PurposeThe management of adolescent hallux valgus (AHV) remains controversial, with reservations about both conservative and surgical treatments. Non-operative management has a limited role in preventing progression. Surgical correction of AHV has, amongst other concerns, been associated with a high prevalence of recurrence of deformity after surgery. We conducted a systematic review to assess clinical and radiological outcomes following surgery for AHV.MethodsA comprehensive literature search was performed in the Cochrane Library, CINAHL, EMBASE, Google Scholar and PubMed. The study was performed in accordance with the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Demographic data, radiographic parameters and results of validated clinical scoring systems were analysed.ResultsThe published literature on AHV is largely heterogeneous and retrospective. Nine contemporary studies reporting on 140 patients (201 osteotomies) were included. The female to male ratio was 10:1. The mean age at operation was 14.5 years (range 10.5–22). The mean follow-up was 41.6 months (range 12–134). The mean post-operative American Orthopaedic Foot and Ankle Society (AOFAS) score was 85.8 (standard deviation, SD ±7.38). The mean AOFAS patient satisfaction showed that 86 % (SD ±11.27) of patients were satisfied or very satisfied with their outcome. On the duPont Bunion Rating Score (BRS), 90 % rated their outcome as good or excellent. There was a statistically significant improvement in the inter-metatarsal angle (IMA, p = 0.0003), hallux valgus angle (HVA, p < 0.0001) and distal metatarsal articular angle (DMAA, p = 0.019).ConclusionBased on the most current published evidence, contemporary surgical interventions for AHV show excellent clinical and radiological outcomes, with high patient satisfaction. The rates of recurrence and other complications are lower than the historically reported figures. There is a need for high-level, multi-centre collaborative studies with prospective data to establish the long-term outcomes and optimal surgical procedure(s).

The aim of this study was to construct and validate a simple patient-related outcome score to quantify the disability caused by Dupuytren's disease (DD), thus enabling prioritisation of treatment, to allow reliable audit of surgical outcome and to support future research. The Southampton Dupuytren's Scoring System (SDSS) was developed in a staged fashion according to the recommendations of The Derby Outcomes Conference. (1) Item generation; (2) Item reduction; (3) Internal consistency; (4) Test-re-test; (5) Field management; (6) Sensitivity to change standardised response mean; and (7) Criterion validity: ability of the SDSS to measure what it is supposed to measure. Internal consistency measured with Cronbach's alpha indicated acceptable reliability. The test-re-test correlation coefficient showed high reliability with SDSS. Field-testing showed SDSS ratings to be higher than the QuickDASH (Disability of the arm, shoulder and hand) ratings evaluated by the patients who answered both questionnaires. Standardised response mean was more sensitive for SDSS compared with QuickDASH showing sensitivity to change. Criterion validity was used to assess if the SDSS was measuring what it is supposed to measure comparing the SDSS with QuickDASH. A highly significant correlation was found between the two scoring systems. SDSS is a disease-specific patient-related outcome measure with a good internal consistency and performs better than QuickDASH in terms of test-re-test reliability and sensitivity to change. SDSS shows better field-testing attributes suggesting that it is a relatively more patient and practitioner friendly scoring system. This study proposes to the SDSS is a useful patient-related outcome measure for DD.Journal of Plastic Surgery and Hand Surgery Downloaded from informahealthcare.com by Nyu Medical Center on 06/21/15For personal use only.

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Over a 6-year period 64 axillofemoral bypass and femorofemoral crossover grafts have been performed in 58 patients, most of whom were considered unfit for intra-abdominal surgery. Indications were peripheral ischaemia in 78 per cent and disabling claudication in 22 per cent. The limb salvage rate at 3 years was 75 per cent. No claudicants lost limbs, but only one-third of patients presenting with forefoot gangrene or ulceration avoided amputation. Most patients presenting with ischaemic symptoms at rest had associated femoropopliteal and distal disease, confirmed by the ankle pressure index measurements, and this influenced graft patency. Although the cumulative patency at 3 years for all grafts combined was 57 per cent with similar patencies for both the axillofemoral and femorofemoral grafts, early occlusion was more common in axillofemoral grafts and this may be reduced in bifemoral grafts by the increased flow rate in the vertical limbs. Peroperative electromagnetic flowmeter measurements were made after reconstruction on 55 femoral arteries in 46 of the patients and graft flow velocities were derived from these measurements. Comparison between velocities from those grafts remaining patent and those subsequently occluding showed a high incidence of occlusion in grafts with a maximal velocity after distal vasodilatation of less than 8 cm/s. Graft occlusion after the first postoperative month was more commonly associated with other factors such as continued smoking, severity of distal disease and perigraft infection.