Bruno Magnan

Percutaneous Distal Metatarsal Osteotomy for Correction of Hallux Valgus

BACKGROUND Distal osteotomy of the first metatarsal is indicated for the surgical treatment of mild-to-moderate hallux valgus deformity. The aim of this study was to evaluate the results of a subcapital distal osteotomy of the first metatarsal with use of a percutaneous technique. METHODS From 1996 to 2001, 118 consecutive percutaneous distal osteotomies of the first metatarsal were performed for the treatment of painful mild-to-moderate hallux valgus in eighty-two patients. The patients were assessed with a clinical and radiographic protocol at a mean of 35.9 months postoperatively. The American Orthopaedic Foot and Ankle Society (AOFAS) hallux-metatarsophalangeal-interphalangeal scale was used for the clinical assessment. RESULTS The patients were satisfied following 107 (91%) of the 118 procedures. The mean score on the AOFAS scale was 88.2 +/- 12.9 points. The postoperative radiographic assessments showed a significant change (p < 0.05), compared with the preoperative values, in the mean hallux valgus angle, first intermetatarsal angle, distal metatarsal articular angle, and sesamoid position. The valgus deformity recurred after three procedures (2.5%), the first metatarsophalangeal joint was stiff but not painful after eight (6.8%), and a deep infection developed after one (0.8%). The infection resolved with antibiotic therapy. CONCLUSIONS The percutaneous technique proved to be reliable for the correct execution of a distal linear osteotomy of the first metatarsal for the correction of a painful mild-to-moderate hallux valgus deformity. The clinical results appear to be comparable with those obtainable with traditional open techniques, with the additional advantages of a minimally invasive procedure, a substantially shorter operating time, and a reduced risk of complications related to surgical exposure.

Preformed acrylic bone cement spacer loaded with antibiotics: Use of two-stage procedure in 10 patients because of infected hips after total replacement

In 10 patients having deep infection after total hip replacement, we used a two-stage revision procedure involving implantation of a preformed spacer with a cylindrical rod coated with acrylic cement containing antibiotics (Spacer-G). This device, which remained in situ for an average of 5 months, permitted healing of the infection in 8 cases and reimplantation of a new prosthesis (mean follow-up 35 months). During treatment, 1 dislocation occurred. The spacer maintained the gap between both bone segments and allowed a certain degree of joint mobility. Use of Spacer-G improved the quality of life of the patients during treatment and accelerated recovery of function after reimplantation.

Long-Term Results of Anti-Protrusio Cage and Massive Allografts for the Management of Periprosthetic Acetabular Bone Loss

From 1992 to 1995, 71 total hip arthroplasties with extensive acetabular bone loss underwent revision using bulk allografts and Burch-Schneider anti-protrusion cages. Twelve patients died of unrelated causes and 3 were lost to follow-up. Fifty-six hips were available for clinical and radiographic follow-up examination at an average of 11.7 years after surgery. The average final Harris hip score was 75. X-ray signs of incorporation of massive bone graft were observed in 49 hips. Two cases developed deep infection that required resection arthroplasty. Aseptic loosening of the acetabular cage occurred in 5 patients, and 2 of them underwent re-revision. With a total survival rate of 87.5%, anti-protrusion cages and structural allografts compare favorably with other techniques in the long-term reconstructive treatment of extensive loss of acetabular bone stock.

Metatarsal lengthening by callotasis during the growth phase

Congenital or acquired shortness of a metatarsal may cause pain in adjacent metatarsals. From 1983 to 1990, we performed nine metatarsal lengthenings in seven adolescent patients by metaphyseal osteotomy followed by gradual distraction of callus (callotasis). Two patients required bone grafts after the lengthening. We used a rigid, unilateral external fixator designed for use in the hand and foot. At follow-up, from three to ten years later, healing had been achieved in all with an average healing index of 50 days/cm, and metatarsalgia had been relieved by the restoration of correct metatarsal length.

Traumatic loss of the talus treated with a talar body prosthesis and total ankle arthroplasty. A case report.

Total talar dislocation is a rare injury1-6 that usually occurs as a result of a high-energy continuation of extreme supination forces causing lateral subtalar dislocation or extreme pronation forces causing medial subtalar dislocation7. Most of these injuries are open and are associated with a high rate of postreduction complications, such as persistent infection (reported in up to 89% of patients2), shearing osteochondral fractures (45%3), osteonecrosis (33% to 50%1,8,9), and severe degenerative arthritis5,6. Prompt closed or open reduction of the talus, when possible, is the recommended treatment, in combination with soft-tissue debridement of open injuries3,10. However, the high rate of complications has led many authors to suggest that primary excision of the talus or tibiocalcaneal arthrodesis1,2,4,5,11 should be performed instead. Tibiotalar or pantalar arthrodesis has been recommended for any cases of osteonecrosis or arthritis that develop later. Primary open dislocation with loss of the talus (“missing talus”)2, however, necessitates the performance of either a tibiocalcaneal arthrodesis or a resection arthroplasty, which is difficult to create and maintain. Both procedures often produce unwanted effects on the foot, particularly in young patients, because of loss of function of the peritalar joints3,12-14. To avoid the necessity of performing these procedures and to preserve ankle function, the implantation of a talar body prosthesis has been proposed15. Because the long-term survival of such an implant, especially in active individuals, is not known, a total ankle arthroplasty coupled with a talar prosthesis fixed to the calcaneus and the navicular may be an alternative solution. We describe the case of a forty-five-year-old man in whom total ankle arthroplasty and …

Minimally invasive retrocapital osteotomy of the first metatarsal in hallux valgus deformity.

ObjectivePercutaneous retrocapital distal osteotomy of the first metatarsal for surgical treatment of hallux valgus.IndicationsMild to moderate hallux valgus deformity in both juveniles and adults.Recurrent hallux valgus deformity after previous surgery.ContraindicationsSevere degenerative changes of the first metatarsophalangeal joint (hallux valgus et rigidus).Previous Kellers procedure.Surgical TechniqueA percutaneous distal linear osteotomy of the first metatarsal is performed and stabilized with a Kirschner wire. The surgical technique follows these steps: distal Kirschner wire insertion; skin incision; sparse periosteal detachment; distal retrocapital osteotomy of the first metatarsal; correction of the first intermetatarsal angle by lateral displacement of the capital fragment; stabilization with Kischner wire insertion into the proximal metatarsal; postoperative taping.ResultsThe patients were satisfied following 107 (91%) of 118 consecutive percutaneous procedures with a follow-up of 35.9 months (range 24–78 months). According to the American Orthopaedic Foot and Ankle Society (AOFAS) hallux metatarsophalangeal-interphalangeal scale for the clinical assessment, a mean score of 88.2 ± 12.9 was obtained at follow-up. The clinical results can be compared to those obtained with open techniques, with the advantages of a minimally invasive procedure.ZusammenfassungOperationszielPerkutane retrokapitale distale Osteotomie des ersten Mittelfußknochens zur chirurgischen Behandlung des Hallux valgus.IndikationenLeichte bis mittelschwere Hallux-valgus-Deformität bei Jugendlichen und Erwachsenen.Wiederauftretende Hallux-valgus-Deformität nach vorangegangener Operation.KontraindikationenSchwere degenerative Veränderungen des ersten Metatarsophalangealgelenks (Hallux valgus et rigidus).Vorheriges Keller-Verfahren.OperationstechnikEine perkutane distale lineare Osteotomie des ersten Mittelfußknochens wird durchgeführt und mit einem Kirschner-Draht stabilisiert. Die Operationstechnik umfasst folgende Schritte: distale Einführung des Kirschner-Drahts; Hautschnitt; sparsame Ablösung der Knochenhaut; distale retrokapitale Osteotomie des ersten Mittelfußknochens; Korrektur des ersten intermetatarsalen Winkels durch seitliche Verschiebung des Kopffragments; Stabilisation durch Einführung des Kirschner-Drahts in den proximalen Mittelfußknochen; postoperativer Verband.ErgebnisseNach 118 konsekutiven perkutanen Verfahren mit einer Nachuntersuchungszeit von durchschnittlich 35,9 Monaten (24–78 Monate) waren 107 (91%) der Patienten mit dem Ergebnis zufrieden. Auf der „hallux metatarsophalangealinterphalangeal“-Skala der American Orthopaedic Foot and Ankle Society (AOFAS) zur klinischen Beurteilung wurde bei den Nachuntersuchungen ein durchschnittliches Ergebnis von 88,2 ± 12,9 erreicht. Die klinischen Ergebnisse können mit denen der offenen Techniken verglichen werden, haben aber den Vorteil eines minimalinvasiven Verfahrens.

Leap Motion Gesture Control With OsiriX in the Operating Room to Control Imaging: First Experiences During Live Surgery

Dear Editor, We would like to present our first experiences with the use of an innovative system to control the imaging in the operation room, the Leap Motion gesture control and OsiriX. Touch-free systems are useful where the contact between the surgeon and computer is disadvantageous; in the operating room a touch-less system is an ideal solution. These solutions reduce surgery time, minimize the risk of infections (in some hospitals, PC monitors are located on the wall and the surgeon must leave the operating table to go there). During surgery, changing gloves each time the computer system has to be operated interrupts the workflow and can result in longer surgery times with higher risk for the patient and higher costs. A Swiss group presented a good prototype: they use Orisix and Microsoft Kinect to perform the touch-free control in the operation room and during autopsy. This solution, in our opinion, can neither be placed on the market nor in operation rooms. The vocal control had several limitations, the Kinect is quite expensive, intraoperative 3-dimensional (3D) imaging was difficult to control, and the working distance of ~1.2 m required a screen of appropriate size. They concluded by suggesting that using more advanced methods, such as recognition of finger gestures, could solve these problems.

Three-Dimensional Matrix-Induced Autologous Chondrocytes Implantation for Osteochondral Lesions of the Talus: Midterm Results

Introduction. We evaluate the midterm results of thirty patients who underwent autologous chondrocytes implantation for talus osteochondral lesions treatment. Materials and Methods. From 2002 to 2009, 30 ankles with a mean lesion size of 2,36 cm2 were treated. We evaluated patients using American Orthopaedic Foot and Ankle Surgery and Coughlin score, Van Dijk scale, recovering time, and Musculoskeletal Outcomes Data Evaluation and Management System. Results. The mean AOFAS score varied from 36.9 to 83.9 at follow-up. Average of Van Dijk scale was 141.1. Coughlin score was excellent/good in 24 patients. MOCART score varied from 6.3 to 3.8. Discussion. This matrix is easy to handle conformable to the lesion and apply by arthroscopy. No correlation between MRI imaging and clinical results is found. Conclusions. Our results, compared with those reported in literature with other surgical procedures, show no superiority evidence for our technique compared to the others regarding the size of the lesions.

Clinical and radiologic outcomes of total knee arthroplasty using the Advance Medial Pivot prosthesis. A mean 7 years follow-up

BACKGROUND Medial Pivot total knee prosthesis has been designed according to studies on normal knee kinematics aiming to replicate physiological knee movement. The purpose of this study was to evaluate clinical and radiologic results of the Advance Medial Pivot Total Knee Arthroplasty, at a mean follow-up of seven years. METHODS One hundred seventy two Medial Pivot total knee arthroplasties in 160 consecutive patients have been evaluated using the American Knee Society Score and the Knee Society Total Knee Arthroplasty Roentgenographic Evaluation and Scoring System. Statistical analysis was performed using the Students t-test and the Wilcoxon matched-pairs signed-rank (Mann-Whitney) test in order to evaluate the significance of differences within the groups of patients. Patients compliance was 93.75% thus only six patients (3.75%) lost to follow-up and four patients (2.5%) died for reasons unrelated to the surgery. RESULTS The mean Knee Society score and range of motion was improved from 77.6 points and 97.7° to 152.8 points and 112.5° respectively (p<.001). In total 85.8% and 82.4% of the knees had an excellent (≥ 80) or good (70-79) functional and knee scores respectively. Relief of pain was satisfactory in 88.9% of the patients, while 96% of the patients return to age-related daily life activities. Stability and comfort during walking was subjectively judged by the patients as satisfactory in about 90%. Anterior knee pain was observed in eight patients (5.4%). The Kaplan-Meier survivorship analysis showed a cumulative success rate of 98.6%. CONCLUSIONS The results are encouraging but longer follow-up of this cohort is necessary in the study of this specific design. Level of evidence IV.

Percutaneous Distal Osteotomy of the Fifth Metatarsal for Correction of Bunionette

BACKGROUND Distal osteotomy of the fifth metatarsal is indicated in the surgical treatment of bunionette and varus deformities of the fifth toe in patients with a valgus deviation of the fifth metatarsal. The aim of this study was to evaluate the results of a subcapital percutaneous osteotomy of the fifth metatarsal in the treatment of this disorder. METHODS From 1996 to 2006, thirty consecutive percutaneous distal osteotomies of the fifth metatarsal were performed in twenty-one patients for the treatment of a painful prominence of the head of the fifth metatarsal. Combined procedures were performed, including a first metatarsal osteotomy in sixteen feet for hallux valgus treatment and a distal open osteotomy of the second metatarsal for painful dorsal dislocation of the second metatarsophalangeal joint in eight feet. The patients were assessed at a mean of ninety-six months with a radiographic and clinical protocol that made use of the American Orthopaedic Foot & Ankle Society (AOFAS) Lesser Toe Metatarsophalangeal-Interphalangeal Scale. RESULTS The AOFAS score improved from a mean and standard deviation of 51.9 ± 10.2 points preoperatively to 98.4 ± 2.6 points at the time of final follow-up. In 73% of feet there was complete resolution of pain at the fifth metatarsophalangeal joint without any functional limitation (AOFAS score of 100). In 20% of the cases the AOFAS score was 95 points with some decrease in function and a need to use comfortable shoes. In the remaining 7% of patients the AOFAS score was 93 points with mildly asymptomatic malalignment. No nonunions or recurrences were observed. CONCLUSIONS The percutaneous procedure described here is a reliable technique to perform a distal transverse osteotomy of the fifth metatarsal to correct a painful varus fifth-toe deformity with prominence of the fifth metatarsal head. The clinical results are comparable with those reported with traditional open techniques, with the advantages of a minimally invasive surgical procedure, substantially shorter operating time, and a reduced risk of complications.