Background Correction of hammertoe deformities at the proximal interphalangeal (PIP) joint results in an inherent loss of motion that can be a concern for active patients who want to maintain toe function and grip strength. Diaphyseal proximal phalangeal shortening osteotomy (DPPSO) is a joint-sparing procedure resecting a cylindrical portion of the proximal phalanx on the middiaphysis. Patients/Methods This was a retrospective review including patients treated using DPPSO with at least a 1-year follow-up. Demographic, comorbidity, and Visual Analogue Scale (VAS) scores and complication data were obtained. Radiological assessment included union status and alignment. Medial frontal anatomical (mFAA), frontal proximal interphalangeal (mFIA), plantar lateral anatomical (pLAA), and medial and plantar lateral interphalangeal angles (pLIA) were measured. Results A total of 31 patients (45 toes) were included, with a mean age of 59 years (range: 24-72) and follow-up of 35 months (range: 12-60; mean preoperative VAS score was 4.9 ± 1.72 improving to 1.62 ± 2.28; P < .01). Union occurred in all patients at an average of 11.2 weeks. Complications were present on 4 toes (8.8%), with no recurrences. The pLIA significantly changed from 44.9° to 17.9°. There were no significant differences in the preoperative and postoperative values of the mFAA, pLAA, and mFIA. Conclusions DPPSO provides adequate pain relief and corrects the PIP joint in the lateral plane without significantly affecting the coronal plane or the anatomical axis of the phalanx in the frontal and lateral views, nor producing secondary deformities. DPPSO is a safe, effective, and reproducible technique with a low complication rate. Levels of Evidence: Level IV: Retrospective case series
Category: Ankle, Hindfoot, Trauma Introduction/Purpose: Open Achilles tendon repair is typically performed in the prone position for easy visibility of the tendon, but serious complications may be associated with general anesthesia in this position. Open Achilles tendon repair with supine position has been described and potentially avoids these issues, but it is not known whether this position is safe. We reviewed the complication rate of supine open Achilles tendon repair in a retrospective series of patients, looking specifically at wound healing, infection, re-rupture, and sural nerve injury. Methods: CPT codes for Achilles tendon rupture were used to search the records of one surgeon for the years 2010-2014. The charts were then reviewed. Patients were included if they had an Achilles tendon rupture that was surgically treated with primary repair in the supine position within 15 days of injury. Patients were excluded if further reconstruction or tendon transfer was performed. A paramedian incision was utilized 1 cm medial to the Achilles sheath. Results: A total of 37 patients met the inclusion criteria. Of these 37 patients, 31 were men and 6 were women. The average age was 40.0 years (range, 20 to 66 years). Average length of follow-up was 159 days (range 25 to 1589 days). The average BMI was 28 (range 24-36). There were no major complications, including no infections or wound complications. No reruptures and no sural nerve injuries were observed. Conclusion: In 37 patients with early follow-up, supine open Achilles tendon repair had a complication rate equivalent to reported historical data for the prone procedure.
This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
Category: Lesser Toes Introduction/Purpose: Hammertoe deformities are a result of imbalance between static and dynamic stabilizers of the lesser toes. Flexor-to-extensor tendon transfer and PIP joint arthrodesis/arthroplasty are the gold standards of treatment. Tendon transfers are associated with stiffness, edema and recurrence. PIP arthrodesis/arthroplasty sacrifices the PIP joint producing loss of both motion and toe grip. Phalangeal sustraction osteotomies have been proposed for correcting these deformities by theoretically relaxing the surrounding soft tissue structures and correcting the hammertoe deformity at the PIP joint. We present the results of a new joint sparing procedure consisting on a Diaphyseal Proximal Phalangeal Shortening Osteotomy (DPPSO) with resection of a 3-4 mm cilindrical bone section. Methods: Retrospective study. Review of medical records of patients who underwent phalangeal shortening osteotomy for hammer toe correction from 2010 to 2016 by the senior author (L.S.). Patients with previous surgery on the toe were excluded of the study as well as patients with incomplete radiological follow-up. Demographic and comorbidities data were noted as well as postoperative complications and secondary procedures. We performed a radiographic analysis of preoperative and postoperative x-rays-Union was defined as the existence of brigding of at least 3 cortices on the osteotomy site. Preoperatively and 6 months follow up x-rays were additionally analyzed to obtain the following measurements (Figure 1): Frontal anatomic angle (medial) FAAm Lateral anatomic angle (plantar) LAAp Frontal proximal interphalangeal angle (medial) mFPIA Lateral interphalangeal angle (plantar) pLIPP Statistical analysis: t-test for paired samples to compare preoperative and postoperative angles. Results: Forty-five toes (31 patients) were included in the study. The mean age of the patients was 59,5 years and the mean follow-up was 27.9 months (range:12-52). Concomitant procedures were performed on 29 patients, most commonly Hallux Valgus correction. All patients evolved with radiographic union at an average 11,2 weeks. Two patients presented with delayed healing (15 and 19 weeks). Complications were present on 4 toes corresponding to Superficial infection (3 patients) and a symptomatic floating toe (1 patient). There were not recurrences in this group. Radiographic measurements showed no significant differences between the preoperative and postoperative mFFA (p:0,43), pLAA (p:0,239) and mFIA (p:0,239). In the other hand, the Plantar lateral interphalangeal angle (pLIA) that corresponds with the hammertoe deformity, was significantly corrected (p<0,05). Conclusion: DPPSO is a safe and reproducible procedure with a low rate of complications. This procedure has a corrective effect on the PIP joint on the sagittal plane, reducing significantly the plantar lateral interphalangeal angle and consequently the hammertoe deformity. There was no significant effect on the PIP joint on the coronal plane and neither on the anat...
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.