INTRODUCTION

Percutaneous surgery is an increasingly accepted technic for the treatment of Hallux valgus but it has some limitations when the intermetatarsal angle ismoderate to severe, having high risk of recurrence.

The mini tight-rope used as a complement for precutaneous surgery avoids complications of open surgery osteotomies (delays consolidation, pain, screws protusion, infection) and it allows us continue with the recurrent trend towards minimal invasive surgery.

Aims: To study the clinical and radiological result of arthroreisis with Giannini’s endo-orthotic implant in the treatment of paediatric flat-foot. Methods: 65 cases were studied in 37 patients, 60% were males and 40% females. The follow-up was 26.5 months. The total average age was 9.4, range of 5 and 14 years old. Surgery in patients that had suffered fractures, inflammatory, rheumatic or neurological processes was contraindicated. We studied: pain, functional and sport activity, as well as the development of radiographic measurements at 3, 6 and every 12 months after the operation. Results: Pain improved from preoperative 60% to postoperative 6.2%. The percentage of postoperative footprint was normal in 58.5% of the cases and first degree flatfoot in 41.5%. Postoperative sport activities were taken up by 49.2% of the patients. The 8 mm endoorhotic implant was the most used (66%). We performed Achilles tenotomy in 58.5% of the cases. The radiographic angles whose correction was greater with regard to the preoperative angle were: talar- first metatarsal (96%) and calcaneal- pitch (34%). Postoperatively the endo-orthotic implant-talus angle had an influence on the rest of the radiographic measurements. There was no postoperative deterioration in any of the radiographic angles measured in the monitoring period. Complications: we had 10.7%, with postoperative pain as a most frequent (6.2%). There was no infection or local reaction to a foreign body. We did not remove the endoorthotic implant systematically. Conclusions: 1) Footprint became normal in over half the cases; 2) radiological morphology was corrected 2/3 of the cases and it did not alter throught follow-up; 3) surgical technique respect anatomical structure of the foot, without medial surgical time.

Aims: Study our experience and short term results using a mix of osteoconductive (HA) and osteoinductive (AGF) materials. Methods: From October 2001 until June 2002, we have treated bone defects in 9 patients. Seven male and 2 female. Mean age 10.4 years (range 4–18 years). Mean follow-up: 5.6 months (range 3–9 months). AGF was obtained after autologous blood centrifugation according to blood volume, knowing the patient height and weight (Nadler Score). AGF was obtained through previous concentrate of platelets and red cells, with a further concentration, reducing its volume to 1/3. 10 c.c. of thrombin (500 UI) and HA (500R) were added, just before applying it to the patient. Total surgery time for preparation AGF was 20–30 minutes. Clinical cases treated were: varus osteotomy in Perthes (1 case- 11%); curettage in osteomyelitis (2 cases- 22%); essential cyst, after conventional corticoid treatment failure (2 cases- 22%); forearm pseudoarthrosis (2 cases- 23%) and triple arthodesis by valgus pronated spastic foot (2 cases- 22%). We never use autologous iliac graft with AGF- HA. Results: We have obtained radiological and clinical consolidation in all bone defects after 3–4 months. Radiological success is not clear after 4 months in one of the osteomyelitis cases (12’5%). Conclusions: 1. The iliac graft harvest morbility is about 9.4%- 49%. 2. A 2nd approach is avoided in children and adolescents. 3. With the use of AGF- HA we avoid morbility, diseases transmission, reduced surgery time and offer an alternative to autologous grafting.