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Short scarf osteotomy for moderate hallux valgus deformity
E-Poster / Foot and Ankle Surgery 22S (2016) 80–104
Conclusion: The occurence of Barbers disease is not only limited to the hand but also possible in the foot. This is the first report about three patients with foot complaints, interestingly enough including two women, who were never affected in the preceeding case reports. Debridement and removal of the hairs is curative. http://dx.doi.org/10.1016/j.fas.2016.05.270
249 FI2016_E-Poster_72 MIPO in distal tibial fractures. Use of the locked plates. Functional outcomes ˜ ez Arauz *, J. del Vecchio, A. Eksarho, J.M. Ya´n ˜ ez Arauz I. Arzac, E. Ya´n Austral University Hospital, Buenos Aires, Argentina *Corresponding author. Background: Distal tibial fractures are a challenge for treatment due to the poor coverage and particular vascularization. The objectives of this study are: a) to analyze the clinical and functional outcomes of patients with distal tibial fracture, treated with MIPO technique with locked plates; b) compare the results between AO 43A fracture group and AO 43C1-C2 group; c) compare the results with conventional open treatment. Materials and Methods: Between 2004 and 2012, 32 distal tibial fractures treated with MIPO technique were evaluated. 20 men and 12 women. Average age: 40.1 years. 59.4% had fractures AO 43A; and 40.6% AO 43 C. Average time between trauma and surgery: 6.8 days. 24 cases associated fibula fracture. Average hospital stay: 1.5 days. Follow-up average: 39.6 months by AOFAS score and radiology. Complications were recorded. AO A type and AO C type results were compared. Results: AOFAS score between pre- and post-operative, increased mean 73.3 points. The group AO type A: average 95.89 AOFAS points in PO. PO average of 92.15 points: in group AO C1-2. Average weight bearing: 8.7 weeks. Comparing AO 43A and 43 C outcomes: p: 0.46 (not significant). Average time to return to pre-injury activity: 9.3 months. Comparing type A and type C: p = 0.16 (not significant). There was 18.75% of complications. Osteosynthesis removal: 14 cases. Conclusions: Minimally invasive plate osteosynthesis is a good choice for distal tibial fractures; with good clinical and functional outcomes, and few complications compared to open surgery. 43A fractures had fewer major complications than 43 C fractures. http://dx.doi.org/10.1016/j.fas.2016.05.271
250 FI2016_E-Poster_73 Fat Bubble Heel Pain (FBHP) - A new type of intrinsic heel disorder J. Plath 1,*, A. Dietze 2 1
Orthopedic Surgery, Stralsund, Germany DRK Krankenhaus Grimmen, D-18516 Su¨derholz, OT Bartmannshagen *Corresponding author.
2
Background: The heel’s functional anatomy is still not sufficiently unterstood. The physiological construction of this essential shock absorber may be more vulnerable than realized.
103
Method and Results: In a prospective clinical study among 1692 ambulant patients with foot pain a good third (n = 600, t = 24 month) complainted of heel or hindfood pain. In 72 (4.2%) cases of them a formation of subcutaneous, white-yellow coloured, nonfluid filled, compressible tumorous tissue was clinically described, while the patients were standing upright. This clinical phenomenon disappeared after changing into supine position. We describe our finding as Fat Bubbles of the Heel (FBH). After excluding patients with other heel pain conditions we identified a group of 34 female and 9 male patients (7.2% of hind foot pain cases, age range 12-84, mean 53.3, SD 15.0) who were suffering from Fat Bubble Heel Pain (FBHP). Conclusions: We believe FBHP to occur due to statically displaced fat tissue being pressed through the fascia of the hind foot which is usually well and tightly structured fibrous tissue. For the treatment of symptoms, various methods such as rest and elevation, shock wave therapy and anti-inflammatory medication were successfully applied. As a result the FBHP resolved. The clinical findings of FBH, however, persisted. With our work we would like to provide a clinical description, as well as photographic and MRI documentation of our findings. Furthermore we present anatomical and histological evidence to illuminate possible causes of the described heel pathology. http://dx.doi.org/10.1016/j.fas.2016.05.272
251 FI2016_E-Poster_74 Forefoot diseases in art K. Milachowski Private, Munich, Germany Background: Producing art is part of the human life. This is well known since the stone age. Animal and human representations con still be seen in some caves. The presentation of diseases and injuries are part of these works. Aims: First representations of forefoot diseases can be seen in the paintings in the grave chambers in old Egypt and the potter works of the Mayas. The presentation of clubfoot, amputations, diseases and paralysis was part of their culture. Methods: A historical overview of the diseased forefoot in art is given. Especially the presentation of the hallux valgus in paintings, drawings, and sculptures is shown. Pictures of Ribera, Du¨rer, de la Tour, Renoir, Dix and others are presented. Summary-Conclusions: A presentation of the diseased forefoot in art is given by means of a historical overview. The particular importance of the hallux valgus in works of art is presented additionally. http://dx.doi.org/10.1016/j.fas.2016.05.273
252 FI2016_E-Poster_75 Short scarf osteotomy for moderate hallux valgus deformity J.-W. Chung * Bucheon St. Mary’s Hospital, Korea *Corresponding author. Among the surgical procedures for correction of hallux valgus deformities, scarf osteotomy has an inherent stability and
104
E-Poster / Foot and Ankle Surgery 22S (2016) 80–104
reliability of the technique. The authors modified the classic technique of scarf osteotomy by shortening the longitudinal cut and named it short scarf osteotomy. This retrospective study aimed to evaluate the radiological and clinical results of short scarf osteotomy. The author has performed short scarf osteotomy in 42 patients (42 feet) under the diagnosis of moderate hallux valgus deformity. All the patients were female, and their mean age was 41.5 (range, 26–63) years. The mean follow-up period was 27.4 (range, 24–38) months. The longitudinal cut was approximately 15 mm, and the fixation was achieved by one or two partially threaded, headless compression screws. The first intermetatarsal angle (IMA) and hallux valgus angle (HVA) were analyzed before and after the surgery. The clinical result was assessed based on American Orthopedic Foot and Ankle Society Hallux Metatarsophalangeal-
Interphalangeal (AOFAS-HMI) score. The first IMA and HVA were reduced from the mean preoperative values of 15.6 degrees and 30.8 degrees to 6.2 degrees and 10.2 degrees, respectively. The mean AOFAS-HMI score was increased from 56.3 points preoperatively to 90.9 points at follow-up. The longitudinal crack occurred during distal screw insertion in two patients. No transfer metatarsalgia or recurrence of the deformity was observed during the follow-up. Short scarf osteotomy can be an effective surgical procedure for moderate hallux valgus with the benefits of minimal soft tissue dissection while maintaining the stable architecture of the classic scarf osteotomy.
http://dx.doi.org/10.1016/j.fas.2016.05.274
Conclusion: The occurence of Barbers disease is not only limited to the hand but also possible in the foot. This is the first report about three patients with foot complaints, interestingly enough including two women, who were never affected in the preceeding case reports. Debridement and removal of the hairs is curative. http://dx.doi.org/10.1016/j.fas.2016.05.270
249 FI2016_E-Poster_72 MIPO in distal tibial fractures. Use of the locked plates. Functional outcomes ˜ ez Arauz *, J. del Vecchio, A. Eksarho, J.M. Ya´n ˜ ez Arauz I. Arzac, E. Ya´n Austral University Hospital, Buenos Aires, Argentina *Corresponding author. Background: Distal tibial fractures are a challenge for treatment due to the poor coverage and particular vascularization. The objectives of this study are: a) to analyze the clinical and functional outcomes of patients with distal tibial fracture, treated with MIPO technique with locked plates; b) compare the results between AO 43A fracture group and AO 43C1-C2 group; c) compare the results with conventional open treatment. Materials and Methods: Between 2004 and 2012, 32 distal tibial fractures treated with MIPO technique were evaluated. 20 men and 12 women. Average age: 40.1 years. 59.4% had fractures AO 43A; and 40.6% AO 43 C. Average time between trauma and surgery: 6.8 days. 24 cases associated fibula fracture. Average hospital stay: 1.5 days. Follow-up average: 39.6 months by AOFAS score and radiology. Complications were recorded. AO A type and AO C type results were compared. Results: AOFAS score between pre- and post-operative, increased mean 73.3 points. The group AO type A: average 95.89 AOFAS points in PO. PO average of 92.15 points: in group AO C1-2. Average weight bearing: 8.7 weeks. Comparing AO 43A and 43 C outcomes: p: 0.46 (not significant). Average time to return to pre-injury activity: 9.3 months. Comparing type A and type C: p = 0.16 (not significant). There was 18.75% of complications. Osteosynthesis removal: 14 cases. Conclusions: Minimally invasive plate osteosynthesis is a good choice for distal tibial fractures; with good clinical and functional outcomes, and few complications compared to open surgery. 43A fractures had fewer major complications than 43 C fractures. http://dx.doi.org/10.1016/j.fas.2016.05.271
250 FI2016_E-Poster_73 Fat Bubble Heel Pain (FBHP) - A new type of intrinsic heel disorder J. Plath 1,*, A. Dietze 2 1
Orthopedic Surgery, Stralsund, Germany DRK Krankenhaus Grimmen, D-18516 Su¨derholz, OT Bartmannshagen *Corresponding author.
2
Background: The heel’s functional anatomy is still not sufficiently unterstood. The physiological construction of this essential shock absorber may be more vulnerable than realized.
103
Method and Results: In a prospective clinical study among 1692 ambulant patients with foot pain a good third (n = 600, t = 24 month) complainted of heel or hindfood pain. In 72 (4.2%) cases of them a formation of subcutaneous, white-yellow coloured, nonfluid filled, compressible tumorous tissue was clinically described, while the patients were standing upright. This clinical phenomenon disappeared after changing into supine position. We describe our finding as Fat Bubbles of the Heel (FBH). After excluding patients with other heel pain conditions we identified a group of 34 female and 9 male patients (7.2% of hind foot pain cases, age range 12-84, mean 53.3, SD 15.0) who were suffering from Fat Bubble Heel Pain (FBHP). Conclusions: We believe FBHP to occur due to statically displaced fat tissue being pressed through the fascia of the hind foot which is usually well and tightly structured fibrous tissue. For the treatment of symptoms, various methods such as rest and elevation, shock wave therapy and anti-inflammatory medication were successfully applied. As a result the FBHP resolved. The clinical findings of FBH, however, persisted. With our work we would like to provide a clinical description, as well as photographic and MRI documentation of our findings. Furthermore we present anatomical and histological evidence to illuminate possible causes of the described heel pathology. http://dx.doi.org/10.1016/j.fas.2016.05.272
251 FI2016_E-Poster_74 Forefoot diseases in art K. Milachowski Private, Munich, Germany Background: Producing art is part of the human life. This is well known since the stone age. Animal and human representations con still be seen in some caves. The presentation of diseases and injuries are part of these works. Aims: First representations of forefoot diseases can be seen in the paintings in the grave chambers in old Egypt and the potter works of the Mayas. The presentation of clubfoot, amputations, diseases and paralysis was part of their culture. Methods: A historical overview of the diseased forefoot in art is given. Especially the presentation of the hallux valgus in paintings, drawings, and sculptures is shown. Pictures of Ribera, Du¨rer, de la Tour, Renoir, Dix and others are presented. Summary-Conclusions: A presentation of the diseased forefoot in art is given by means of a historical overview. The particular importance of the hallux valgus in works of art is presented additionally. http://dx.doi.org/10.1016/j.fas.2016.05.273
252 FI2016_E-Poster_75 Short scarf osteotomy for moderate hallux valgus deformity J.-W. Chung * Bucheon St. Mary’s Hospital, Korea *Corresponding author. Among the surgical procedures for correction of hallux valgus deformities, scarf osteotomy has an inherent stability and
104
E-Poster / Foot and Ankle Surgery 22S (2016) 80–104
reliability of the technique. The authors modified the classic technique of scarf osteotomy by shortening the longitudinal cut and named it short scarf osteotomy. This retrospective study aimed to evaluate the radiological and clinical results of short scarf osteotomy. The author has performed short scarf osteotomy in 42 patients (42 feet) under the diagnosis of moderate hallux valgus deformity. All the patients were female, and their mean age was 41.5 (range, 26–63) years. The mean follow-up period was 27.4 (range, 24–38) months. The longitudinal cut was approximately 15 mm, and the fixation was achieved by one or two partially threaded, headless compression screws. The first intermetatarsal angle (IMA) and hallux valgus angle (HVA) were analyzed before and after the surgery. The clinical result was assessed based on American Orthopedic Foot and Ankle Society Hallux Metatarsophalangeal-
Interphalangeal (AOFAS-HMI) score. The first IMA and HVA were reduced from the mean preoperative values of 15.6 degrees and 30.8 degrees to 6.2 degrees and 10.2 degrees, respectively. The mean AOFAS-HMI score was increased from 56.3 points preoperatively to 90.9 points at follow-up. The longitudinal crack occurred during distal screw insertion in two patients. No transfer metatarsalgia or recurrence of the deformity was observed during the follow-up. Short scarf osteotomy can be an effective surgical procedure for moderate hallux valgus with the benefits of minimal soft tissue dissection while maintaining the stable architecture of the classic scarf osteotomy.
http://dx.doi.org/10.1016/j.fas.2016.05.274