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We report 3 cases of dorsal dislocation of the first metatarsophalangeal joint treated by closed reduction. Associated dislocation of the sesamoid complex may make reduction difficult. We suggest a modification of Jahss's classification and have confirmed our findings in amputation specimens.

We carried out a case-control study with 90 patients with Legg-Calvé-Perthes disease (LCPD) and 183 normal children, as controls, selected at random to determine whether the condition of passive smoking is related to the disease. Seventy-one of 90 of the LCPD group (78.9%) were passive smokers. Only 79 of 183 (43.2%) in the control group were passive smokers (p = 0.00000). We did not find any statistical relationship between passive smoking and evolution of the condition (p = 0.42883), Catterall extension (p = 0.60544), final Stulberg result (p = 0.53201), or presence of sequelae (p = 0.53256). We also could not find any statistical difference between ages (p = 0.18). The odds ratio was 5.3203 (95% confidence interval 2.92-9.69). The association between LCPD and passive smoking, after controlling for age and gender, became significant (p = 0.0000). Thus the risk of LCPD in passive smoking children is more than five times higher than in children who are not exposed to smoke. It seems that passive smoking is a factor directly or indirectly associated with LCPD.

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Plantar dislocation of the metatarsophalangeal joint of the great toe is a rare injury. We report one example which occurred in a lactating lady following minor trauma, and which was successfully treated by closed manipulation. There was no evidence of major generalised ligamentous laxity.

A case of dorsal dislocation of the first metatarso-phalangeal joint is reported because it is a very unusual injury, and the literature is reviewed.

Background. In the last few years, instruments that measure outcomes and quality of life as perceived by the patient have become tools of great clinical value. The Zurich Claudication Questionnaire is one of the main instruments for the assessment of patients suffer ing from lumbar spinal stenosis. Nonetheless, no valid version has been published for use in the Spanish po pulation.