RESUMO

BACKGROUND: Instability of the lesser metatarsophalangeal (MTP) joints is a common cause of deformity and pain. The purpose of this study was to prospectively evaluate the surgical outcomes for the different grades of plantar plate tears and propose a treatment protocol. METHODS: Sixty-eight patients (100 MTP joints) were prospectively enrolled and graded according to the anatomical grade system for plantar plate tears. Based on this classification, the appropriate surgical procedure was chosen as follows: grades 0 and I, thermal shrinkage with radiofrequency; grades II and III, direct reinsertion of the plantar plate; and grade IV, flexor-to-extensor tendon transfer. All surgical procedures were associated with a Weil metatarsal osteotomy. Evaluations were performed before and after surgical treatment with a mean follow-up of 2 years (12-36 months), using clinical and radiological parameters: American Orthopaedic Foot and Ankle Society (AOFAS) Lesser MTP-IF Scale, visual analog scale (VAS), ground touch, joint stability, and toe purchase. RESULTS: The analysis of the clinical parameters demonstrated a significant improvement of all groups (P < .0001) after surgical treatment, but grade IV had less VAS improvement and a fair AOFAS average score (72 points). All groups improved regarding physical examination parameters, but grade I, III, and IV tears had proportionally less stable MTP joints following surgery, as well as a lower proportion of normal postoperative toe purchase and ground touch. All groups showed a significant improvement regarding radiographic parameters. CONCLUSION: All groups of operatively treated patients had significant improvement with regard to subjective and objective parameters. Grades I, III, and IV presented inferior results compared with grades 0 and II. LEVEL OF EVIDENCE: Level IV, case series.

Assuntos

Ligamentos Articulares/lesões , Ligamentos Articulares/cirurgia , Articulação Metatarsofalângica/lesões , Articulação Metatarsofalângica/cirurgia , Adulto , Idoso , Feminino , Seguimentos , Humanos , Instabilidade Articular/etiologia , Instabilidade Articular/cirurgia , Masculino , Ossos do Metatarso/cirurgia , Pessoa de Meia-Idade , Osteotomia , Avaliação de Resultados da Assistência ao Paciente , Estudos Prospectivos , Terapia por Radiofrequência , Transferência Tendinosa , Escala Visual Analógica

RESUMO

BACKGROUND: Operative correction of a hammertoe deformity is often accomplished by excision of the articular surface of the proximal interphalangeal joint (PIP) and fixation across the joint. This study aimed to prospectively evaluate clinical and radiographic outcomes of hammertoe operative correction utilizing an internal implant and assess its ability to maintain postoperative alignment. METHODS: Twenty-nine patients (53 toes) with a painful rigid hammertoe deformity were prospectively enrolled and operatively treated with resection arthroplasty of the PIP joint and fixation with an implant. Five patients were lost to follow-up, and 24 patients (42 toes) returned at an average of 12 months for final clinical and radiographic evaluation. All patients were evaluated pre- and postoperatively by AOFAS and Visual Analog Pain Scale (VAS) scores. On physical exam, the location and magnitude of the deformity, callosities, and digit circumference were recorded. Radiological parameters evaluated were digital alignment, successful union, implant position, and bone reaction. RESULTS: All patients reported satisfaction at final follow-up, with an average improvement of AOFAS score from 52 (range, 24-87 points) to 71 (range, 42-95 points) points. The mean VAS pain score improved from 5 points (range, 2 to 10) preoperatively to 1 point (range, 0 to 5) postoperatively. Of patients, 87% reported an ability to return to their preoperative activities without limitations. Regarding digital alignment, there were no recurrent deformities or transverse plane deformities; 1 toe presented with a minor digital rotational deformity at final follow-up. Postoperative radiographs indicated 100% of proximal interphalangeal (PIP) joints with good alignment, and 81% demonstrated bony union. CONCLUSION: Our results suggest that utilization of an internal implant for hammertoe correction was safe and provided acceptable alignment, pain reduction, and improved function at final follow-up. LEVEL OF EVIDENCE: Level IV, case series.

Assuntos

Artroplastia/métodos , Síndrome do Dedo do Pé em Martelo/cirurgia , Prótese Articular , Adulto , Idoso , Feminino , Síndrome do Dedo do Pé em Martelo/diagnóstico por imagem , Humanos , Pessoa de Meia-Idade , Medição da Dor , Estudos Prospectivos , Radiografia , Resultado do Tratamento

RESUMO

Although metatarsophalangeal (MTP) plantar plate tears are common, they are still often missed. The purpose of this study is to find the best clinical variables to define and grade the plantar plate injuries. Sixty-eight patients (100 MTP joints) were graded arthroscopically and divided into five groups (0 to IV) according to the anatomical classification. Their medical records were reviewed to establish correlations of clinical findings with the anatomical lesions. The positive correlations found were acute pain, widening of the interdigital space, loss of ground touch, positivity of the MTP joint drawer test, reduction of the toe purchase, and toe supination. The drawer test is the most reliable and accurate tool to classify and grade the plantar plate lesion, followed by ground touch and rotational deformities. It is possible to improve the accuracy of diagnosis of plantar plate tears by means of the combination of both clinical history and physical examination data.

Assuntos

Traumatismos do Pé/diagnóstico , Articulação Metatarsofalângica/lesões , Exame Físico/métodos , Adulto , Idoso , Algoritmos , Feminino , Traumatismos do Pé/classificação , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Índice de Gravidade de Doença

RESUMO

BACKGROUND: In an early report on this patient cohort, we concluded that a hallux valgus deformity in males is frequently hereditary in nature. An increase in the distal metatarsal articular angle (DMAA) was observed to be the major defining characteristic of hallux valgus in males. In this follow-up study, our goal was to evaluate the effectiveness of surgical treatment for this cohort of male patients. METHODS: Data from 50 feet of male patients with hallux valgus who were surgically treated by the same surgeon between 1985 and 2005 were retrospectively analyzed. The technique was algorithmically chosen according to the severity and complexity of the deformity. Thus, 10 chevron osteotomies, 9 biplanar chevron osteotomies, 12 Mitchell osteotomies, 9 scarf osteotomies, and 10 basilar first metatarsal osteotomies were performed. The average follow-up was 10 years (range, 2-20). RESULTS: After analyzing the angular radiological parameters, sesamoid subluxation, and the articular congruency, most procedures proved to have achieved adequate correction of the angular deformities. When examining each of the procedures separately, 4 of the 5 procedures had similar corrective capacities; the scarf osteotomy however had decidedly inferior results. The improvement in the postoperative American Orthopaedic Foot and Ankle Society (AOFAS) score demonstrated the clinical and functional improvement. CONCLUSIONS: The algorithm was based mainly upon the presence of increased DMAA and increased severity of angular deformities. We conclude that hallux valgus deformities in males were adequately corrected with the selected techniques. Greater difficulty or resistance to surgical treatment could not be detected when we contrasted our results to females. The scarf osteotomy proved to have an inferior corrective capacity compared to the other techniques used in this series. LEVEL OF EVIDENCE: Level III, retrospective comparative series.

Assuntos

Hallux Valgus/diagnóstico por imagem , Hallux Valgus/cirurgia , Adolescente , Adulto , Idoso , Placas Ósseas , Criança , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Osteotomia , Radiografia , Amplitude de Movimento Articular , Recuperação de Função Fisiológica , Estudos Retrospectivos , Fatores Sexuais , Resultado do Tratamento , Adulto Jovem

RESUMO

BACKGROUND: Instability of the lesser metatarsophalangeal (MTP) joints has been widely reported and plantar plate insufficiency is a key part of this pathologic process. The diagnosis is made clinically but can be aided by imaging studies, particularly magnetic resonance imaging (MRI); however, the sensitivity and accuracy of this method compared to direct visualization of these lesions has not yet been established, nor has interobserver accuracy of MRI been assessed for evaluation of plantar plate pathology. In this study, our goals were to identify the accuracy of the MRI in describing plantar plate tears when compared to direct arthroscopic visualization using an anatomic grading system and to test the influence of an anatomic grading system in the accuracy of the MRI readings. METHODS: We evaluated the clinical exam, MRI scans, and arthroscopic findings of 35 patients with lesser MTP instability. RESULTS: Using an anatomic grading system, a distinct improvement in the radiological evaluation and interpretation occurred. Knowledge of the pattern of plantar plate tears by a radiologist enabled them to locate and describe the type of tears of the plantar plate on the MRI. The amount of training and the experience of the radiologist were also important factors in our study. The senior radiologists had much better levels of accuracy (Group A, 77.0%; Group B, 88.5%) than less experienced radiologists. CONCLUSION: Prior knowledge of the pathophysiology and morphological types of lesions of the plantar plates was helpful for accurate identification and description of the tears by the radiologist. LEVEL OF EVIDENCE: Level II, prospective comparative study.

Assuntos

Instabilidade Articular/diagnóstico , Imageamento por Ressonância Magnética/métodos , Articulação Metatarsofalângica/patologia , Adulto , Idoso , Artroscopia , Feminino , Humanos , Instabilidade Articular/patologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Sensibilidade e Especificidade

RESUMO

BACKGROUND: The high frequency of hallux valgus deformities in females is well known and has been widely reported in the literature. This finding tends to obscure the importance and the characteristic details of hallux valgus deformities in males. The severity of the deformity, its onset at an earlier age, and its inheritability seem to be more frequent in males, but there are no reports in the literature to substantiate these concepts. The purpose of this study was to analyze these questions in regard to males with hallux valgus. METHODS: The records and plain radiographs of 31 males (53 feet) with a diagnosis of hallux valgus that were treated over a 20-year period (1985-2005) were analyzed. During that same period, the senior author (CN) performed 812 procedures for the correction of hallux valgus deformities in women. In order to compare gender-related differences associated with this deformity, 31 women's charts-paired by age and affected side-were randomly selected and both clinical and radiological data were statistically compared. RESULTS: The onset of the complaints of first ray pain in males was equally distributed by decades, indicating that the deformity begins earlier in this group. Among males, we found 68% of the subjects had a familial history of bunion deformities-58% were maternal and 10% were fraternal. In the control group of females, only 35% of the women reported inheritance of the deformity. No correlation with footwear was found among males. The radiographic measurements were significantly higher in the male group, which included the hallux valgus angle (HVA), the distal metatarsal articular angle (DMAA), and the tarsal metatarsal angle (TMA). The main gender difference was found to be the DMAA with first metatarsophalangeal (MTP) joint congruence being much more common in males (males = 57%, females = 30%). No correlations were found for metatarsus primus varus or pes planus. CONCLUSION: Based on our observations, we conclude that hallux valgus in males is commonly hereditary in nature and is mainly transmitted by the mother, with early onset and higher severity when compared to women. We report a female/male ratio of 15:1. The main intrinsic factor associated with a hallux valgus deformity in males is a high DMAA. LEVEL OF EVIDENCE: Level III, retrospective comparative series.

Assuntos

Hallux Valgus/diagnóstico por imagem , Hallux Valgus/epidemiologia , Adulto , Fatores Etários , Idoso , Demografia , Feminino , Hallux Valgus/genética , Humanos , Padrões de Herança , Masculino , Pessoa de Meia-Idade , Radiografia , Amplitude de Movimento Articular , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais , Adulto Jovem

RESUMO

OBJECTIVES: Tibiotalar (TT) arthrodesis is still a very important option in the treatment of primary or post-traumatic arthritis of the ankle but persists the controversy regarding the optimal method for the fixation of the arthrodesis site. No matter the implant used, the goal is to obtain a solid, healthy, pain-free fusion. The purpose of the current study is to present the preliminary results of a novel laterally based tibiotalar compression arthrodesis system using a locked plate. METHODS: Thirteen consecutive patients with tibiotalar arthritis were submitted to an arthrodesis using a new lateral plating system. The average age was 59.7 years (range 36~72); nine patients were male and four female. Using a cutting guide, the remaining articular surfaces of the tibia and talus were removed. A compression device was applied to avoid malalignment of the ankle and a precontoured lateral locking plate was used to achieve the joint fusion. RESULTS: Both the AOFAS ankle-hindfoot score and the VAS score improved with the surgery. All patients' ankles fused by 6 months. In all patients we found a very good alignment in the sagittal, coronal and transverse planes. CONCLUSION: We believe that a combination of a bilateral compression, contoured bony cuts, and lateral locked plating offers a novel, accurate and useful technique for ankle arthrodesis.

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OBJETIVOS: A artrodese tibiotársica (TT) continua sendo uma importante opção no tratamento da artrose primária ou pós-traumática do tornozelo mas persiste ainda a controvérsia sobre o melhor método de fixação do foco de artrodese. Independentemente do tipo de material utilizado, o objetivo maior é a obtenção da fusão articular sólida, saudável e indolor. O propósito do presente estudo é apresentar os resultados preliminares de um novo sistema de placa bloqueada lateral compressiva para a artrodese do tornozelo. MÉTODO: Treze pacientes consecutivos portadores de artrose tibiotársica foram submetidos à artrodese do tornozelo nove pacientes eram homens e quatro mulheres. Com o auxílio de um guia, as superfícies articulares do talo e da tíbia foram decorticadas. Um sistema de compressão foi aplicado para evitar o alinhamento indesejável dos segmentos e uma placa bloqueada pré-moldada lateral foi utilizada para obter a fusão articular. RESULTADOS: Tanto o escore AOFAS quanto o VAS melhoraram com a cirurgia. Todos os tornozelos operados consolidaram dentro do prazo de seis meses. Em todos os pacientes, foi obtido um ótimo alinhamento nos planos sagital, coronal e transverso. CONCLUSÃO: Acreditamos que a combinação de compressão bilateral, cortes ósseos com contornos pré-demarcados e placa lateral bloqueada, constitui uma técnica moderna, segura e útil para a artrodese do tornozelo.

Assuntos

Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Traumatismos do Tornozelo , Artrodese , Placas Ósseas

RESUMO

BACKGROUND: Anatomical dissection of the second metatarsophalangeal (MTP) joint suggests that the plantar plate is the major stabilizing structure of the joint due to its central location and multiple important attachments. Many surgical procedures have been recommended when conservative treatment has failed, but some have had limited clinical success. The aim of our prospective study was to show the results obtained in the treatment of a group of patients with plantar plate tears by direct repair through a dorsal approach combined with a Weil metatarsal osteotomy with a minimum followup of 12 months. METHODS: We prospectively treated 28 patients (55 MTP joints) with lesser MTP joint instability, but only 22 patients (40 MTP joints) were treated by the direct repair of the plantar plate and were included in the study. All of them had initial complaints of acute forefoot pain with the subsequent development of deformity and instability of the MTP joints. All patients were evaluated clinically, radiographically, (plain radiographs and MRI exam), and by MTP joint arthroscopy. With this data, a direct correlation between the clinical staging and the anatomical grading for plantar plate dysfunction of each patient was determined RESULTS: The plantar plate of the second MTP joint was the most commonly affected joint (63%), and Grade III type tear (transverse and/or longitudinal extension tear) was the most frequent type. With the surgical treatment, we were able to markedly improve the parameters studied (pain, medial or dorsomedial deviation of the toe, joint stability, muscle balance, and joint congruence) to acceptable levels, The AOFAS score improved substantially from an average of 52 points preoperatively to 92 points postoperatively. CONCLUSION: The direct plantar plate repair combined with a Weil osteotomy and lateral soft tissue reefing can restore the normal alignment of the MTP joint. We have demonstrated that the anatomic repair of the plantar plate can correct the deviation of the affected toe (medial, dorsal, dorsomedial or dorsolateral), which lead to diminished pain with improved functional scores.

Assuntos

Fibrocartilagem/lesões , Fibrocartilagem/cirurgia , Deformidades Adquiridas do Pé/cirurgia , Instabilidade Articular/cirurgia , Articulação Metatarsofalângica/cirurgia , Adulto , Idoso , Artroscopia , Diagnóstico por Imagem , Feminino , Fibrocartilagem/patologia , Seguimentos , Deformidades Adquiridas do Pé/classificação , Deformidades Adquiridas do Pé/etiologia , Humanos , Instabilidade Articular/etiologia , Metatarsalgia/etiologia , Metatarsalgia/cirurgia , Articulação Metatarsofalângica/patologia , Pessoa de Meia-Idade , Osteotomia , Medição da Dor , Estudos Prospectivos

RESUMO

OBJECTIVE: The objective of this study was to evaluate the short-term clinical and radiographic results from a TTC fusion procedure using a lateral locking plate specifically designed for this purpose. METHODS: All the fourteen patients were evaluated using a variety of methods, including a visual analogue scale (VAS), the AOFAS hindfoot score and a subjective satisfaction scale. The average follow-up was 10 months. RESULTS: The average AOFAS score improved from 41 points preoperatively to 63 points postoperatively. The VAS pain score decreased from 7 to 3 points. Four patients reported excellent results, eight good, one fair and one poor. CONCLUSION: Our study provides support for using a specially designed plate for TTC fusion in hindfoot salvage surgery. RESUMO: Objetivo: O propósito deste estudo é avaliar os resultados clínicos e radiológicos a curto prazo do procedimento de fusão tíbio-talo-calcaneana (TTC) com o uso de uma placa lateral bloqueada específicamente concebida para este fim. Métodos: Todos os 14 pacientes foram avaliados usando uma variedade de métodos, incluindo a escala analógico visual da dor (EAV), escore da AOFAS para o retropé e escala subjetiva de satisfação. O acompanhamento médio foi de 10 meses. Resultados: O escore AOFAS médio melhorou de 41 pontos no período pré-operatório para 63 pontos no período pós-operatório. O escore da dor (EAV) caiu de 7 para 3 pontos. Quatro pacientesforam classificados como excelentes resultados, oito bons, um moderado e um ruim. Conclusão: Nosso estudo dá suporte ao uso da placa especialmente desenhada para a fusão tibio-talo-calcaneana (TTC) nas cirurgias de salvamento do retropé.

RESUMO

OBJECTIVES: Tibiotalar (TT) arthrodesis is still a very important option in the treatment of primary or post-traumatic arthritis of the ankle but persists the controversy regarding the optimal method for the fixation of the arthrodesis site. No matter the implant used, the goal is to obtain a solid, healthy, pain-free fusion. The purpose of the current study is to present the preliminary results of a novel laterally based tibiotalar compression arthrodesis system using a locked plate. METHODS: Thirteen consecutive patients with tibiotalar arthritis were submitted to an arthrodesis using a new lateral plating system. The average age was 59.7 years (range 36~72); nine patients were male and four female. Using a cutting guide, the remaining articular surfaces of the tibia and talus were removed. A compression device was applied to avoid malalignment of the ankle and a precontoured lateral locking plate was used to achieve the joint fusion. RESULTS: Both the AOFAS ankle-hindfoot score and the VAS score improved with the surgery. All patients' ankles fused by 6 months. In all patients we found a very good alignment in the sagittal, coronal and transverse planes. CONCLUSION: We believe that a combination of a bilateral compression, contoured bony cuts, and lateral locked plating offers a novel, accurate and useful technique for ankle arthrodesis.

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Objetivos: A artrodese tibiotársica (TT) continua sendo uma importante opção no tratamento da artrose primária ou pós-traumática do tornozelo mas persiste ainda a controvérsia sobre o melhor método de fixação do foco de artrodese. Independentemente do tipo de material utilizado, o objetivo maior é a obtenção da fusão articular sólida, saudável e indolor. O propósito do presente estudo é apresentar os resultados preliminares de um novo sistema de placa bloqueada lateral compressiva para a artrodese do tornozelo. Método: Treze pacientes consecutivos portadores de artrose tibiotársica foram submetidos à artrodese do tornozelo nove pacientes eram homens e quatro mulheres. Com o auxílio de um guia, as superfícies articulares do talo e da tíbia foram decorticadas. Um sistema de compressão foi aplicado para evitar o alinhamento indesejável dos segmentos e uma placa bloqueada pré-moldada lateral foi utilizada para obter a fusão articular. Resultados: Tanto o escore AOFAS quanto o VAS melhoraram com a cirurgia. Todos os tornozelos operados consolidaram dentro do prazo de seis meses. Em todos os pacientes, foi obtido um ótimo alinhamento nos planos sagital, coronal e transverso. Conclusão: Acreditamos que a combinação de compressão bilateral, cortes ósseos com contornos pré-demarcados e placa lateral bloqueada, constitui uma técnica moderna, segura e útil para a artrodese do tornozelo.