To assess the repeatability and error of conventional x-ray measurements, intra- and interobserver evaluations of measurement accuracy were done on 20 preoperative and 40 postoperative (20 chevron and 20 proximal osteotomy) x-rays of hallux valgus patients. Standard x-rays showed an average interobserver error of measurement of 6.4 degrees for the hallux valgus angle, 5.4 degrees for the intermetatarsal angle, and 2.0 mm for the intermetatarsal distance. The intraobserver error did not differ greatly. The repeatability and error of two clinical measurements, ball circumference, and dorsal to plantar range of motion of the first metatarsophalangeal joint were evaluated for 20 healthy volunteers. The ball circumference had an average measurement error of 1.1 cm, whereas the dorsal and plantar range of motion of the great toe had an average measurement error of 12 degrees in dorsiflexion and 16 degrees in plantarflexion. In both clinical and radiographic parameters, linear measurements were more accurate than angular measurements. Although x-rays are of value in hallux valgus surgery, standard x-rays are less accurate than previously assumed. Small changes produced by osteotomies may be hidden by the postoperative measurement error. The results of hallux valgus surgery should primarily be evaluated clinically. When clinical and radiological evaluations are made, linear measurements may be preferable.
I assessed the incidence of lumbar spinal stenosis as well as the frequency of severe neurological symptoms and signs based on patients seen in 2 orthopedic departments. The annual incidence in Malmõ, 1982-1986, was 59 and in the period 1987-1991, 47 per million inhabitants. In Växjö, 1987-1991, the annual incidence was 45 per million. Severe neurological symptoms were few. Reduced EHL power and peroneal paresis were the most prevalent signs and were found in 13 and 12 percent, respectively, of all 163 patients. 1 patient had bladder dysfunction, 1 had impotence and 2 had a cauda equina syndrome.
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