Chevron osteotomy for correction of symptomatic hallux valgus deformity is a widely accepted method. Full weight bearing in regular shoes is not recommended before six weeks after surgery. Low intensity pulsed ultrasound is known to stimulate bone formation leading to more stable callus and faster bony fusion. We performed a randomized, placebo-controlled, double-blinded study on 44 patients (52 feet) who underwent chevron osteotomy to evaluate the influence of daily transcutaneous low intensity pulsed ultrasound (LIPUS) treatment at the site of osteotomy. Follow up at six weeks and one year was done with plain dorsoplantar radiographs, halluxrmetatarsophalangeal-interphalangeal scale and a questionnaire on patient satisfaction. There was no statistical difference concerning all pre- and postoperative clinical features, patient satisfaction and all radiographic measurements (hallux valgus angle, intermetatarsal angle, sesamoid index, metatarsal index) except for the first distal metatarsal articular angle (DMAA). The DMAA showed statistical significant (p=0,046) relapse in the placebo group comparing intraoperative radiographs after correction and fixation (5,2 degrees) and at six weeks follow up (10,6 degrees). Despite potential impact of LIPUS on bone formation we found no clinical evidence for its influence on outcome six weeks and one year after chevron osteotomy for correction of hallux valgus deformity.

Background: Desmoplastic fibroma (DF) of bone is a very infrequent non-metastasizing osseous tumour with local aggressive appearance. The tendency of local recurrence in published cases is high.

Case reports: We present the clinical and radiological data of a male (35 years) and a female (37years) patient suffering from desmoplastic fibroma. Although in literature spinal lesions are severity rare, in our database two lesions located in the spine (C6 and L4) were identified. The first disturbances have been variable: The lesion in C6 was an accidental finding due to a control examination of a thyroid-ca, whereas the relapse-tumour of the L4 induced lumbago and hypaesthesia of the left heel.

Due to the importance of the thyroid treatment it was decided to control the lesion in C6 in close intervals. The lumbar tumour was initially treated outside and the first relapse was marginal resected at our department 11 years after the first diagnosis. The bone alterations appeared radiographically lytic and cystic.

Discussion: The spine is an unusual location of desmoplastic fibroma which arises in 56% at the long tubular bones followed by the mandible. To our knowledge only a few cases are reported to be located in the spine. DF located spinal, is a very untypical tumour and initial symptoms can be very unequal. Due to this dissimilar symptoms and variable histological appearance the diagnosis can be tricky. At least marginal resection should be achieved because intraleasional resected lesions show a local recurrence of 43%.

We conducted a prospective clinical study to determine the influence of personality traits on the subjective outcome of operative hallux valgus correction. The surgical technique used in all patients was the chevron osteotomy. Preoperatively, personality traits were evaluated by means of the Freiburg Personality Inventory (FPI-R). 42 patients (38 female, 4 male) could be enrolled in the analysis. The mean age of the patients at the time of operation was 48.3 years (20 to 70). Three months postoperatively 37 patients were satisfied, and 5 patients were not satisfied with the operative procedure. The comparison of the two groups (satisfied and dissatisfied patients) revealed statistically significant differences in the personality traits aggressiveness (p=0.003), extraversion (p=0.001) and health worries (p=0.04). The postoperative hallux valgus angles were 12.2° ± 7.8 and 13.4° ± 8.3 (p=0.74), and the first-second intermetatarsal angles were 7.4° ± 2.5 and 7.6° ± 4 (p=0.89) in the two groups. The results of the current study suggest that the patient’s subjective result after the operative hallux valgus correction is influenced by some individual personality profiles.