Objective: The purpose of the study was to evaluate early clinical and radiological results with a novel minimally invasive surgery (MIS) technique for Lapidus arthrodesis using intramedullary nail. Methods: Retrospective review of patients with hallux valgus surgery during an 18-month period. Patients with a procedure other than MIS Lapidus nail fixation were excluded. We describe surgical technique with a percutaneous joint preparation and fixation with an intramedullary nail through a MIS approach. Demographic variables, early complications and radiographic parameters were measured. Results: Ten feet in 8 patients with severe HV underwent a Lapidus procedure performed with a minimal invasive technique using intramedullary nail for fixation. No soft tissue complications and 1 patient required screw removal after bone healing. Mean HVA decreased from 31,4 degrees (range 17 to 47) SD (±9,3) to 10,3 degrees (range, -8,8 to 31,5) SD (±8,4), mean IMA decreased from 17,91 degrees (range, -17 to 20) SD (±0,9) to 5,46 degrees (range, –7,3 to 15.3) SD (±2,9) and mean DMAA decreased from 20,36 (range, 10-40) SD (±8,4) to 7,67 (range, -5 to 30) SD (±8,0). Conclusion: Intramedullary nail for Lapidus arthrodesis with minimally invasive technique showed satisfactory radiographic correction and minimal complications, but further follow up is needed to analyze clinical-radiographic results. Level of Evidence IV; Therapeutic Study; Case Series.
Surgical treatment remains the standard of care for active patients with acute midsubstance Achilles tendon ruptures. Minimal invasive surgery, rupture’s site hematoma preservation, strong fixation, avoidance of sural nerve entrapment, and early rehabilitation are essential concepts desirable for any Achilles tendon repair. Hereby, we present a technique modification that incorporates all these advantages in one single procedure.
Objective: Our objective was to compare foot width (bony and soft tissues) in radiological images pre- vs. post-corrective scarf osteotomy in patients with hallux valgus. Methods: We retrospectively performed measurements of forefoot width (both bony diameter and total diameter including soft tissues) on anterior posterior standard radiographs of 30 patients, totaling 42 feet, pre- and postoperatively, at three months. These measurements were performed by two evaluators and their reliability was calculated. Results: Radiologically, preoperative mean of the 1-5 metatarsal bony width was 89.30mm (SD ± 5.8), reduced to 80.42mm postoperatively (SD ± 3.5; p<0.001). Regarding the soft tissue width, preoperative mean was 102.45mm (SD ± 6.4) and postoperative, 98.3mm (SD ± 5.1; p<0.001). The interclass correlation coefficient between both observers was excellent in most measurements (range, 0.884-0.973). Conclusion: We report an objective reduction in forefoot width, in both bony and soft tissue diameter, finding means of 8.88 mm (10%) and 4.12mm (4.1%), respectively, after scarf-Akin osteotomy. Level of Evidence IV; Case Series.
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