Florian Dreyer

Die proximale Open-Wedge-Osteotomie mit winkelstabiler Plattenosteosynthese zur Korrektur der Spreizfußdeformität mit Hallux valgus

OBJECTIVE Correction of splayfoot deformity through reduction of the increased first intermetatarsal angle by a proximal open-wedge osteotomy. INDICATIONS Splayfoot deformity with a first intermetatarsal angle > 14 degrees and hallux valgus deformity in younger patients. Splayfoot deformities with a short first metatarsal. CONTRAINDICATIONS Degenerative changes in the first metatarsophalangeal joint. Contractures of the first metatarsophalangeal joint. Relative: overlength of the first metatarsal. Relative: lateral tilt of the articular cartilage surface of the first metatarsal head. SURGICAL TECHNIQUE Proximal metatarsal osteotomy approximately 10 mm distal of the first tarsometatarsal joint with preservation of the lateral cortex. Careful manual opening of the osteotomy to avoid a fracture of the lateral cortex. Fixation of the osteotomy with an interlocking plate. Filling of the defect with cancellous bone. Distal soft-tissue procedure. POSTOPERATIVE MANAGEMENT Postoperative hallux shoe for 6 weeks. Partial weight bearing (20 kg) for 2 weeks, afterwards full weight bearing. Mobilization of the first metatarsophalangeal joint. Full weight bearing in comfortable shoes after appropriate bony healing has occurred radiologically. Sports with a high impact on the foot is allowed after 12 weeks. Orthotics are prescribed, if some pain remains or associated pathologies require external support. RESULTS In a consecutive series of 35 patients, the first intermetatarsal angle could be reduced to normal values (6.8 degrees , standard deviation 1.3 degrees ). The open-wedge osteotomy resulted in a slight lengthening of the first metatarsal (1-2 mm). In one patient local wound healing problems had to be treated with oral antibiotics. Operative revision was not necessary in any case. Implant failure or nonunion was not observed. One plate was removed because of local subcutaneous irritation.ZusammenfassungOperationszielKorrektur der schmerzhaften Spreizfussdeformität durch Reduktion des vergrösserten ersten Intermetatarsalwinkels durch eine basisnahe öffnende Osteotomie.IndikationenSpreizfussdeformität mit erstem Intermetatarsalwinkel > 14° und Hallux-valgus-Deformität bei Patienten ohne degenerative Veränderungen des Grosszehengrundgelenks.Spreizfussdeformität bei kurzem Metatarsale I.KontraindikationenDegenerative Veränderungen des Grosszehengrundgelenks.Fortgeschrittene Kontrakturen des Grosszehengrundgelenks.Relativ: Anlagebedingte Überlänge des Metatarsale I.Relativ: Abweichung der Gelenkfläche des Metatarsale I nach lateral (in diesen Fällen sollte die Open-Wedge-Osteotomie nur in Verbindung mit einer distalen Osteotomie zur Korrektur des Gelenkflächenwinkels durchgeführt werden).OperationstechnikOsteotomie des Metatarsale I unter Erhalt der lateralen Kortikalis ca. 10 mm distal des ersten Tarsometatarsalgelenks. Langsames Aufspreizen der Osteotomie, um ein Brechen der lateralen Kortikalis zu vermeiden. Sichern des Korrekturergebnisses mit einer winkelstabilen Platte. Auffüllen des medialen Defekts mit Spongiosa. Distaler Weichteileingriff am Grosszehengrundgelenk.Weiterbehandlung6 Wochen im Vorfussentlastungsschuh, in den ersten 2 Wochen Teilbelastung mit 20 kg, dann Vollbelastung. Bei gesicherter Wundheilung Mobilisation des Grosszehengrundgelenks durch den Patienten, ggf. auch unter krankengymnastischer Anleitung. Vollbelastung im Konfektionsschuh nach 6 Wochen bei radiologisch gesicherter Überbauung. Sport mit hoher Fussbelastung nach 12 Wochen. Einlagenversorgung nur bei Restbeschwerden oder assoziierten Pathologien.ErgebnisseIn einer Serie mit 35 konsekutiven Patienten konnte der erste Intermetatarsalwinkel von präoperativ > 14° (14–23°) um durchschnittlich 9° auf Normwerte korrigiert werden (6,8°, Standardabweichung 1,3°). Die Technik der additiven Osteotomie führte in allen Fällen zu einer leichten Verlängerung des Os metatarsale I um 1–2 mm. Bei einem Patienten kam es zu einer lokalen Wundheilungsstörung, die mit oraler Antibiotikatherapie und lokalen Massnahmen behandelt werden konnte. Eine operative Revision war in keinem der Fälle notwendig. Implantatversagen und Pseud arthrosenbildung traten nicht auf. Bei einer Patientin wurde die Platte aufgrund einer subkutanen mechanischen Irritation entfernt.AbstractObjectiveCorrection of splayfoot deformity through reduction of the increased first intermetatarsal angle by a proximal open-wedge osteotomy.IndicationsSplayfoot deformity with a first intermetatarsal angle > 14° and hallux valgus deformity in younger patients.Splayfoot deformities with a short first metatarsal.ContraindicationsDegenerative changes in the first metatarsaphalangeal joint.Contractures of the first metatarsophalangeal joint.Relative: overlength of the first metatarsal.Relative: lateral tilt of the articular cartilage surface of the first metatarsal head.Surgical TechniqueProximal metatarsal osteotomy approximately 10 mm distal of the first tarsometatarsal joint with preservation of the lateral cortex. Careful manual opening of the osteotomy to avoid a fracture of the lateral cortex. Fixation of the osteotomy with an interlocking plate. Filling of the defect with cancellous bone. Distal soft-tissue procedure.Postoperative ManagementPostoperative hallux shoe for 6 weeks. Partial weight bearing (20 kg) for 2 weeks, afterwards full weight bearing. Mobilization of the first metatarsophalangeal joint. Full weight bearing in comfortable shoes after appropriate bony healing has occurred radiologically. Sports with a high impact on the foot is allowed after 12 weeks. Orthotics are prescribed, if some pain remains or associated pathologies require external support.ResultsIn a consecutive series of 35 patients, the first intermetatarsal angle could be reduced to normal values (6.8°, standard deviation 1.3°). The open-wedge osteotomy resulted in a slight lengthening of the first metatarsal (1–2 mm). In one patient local wound healing problems had to be treated with oral antibiotics. Operative revision was not necessary in any case. Implant failure or nonunion was not observed. One plate was removed because of local subcutaneous irritation.

Functional Medium-Term Results After Autologous Matrix-Induced Chondrogenesis for Osteochondral Lesions of the Talus: A 5-Year Prospective Cohort Study

&NA; Autologous matrix‐induced chondrogenesis (AMIC) has gained popularity in the treatment of osteochondral lesions of the talus. Previous studies have presented promising short‐term results for AMIC talar osteochondral lesion repair, a 1‐step technique using a collagen type I/III bilayer matrix. The aim of the present study was to investigate the mid‐term effects. The 5‐year results of a prospective cohort study are presented. All patients underwent an open AMIC procedure for a talar osteochondral lesion. Data analysis included general demographic data, preoperative magnetic resonance imaging findings, intraoperative details, and German version of the Foot Function Index (FFI‐D) scores preoperatively and at 1 and 5 years after surgery. The primary outcome variable was the longitudinal effect of the procedure, and the influence of various variables on the outcome was tested. Of 47 consecutive patients, 21 (45%) were included. Of the 21 patients, 8 were female (38%) and 13 were male (62%), with a mean age of 37 ± 15 (range 15 to 62) years and a body mass index of 26 ± 5 (range 20 to 38) kg/m2. The defect size was 1.4 ± 0.9 (range 0.2 to 4.0) cm2. The FFI‐D decreased significantly from preoperatively to 1 year postoperatively (56 ± 18 versus 33 ± 25; p = .003), with a further, nonsignificant decrease between the 1‐ and 5‐year follow‐up examination (33 ± 25 versus 24 ± 21; p = .457). Similar results were found for the FFI‐D subscales of function and pain. The body mass index and lesion size showed a positive correlation with the preoperative FFI‐D overall and subscale scores. These results showed a significant improvement in pain and function after the AMIC procedure, with a significant return to sports by the 5‐year follow‐up point. The greatest improvement overall was seen within the first year; however, further clinical satisfaction among the patients was noticeable after 5 years. &NA; Level of Clinical Evidence: 3

[The proximal open-wedge osteotomy with interlocking plate for correction of splayfoot deformities with hallux valgus].

OBJECTIVE Correction of splayfoot deformity through reduction of the increased first intermetatarsal angle by a proximal open-wedge osteotomy. INDICATIONS Splayfoot deformity with a first intermetatarsal angle > 14 degrees and hallux valgus deformity in younger patients. Splayfoot deformities with a short first metatarsal. CONTRAINDICATIONS Degenerative changes in the first metatarsophalangeal joint. Contractures of the first metatarsophalangeal joint. Relative: overlength of the first metatarsal. Relative: lateral tilt of the articular cartilage surface of the first metatarsal head. SURGICAL TECHNIQUE Proximal metatarsal osteotomy approximately 10 mm distal of the first tarsometatarsal joint with preservation of the lateral cortex. Careful manual opening of the osteotomy to avoid a fracture of the lateral cortex. Fixation of the osteotomy with an interlocking plate. Filling of the defect with cancellous bone. Distal soft-tissue procedure. POSTOPERATIVE MANAGEMENT Postoperative hallux shoe for 6 weeks. Partial weight bearing (20 kg) for 2 weeks, afterwards full weight bearing. Mobilization of the first metatarsophalangeal joint. Full weight bearing in comfortable shoes after appropriate bony healing has occurred radiologically. Sports with a high impact on the foot is allowed after 12 weeks. Orthotics are prescribed, if some pain remains or associated pathologies require external support. RESULTS In a consecutive series of 35 patients, the first intermetatarsal angle could be reduced to normal values (6.8 degrees , standard deviation 1.3 degrees ). The open-wedge osteotomy resulted in a slight lengthening of the first metatarsal (1-2 mm). In one patient local wound healing problems had to be treated with oral antibiotics. Operative revision was not necessary in any case. Implant failure or nonunion was not observed. One plate was removed because of local subcutaneous irritation.ZusammenfassungOperationszielKorrektur der schmerzhaften Spreizfussdeformität durch Reduktion des vergrösserten ersten Intermetatarsalwinkels durch eine basisnahe öffnende Osteotomie.IndikationenSpreizfussdeformität mit erstem Intermetatarsalwinkel > 14° und Hallux-valgus-Deformität bei Patienten ohne degenerative Veränderungen des Grosszehengrundgelenks.Spreizfussdeformität bei kurzem Metatarsale I.KontraindikationenDegenerative Veränderungen des Grosszehengrundgelenks.Fortgeschrittene Kontrakturen des Grosszehengrundgelenks.Relativ: Anlagebedingte Überlänge des Metatarsale I.Relativ: Abweichung der Gelenkfläche des Metatarsale I nach lateral (in diesen Fällen sollte die Open-Wedge-Osteotomie nur in Verbindung mit einer distalen Osteotomie zur Korrektur des Gelenkflächenwinkels durchgeführt werden).OperationstechnikOsteotomie des Metatarsale I unter Erhalt der lateralen Kortikalis ca. 10 mm distal des ersten Tarsometatarsalgelenks. Langsames Aufspreizen der Osteotomie, um ein Brechen der lateralen Kortikalis zu vermeiden. Sichern des Korrekturergebnisses mit einer winkelstabilen Platte. Auffüllen des medialen Defekts mit Spongiosa. Distaler Weichteileingriff am Grosszehengrundgelenk.Weiterbehandlung6 Wochen im Vorfussentlastungsschuh, in den ersten 2 Wochen Teilbelastung mit 20 kg, dann Vollbelastung. Bei gesicherter Wundheilung Mobilisation des Grosszehengrundgelenks durch den Patienten, ggf. auch unter krankengymnastischer Anleitung. Vollbelastung im Konfektionsschuh nach 6 Wochen bei radiologisch gesicherter Überbauung. Sport mit hoher Fussbelastung nach 12 Wochen. Einlagenversorgung nur bei Restbeschwerden oder assoziierten Pathologien.ErgebnisseIn einer Serie mit 35 konsekutiven Patienten konnte der erste Intermetatarsalwinkel von präoperativ > 14° (14–23°) um durchschnittlich 9° auf Normwerte korrigiert werden (6,8°, Standardabweichung 1,3°). Die Technik der additiven Osteotomie führte in allen Fällen zu einer leichten Verlängerung des Os metatarsale I um 1–2 mm. Bei einem Patienten kam es zu einer lokalen Wundheilungsstörung, die mit oraler Antibiotikatherapie und lokalen Massnahmen behandelt werden konnte. Eine operative Revision war in keinem der Fälle notwendig. Implantatversagen und Pseud arthrosenbildung traten nicht auf. Bei einer Patientin wurde die Platte aufgrund einer subkutanen mechanischen Irritation entfernt.AbstractObjectiveCorrection of splayfoot deformity through reduction of the increased first intermetatarsal angle by a proximal open-wedge osteotomy.IndicationsSplayfoot deformity with a first intermetatarsal angle > 14° and hallux valgus deformity in younger patients.Splayfoot deformities with a short first metatarsal.ContraindicationsDegenerative changes in the first metatarsaphalangeal joint.Contractures of the first metatarsophalangeal joint.Relative: overlength of the first metatarsal.Relative: lateral tilt of the articular cartilage surface of the first metatarsal head.Surgical TechniqueProximal metatarsal osteotomy approximately 10 mm distal of the first tarsometatarsal joint with preservation of the lateral cortex. Careful manual opening of the osteotomy to avoid a fracture of the lateral cortex. Fixation of the osteotomy with an interlocking plate. Filling of the defect with cancellous bone. Distal soft-tissue procedure.Postoperative ManagementPostoperative hallux shoe for 6 weeks. Partial weight bearing (20 kg) for 2 weeks, afterwards full weight bearing. Mobilization of the first metatarsophalangeal joint. Full weight bearing in comfortable shoes after appropriate bony healing has occurred radiologically. Sports with a high impact on the foot is allowed after 12 weeks. Orthotics are prescribed, if some pain remains or associated pathologies require external support.ResultsIn a consecutive series of 35 patients, the first intermetatarsal angle could be reduced to normal values (6.8°, standard deviation 1.3°). The open-wedge osteotomy resulted in a slight lengthening of the first metatarsal (1–2 mm). In one patient local wound healing problems had to be treated with oral antibiotics. Operative revision was not necessary in any case. Implant failure or nonunion was not observed. One plate was removed because of local subcutaneous irritation.

Epithelioid sarcoma of the plantar fascia mimicking Morbus Ledderhose — A severe pitfall for clinical and histopathological misinterpretation

Plantar fibromatosis, also known as Morbus Ledderhose, is a well known and frequently encountered disorder of the planta pedis. When conservative treatment fails, surgical therapy with complete resection is the therapeutical procedure of choice. Soft tissue sarcoma is a heterogeneous and rare malignant disease of the musculoskeletal system with over 50 histopathological subtypes which can potentially arise in any localization but is most commonly found at the extremities. Here, we report the case of an epithelioid sarcoma of the sole of the foot which was initially and repeatedly clinically and histopathologically misinterpreted as plantar fibromatosis, receiving insufficient resection and subsequently ending in amputation of the lower leg.

Die proximale Open-Wedge-Osteotomie mit winkelstabiler Plattenosteosynthese zur Korrektur der Spreizfußdeformität mit Hallux valgus@@@The Proximal Open-Wedge Osteotomy with Interlocking Plate for Correction of Splayfoot Deformities with Hallux Valgus

OBJECTIVE Correction of splayfoot deformity through reduction of the increased first intermetatarsal angle by a proximal open-wedge osteotomy. INDICATIONS Splayfoot deformity with a first intermetatarsal angle > 14 degrees and hallux valgus deformity in younger patients. Splayfoot deformities with a short first metatarsal. CONTRAINDICATIONS Degenerative changes in the first metatarsophalangeal joint. Contractures of the first metatarsophalangeal joint. Relative: overlength of the first metatarsal. Relative: lateral tilt of the articular cartilage surface of the first metatarsal head. SURGICAL TECHNIQUE Proximal metatarsal osteotomy approximately 10 mm distal of the first tarsometatarsal joint with preservation of the lateral cortex. Careful manual opening of the osteotomy to avoid a fracture of the lateral cortex. Fixation of the osteotomy with an interlocking plate. Filling of the defect with cancellous bone. Distal soft-tissue procedure. POSTOPERATIVE MANAGEMENT Postoperative hallux shoe for 6 weeks. Partial weight bearing (20 kg) for 2 weeks, afterwards full weight bearing. Mobilization of the first metatarsophalangeal joint. Full weight bearing in comfortable shoes after appropriate bony healing has occurred radiologically. Sports with a high impact on the foot is allowed after 12 weeks. Orthotics are prescribed, if some pain remains or associated pathologies require external support. RESULTS In a consecutive series of 35 patients, the first intermetatarsal angle could be reduced to normal values (6.8 degrees , standard deviation 1.3 degrees ). The open-wedge osteotomy resulted in a slight lengthening of the first metatarsal (1-2 mm). In one patient local wound healing problems had to be treated with oral antibiotics. Operative revision was not necessary in any case. Implant failure or nonunion was not observed. One plate was removed because of local subcutaneous irritation.ZusammenfassungOperationszielKorrektur der schmerzhaften Spreizfussdeformität durch Reduktion des vergrösserten ersten Intermetatarsalwinkels durch eine basisnahe öffnende Osteotomie.IndikationenSpreizfussdeformität mit erstem Intermetatarsalwinkel > 14° und Hallux-valgus-Deformität bei Patienten ohne degenerative Veränderungen des Grosszehengrundgelenks.Spreizfussdeformität bei kurzem Metatarsale I.KontraindikationenDegenerative Veränderungen des Grosszehengrundgelenks.Fortgeschrittene Kontrakturen des Grosszehengrundgelenks.Relativ: Anlagebedingte Überlänge des Metatarsale I.Relativ: Abweichung der Gelenkfläche des Metatarsale I nach lateral (in diesen Fällen sollte die Open-Wedge-Osteotomie nur in Verbindung mit einer distalen Osteotomie zur Korrektur des Gelenkflächenwinkels durchgeführt werden).OperationstechnikOsteotomie des Metatarsale I unter Erhalt der lateralen Kortikalis ca. 10 mm distal des ersten Tarsometatarsalgelenks. Langsames Aufspreizen der Osteotomie, um ein Brechen der lateralen Kortikalis zu vermeiden. Sichern des Korrekturergebnisses mit einer winkelstabilen Platte. Auffüllen des medialen Defekts mit Spongiosa. Distaler Weichteileingriff am Grosszehengrundgelenk.Weiterbehandlung6 Wochen im Vorfussentlastungsschuh, in den ersten 2 Wochen Teilbelastung mit 20 kg, dann Vollbelastung. Bei gesicherter Wundheilung Mobilisation des Grosszehengrundgelenks durch den Patienten, ggf. auch unter krankengymnastischer Anleitung. Vollbelastung im Konfektionsschuh nach 6 Wochen bei radiologisch gesicherter Überbauung. Sport mit hoher Fussbelastung nach 12 Wochen. Einlagenversorgung nur bei Restbeschwerden oder assoziierten Pathologien.ErgebnisseIn einer Serie mit 35 konsekutiven Patienten konnte der erste Intermetatarsalwinkel von präoperativ > 14° (14–23°) um durchschnittlich 9° auf Normwerte korrigiert werden (6,8°, Standardabweichung 1,3°). Die Technik der additiven Osteotomie führte in allen Fällen zu einer leichten Verlängerung des Os metatarsale I um 1–2 mm. Bei einem Patienten kam es zu einer lokalen Wundheilungsstörung, die mit oraler Antibiotikatherapie und lokalen Massnahmen behandelt werden konnte. Eine operative Revision war in keinem der Fälle notwendig. Implantatversagen und Pseud arthrosenbildung traten nicht auf. Bei einer Patientin wurde die Platte aufgrund einer subkutanen mechanischen Irritation entfernt.AbstractObjectiveCorrection of splayfoot deformity through reduction of the increased first intermetatarsal angle by a proximal open-wedge osteotomy.IndicationsSplayfoot deformity with a first intermetatarsal angle > 14° and hallux valgus deformity in younger patients.Splayfoot deformities with a short first metatarsal.ContraindicationsDegenerative changes in the first metatarsaphalangeal joint.Contractures of the first metatarsophalangeal joint.Relative: overlength of the first metatarsal.Relative: lateral tilt of the articular cartilage surface of the first metatarsal head.Surgical TechniqueProximal metatarsal osteotomy approximately 10 mm distal of the first tarsometatarsal joint with preservation of the lateral cortex. Careful manual opening of the osteotomy to avoid a fracture of the lateral cortex. Fixation of the osteotomy with an interlocking plate. Filling of the defect with cancellous bone. Distal soft-tissue procedure.Postoperative ManagementPostoperative hallux shoe for 6 weeks. Partial weight bearing (20 kg) for 2 weeks, afterwards full weight bearing. Mobilization of the first metatarsophalangeal joint. Full weight bearing in comfortable shoes after appropriate bony healing has occurred radiologically. Sports with a high impact on the foot is allowed after 12 weeks. Orthotics are prescribed, if some pain remains or associated pathologies require external support.ResultsIn a consecutive series of 35 patients, the first intermetatarsal angle could be reduced to normal values (6.8°, standard deviation 1.3°). The open-wedge osteotomy resulted in a slight lengthening of the first metatarsal (1–2 mm). In one patient local wound healing problems had to be treated with oral antibiotics. Operative revision was not necessary in any case. Implant failure or nonunion was not observed. One plate was removed because of local subcutaneous irritation.