The hallux rigidus, first described by Nicoladoni in 1881 (1), is the painful and decreased motion, especially dorsiflexion at the metatarsophalangeal joint, of the great toe. The purposes of this report were to evaluate the mid-term results of the Sliding osteotomy technique(2,3,4). Thirty nine (46 feet) consecutive patients (mean age 38 years) with hallux rigidus of I and II grade were followed over a five-year period. All patients were evaluated clinically and radiographically preoperatively and post operatively. At the time of final follow-up, the mean AOFAS score was significantly improved: excellent 26 (56,5%); good 12 (26%); fair 6 (13%); poor 2 (4,5%). This clinical review suggest that this procedure as a safe, effective measure to treat in patients with hallux rigidus of I and II grade.
Hip arthroscopy is a well-established technique becoming more and more an indispensable tool in institutions specialized in hip diseases. Several surgeons around the world have developed and refined the proper instruments and the surgical technique for this operation. By now, the indications have been well formulated for both diagnostic and interventional purposes. My personal experience is of 98 hip arthroscopies performed in the last 6 years. Most common preoperative indication has been chronic hip pain after failure of conservative treatment. Other indications or arthroscopic findings have been: labral pathology, hip dysplasia, synovial chondromatosis, initial osteoarthritis, calcium pyrophosphate disease, ligamentum teres damage, chondral damage, post-traumatic loose bodies, avascular necrosis, sepsis, villonodular synovitis. More recent, indications for hip arthroscopy are staging of avascular necrosis of the femoral head and shaving of polyethylene debris after total hip replacement. Contraindications to arthroscopy include recent fracture of the pelvis osteoarthritis with osteophytosis, AVN with head collapse. Hip arthroscopy can facilitate both comprehensive access to and treatment of an evolving series of conditions that affect the hip joint. Purpose of this presentation is to show the surgical technique and present the results obtained. New indications and potential future evolutions are also discussed.
Different techniques are available but many surgeons have recently expressed a preference for retrograde nailing. We present our results with new generation retrograde self-locking nail.
Proximal locking, in this device, is obtained by the angled protrusion of a wire from the nail proximal extremity. Experimental tests in the lab have confirmed the excellent torsion stability of this mechanism. Distally, the EXP nail has two little wings shaped to sit on the medial and lateral columns of the olecranic fossa and to thus provide an effective rotational and traction control. We treated 67 traumatic fracture, 15 pathological fractures, 10 impending fracture and 20 a non-unions. 10 patients in this series were obese.
Union was obtained in all the 67 primary fractures and stability was secured for all the impending and pathological cases. All but 1 non-union healed after an average of 2.6 months. In 2 patients of the primary fractures and in 3 patients of the non-union group we had a delayed union. The 3 non-union patients healed after 5, 7 and 9 months respectively. Overall 9 of the 10 obese patients healed. No patients suffered shoulder pain. In 8 cases a reduction of less than 10 degrees of elbow extension was detected. Forty-five nails have been removed so far after an average of 11 months after nailing. No major problems in nail removal have been encountered.
