fusions. Therefore, 94% of the valgus group retained their original components at final follow-up Thus far, this is the largest reported study that specifically evaluates TAR with significant preoperative valgus alignment, in addition to having the longest follow-up. Satisfactory midterm results were achieved in patients with valgus mal-alignment of ≥15°. The valgus cohort required more procedures during and after their TAR, as well as receiving more novel techniques to balance their TAR. Whilst longer term studies are needed, valgus coronal-plane alignment of ≥15° should not be considered an absolute contraindication to TAR if the associated deformities are addressed.
The extensive variation in axial rotation of tibial components can lead to coronal plane malalignment. We analyzed the change in coronal alignment induced by tray malrotation. We constructed a computer model of knee arthroplasty and used a virtual cutting guide to cut the tibia at 90° to the coronal plane. The virtual guide was rotated axially (15° medial to 15° lateral) and with posterior slopes (0° to 7°). To assess the effect of axial malrotation, we measured the coronal plane alignment of a tibial tray that was axially rotated (25° internal to 15° external), as viewed on a standard anteroposterior (AP) radiograph.Aims
Methods
Recent large studies of third-generation minimally invasive hallux valgus surgery (MIS) have demonstrated significant improvement in clinical and radiological outcomes. It remains unknown whether these clinical and radiological outcomes are maintained in the medium to long-term. The aim of this study was to investigate the five-year clinical and radiological outcomes following third-generation MIS hallux valgus surgery. A retrospective observational single surgeon case series of consecutive patients undergoing primary isolated third-generation percutaneous Chevron and Akin osteotomies (PECA) for hallux valgus with a minimum 60 month clinical and radiographic follow up. Primary outcome was radiographic assessment of the hallux valgus angle (HVA) and intermetatarsal angle (IMA) pre-operatively, 6 months and ≥60 months following PECA. Secondary outcomes included the Manchester-Oxford Foot Questionnaire, patient satisfaction, Euroqol-5D Visual Analogue Scale and Visual Analogue Scale for Pain.Background
Methods
We present the long-term results of a single institute’s experience of the Mann 3 in 1 procedure. This prospective study initially selected 36 feet (25 patients) with severe hallux valgus, classified by a HV angle <
40° or IM angle>
15°, for the Mann 3 in 1 procedure. Preoperative and postoperative standing radiographs were taken to calculate the correction of the deformity, and a postoperative subjective questionnaire was completed which was based on the assessment criteria suggested by the American Orthopaedic Foot and Ankle Society in 1984. The initial follow-up was completed at up to one year. The original cohort of patients was contacted again at 10 years (range 9–11 years) to repeat the same questionnaire and radiographs. In total 19 patients (27 feet) were contactable with an average age of 51 years (range 34–74). The questionnaire revealed one patient unable to perform the same occupation and three patients unable to perform the same activities due to ongoig problems with the operated feet. Thirteen patients had to wear modified footwear but only 2 required specially made shoes. Sixteen of the nineteen (84%) were pleased or satisfied with pain relief and appearance following the procedure, with 14 stating that they would undergo the procedure again given the same circumstance and 5 patients that would not. The complications included 8 patients requiring screw removal, 2 patients with metatarsalgia, one patient undergoing multiple further corrective procedures and one requiring a second ray amputation for osteomyelitis. Sixteen patients (23 feet) were available for repeat radiographic assessment. This revealed that there had been some recurrence of the deformity with the initial correction of the HV angle being a mean of 40° (range 36–51°) to 15° (9–23°) at up to one year and 23° (0–52°) at ten years. Similarly with the mean IM angle initially corrected from 18° (15–25°) to 8.5°(6–12°), being 14° (7–20°) at ten years. In conclusion, despite some recurrence of the deformity on x-ray the subjective satisfaction with this procedure is good. Care should be taken in patient selection but the Mann 3 in 1 appears to be a good procedure for the correction of severe Hallux
Fibula contributes to weight bearing and serves as a lateral buttress to the talus. Fibular shortening leads to ankle valgus, distal tibial epiphyseal wedging and ankle instability. Trauma, infection and skeletal dyplasias are the common causes of fibular shortening in children. Aim was to review this cohort who underwent fibular lengthening and ankle reconstruction Retrospective review from a prospective database of clinical and radiographic data of all children who underwent fibular lengthening for correction of ankle valgus. Distraction osteogenesis with external fixator was performed for all cases.Introduction
Materials and Methods
The aim of this study was to compare the accuracy of limb alignment and component positioning after total knee arthroplasty(TKA) performed using fixed or individual distal femoral valgus correction angle(VCA)in valgus knees. One hundred and twenty-four patients were randomised to undergo TKA with either of the clinical baseline, radiological outcomes and subsequent outcome such as knee HSS scores, knee range of motion (ROM) and visual analogue scale (VAS) scores were assessed. Knees in the individual group (n=62) were performed with a tailored VCA. Knees in the fixed group (n=62) were performed utilizing a 4°VCA.Purpose
Materials and Methods
Purpose: There are many different operations for hallux valgus and it is often difficult to know which one to perform. Many of the patients who present with hallux valgus have first ray hypermobility. We use the metatarsocuneiform arthrodesis for the treatment of symptomatic Hallux
Purpose: The advantages of the Scarf osteotomy are the greater ROM and the ability of better Stabilisation. We had compared our results with this theory. Methods-Results: At 41 patients with mean age 52,5, y(16–70) we made 47 Scarf osteotomies. At 25 patients we made also corrective osteotomies at the kleiner toes. The preoperative criteria for our study were degenerative Osteoarthritis of the 1st MP joint, HV angle>
40° or IM I-II angle>
20°. The postoperative and radiologic control was continued for 11–18 months(M. 18m). 38 patients were very satisfied with the results,2 sat-isfied, 1 patient was claimed for reduced ROM of the 1st PIP joint. The mean rehabilitation time was 2,9 months(1,5–6M). Pre- and postoperative compare had shown a change at AOFAS score from 48 (19–80) to 87 (35–100),change of the HVA from 35,2° (29°–48°) to 16°(4°–33°) and change of the IM I-II angle from 14,7°(11°–19°) to 8,4°(6°–12°). The DMAA didn’t show any particular change. The major shortening of the 1st Metatarsal was 3mm. A t 1 patient we find early osteoarthitic changes, but we have seen no pseudarthrosis or Metatarsal Head Necrosis. At 10 patients we measured the 1st MP joint ROM<
75° and at 1 patient <
30°. Conclusions: The Scarf osteotomy with the modified Mc Bride procedure is an effective method for the treatment of Hallux
Angular deformities of the distal femur can be corrected by opening, closing and neutral wedge techniques. Opening wedge (OW) and closing wedge (CW) are popular and well described in the literature. CW and OW techniques lead to leg length difference whereas the advantage of neutral wedge (NW) technique has several unique advantages. NW technique maintains limb length, wedge taken from the closing side is utilised on the opening side and since the angular correction is only half of the measured wedge on either side, translation of distal fragment is minimum. Leg lengths are not altered with this technique hence a useful technique in large deformities. We found no reports of clinical outcomes using NW technique. We present a technique of performing external fixator assisted NW correction of large valgus and varus deformities of distal femur and dual plating and discuss the results. We have treated 20 (22 limbs – 2 patients requiring staged bilateral corrections) patients for distal femoral varus and valgus deformities with CWDFO between 2019 and 2022. Out of these 4 patients (5 limbs) requiring large corrections of distal femoral angular deformities were treated with Neutral Wedge (NW) technique. 3 patients (four limbs) had distal femoral valgus deformity and one distal femoral varus deformity. Indication for NW technique is an angular deformity (varus or valgus of distal femur) requiring > 12 mm opening/closing wedge correction. We approached the closing side first and marked out the half of the calculated wedge with K – wires in a uniplanar fashion. Then an external fixator with two Schanz screws is applied on the opposite side, inserting the distal screw parallel to the articular surface and the proximal screw 6–7 cm proximal to the first pin and at right angles to the femoral shaft mechanical axis. Then the measured wedge is removed and carefully saved. External fixator is now used to close the wedge and over correct, creating an appropriate opening wedge on the opposite side. A Tomofix (Depuoy Synthes) plate is applied on the closing side with two screws proximal to osteotomy and two distally (to be completed later). Next the osteotomy on the opposite side is exposed, the graft is inserted. mLDFA is measured under image intensifier to confirm satisfactory correction. Closing wedge side fixation is then completed followed by fixation of opposite side with a Tomofix or a locking plate.Introduction
Materials & Methods
Aim. To determine differences in knee valgus angles produced during a single leg squat and hip muscle strength between healthy subjects and patients with patellofemoral pain (PFP). To determine correlations between variables of hip muscle strength, knee valgus angle and pain. Study design: Observational study of 20 (8 male 12 female) healthy (H) subjects, matched for age height and weight with 20 (8 male 12 female) PFP patients (mean symptom duration 46.75 weeks). All subjects fulfilled specific inclusion and exclusion criteria. Appropriate Ethical approval was obtained. Measures for both groups were Knee valgus angle during a single leg squat using 2D motion capture and SiliconCoach software for measurement of knee valgus angles, hip abduction, internal and external rotation muscle strength using hand held dynamometry, visual analogue scale for pain. Strength was reported as a percentage of body weight. All measures were taken on the affected leg for PFP subjects and matched for the equivalent leg in healthy group. SiliconCoach was determined to be reliable for intra-rater reliability of knee valgus angle (ICC.996). Results. There were no significant differences in age, height and weight (p=.59,.51,.26 respectively). Significant differences existed in hip abduction strength p=.001(PFP 19.93(9.2), H 32.22(8.26)), Hip internal rotation p=0.001 (PFP 12.94(4.35), H 19.53(6.36)), Hip external rotation p=0.001(PFP 10.00(3.07), H 16.26 (4.62)), Knee
Adolescent hallux valgus is a progressive deformity of childhood. Patients with this disorder complain of pain, deformity, redness at the site of deformity, shoewear limitation and altered cosmesis. Surgery to correct the bunion is considered as pain gets worst, deformity increases or significant shoe wear limitation is present. However, there is still not an uniformly satisfying surgical treatment for the adolescent hallux valgus. This kind of surgery has been often associated with a high rate of recurrence and poor results. The adolescent condition often includes significant metatarsus primus varus as a primary element. This is the reason why isolated soft tissue procedures frequently fail. Surgical treatment often combines first metatarsal osteotomy with a soft tissue realignement of the first metatarsal phalangeal joint. Simmonds and Menelaus in 1960 reported their results with an osteotomy of the base of the first metatarsal in addition to McBride’s soft tissue recostruction. The procedure addresses the three main components of the adolescent hallux valgus deformity: the medial eminence, the hallux valgus and the metatarsus primus varus. Although Simmonds and Menelaus did not use any internal fixation to fix the osteotomy site, they performed a complete transverse osteotomy at the base of the first metatarsus. Besides they used an immobilization for six weeks in the post operative period. We describe a modified procedure where the osteotomy is performed incompletely at the base of the first metatarsal bone and we shortened the post operative immobilization period with a cast for three weeks. Simmonds’ procedure does not interfere with the sesamoid bones while in our method a repositioning of the sesamoids below the metatarsal head has been performed. Materials and methods: From 1997 to 2000, 22 feet in 12 female and 1 male patients were treated surgically with the modified Simmonds-Menelaus bunion procedure. A primary operation was performed on all feet treated. The average age at surgery was 12.4 years (range 10.5 – 14.6 years). Preoperative, postoperative and final follow up evaluation included history, physical examination, record of range of motion of the first metatarsophalangeal joint, anteroposterior and lateral radiograph of the feet in the weight bearing position. Results: Lenght of follow up averaged 3.9 years. The average pre operative Hallux
Correction of fixed valgus is a challenge in primary TKA. Achieving patello-femoral and femoral-tibial stability requires superficial/deep lateral side releases if non-constrained prostheses are utilized. The medial approach has disadvantages with more reported complications. The direct lateral approach, with/without tubercle osteotomy, is an approach option utilized in two reporting centers. Methods: 255 valgus TKAs with 5- to15-year follow-up were reviewed. Demographics included 91% females, 15% rheumatoid, mean age 69. Prostheses utilized were LCS mobile-bearing (meniscal PCL-retaining/rotating PCL-sacrificing). Patella was non-resurfaced in 90%; cementless fixation in 86%. The direct lateral approach with similar lengthening techniques was used with tubercle osteotomy in one center and osteo-periosteal joint exposure in another. Results: Good/excellent 91%, modified HSS score improvement 57 to 85. Deformity (12) improved <
8 to 12 points (>
15o valgus to <
5o valgus). ROM improved from mean 11o/97o to 1/110o latest. Technical/prosthetic-related complications included: 7 bearing failures (5 meniscal, 2 rotating platform), 2 aseptic loosenings (tibial), 1 patella ligament rupture and 2 screw loosenings in the osteotomy group, 1 patella re-dislocation in a 75-year-old female with dislocation since age 15 (non-osteotomy group), 2 infections, and 1 re-operation for arthrofibrosis . Discussion/Conclusion:
To explore the relationship in terms of time scale between pre-operative expectations and postoperative outcomes and satisfaction after Hallux valgus surgery. A patient derived questionnaire was developed and 30 patients aged 19 to 67 were included undergoing primary hallux valgus correction with a first metatarsal osteotomy and distal soft tissue release. Patients were asked pre-operatively to quantify their expected time scale for improvement in pain, ability to walk unaided, ability to drive, routine foot wear and foot feeling normal at 6 weeks, 3 and 6 months following surgery, and to indicate their confidence in achieving this result. Patients recorded postoperative outcomes achieved at number of weeks. Ordinal logistic regression multivariate modelling was used to examine predictors of postoperative satisfaction.Purpose
Methods