Nicolò Martinelli

Comparison of Plantar Pressure, Clinical, and Radiographic Changes of the Forefoot after Biplanar Austin Osteotomy and Triplanar Boc Osteotomy in Patients with Mild Hallux Valgus

Background: Bocs modification of the Austin procedure is a triplane distal osteotomy that achieves shortening and plantarflexion of the first metatarsal with a lateral translation of the metatarsal head. The clinical results and influence of the Austin and Boc osteotomies on plantar pressure have been compared retrospectively. Materials and Methods: The patients were divided into two groups: 30 Austin and 30 Boc osteotomies were performed with a mean followup of 37 (range, 29 to 56) months. Results: Sixty patients with mild hallux valgus deformities and central metatarsalgia, took part in the study. Pressure measurements were performed with a Diagnostic Support system® footplate. The average postoperative American Orthopaedic Foot and Ankle Society score of the Austin group was 81.9 and 86.4 for the Boc group. The pressure distributions under the fourth and fifth metatarsal head were comparable in both groups (p > 0.05). The Austin group showed decreased load bearing under the hallux and the first metatarsal head (p < 0.01), consistent with a persistent overloading of the second and third metatarsal head (p > 0.05). The Boc group showed decreased weightbearing under the hallux with better load distribution beneath the second and the third metatarsal head (p < 0.05). Correlation of the American Orthopaedic Foot and Ankle Society scores and pressure variables confirmed a significant negative correlation with altered hallux and central metatarsal head loading (p < 0.01). Conclusion: The Boc triplane osteotomy seems to restore more physiologic loading of the forefoot in comparison to the Austin procedure, reducing the incidence of painful callus under the second and third metatarsal head.

Treatment of osteochondral defects of the talus in children

Purpose Osteochondral talar defects are infrequent in children, and little is known about the treatment and clinical outcome of these defects. The purpose of this study was to evaluate the clinical and radiographic outcomes of conservative and primary surgically treated osteochondral talar defects in skeletally immature children.

Femoro-tibial kinematics after TKA in fixed- and mobile-bearing knees in the sagittal plane

PurposeLack of the anterior cruciate ligament in total knee arthroplasty results in paradoxical movement of the femur as opposed to the tibia under deep flexion. Total knee arthroplasty with mobile-bearing inlays has been developed to provide increased physiological movement of the knee joint and to reduce polyethylene abrasion. The aim of this study was to perform an in vitro analysis of the kinematic movement in the sagittal plane in order to show differences between fixed- and mobile-bearing TKA in comparison with the natural knee joint.MethodsSeven knee joints of human cadaver material were used in a laboratory experiment. Fixed- and mobile-bearing inlays were tested in sequences under isokinetic extension in so-called kinemator for knee joints, which can simulate muscular traction power by the use of hydraulic cylinders, which crossover the knee joint. As a target parameter, the a.p. translation of the tibio-femoral relative movement was measured in the sagittal plane under ultrasound (Zebris) control.ResultsThe results show a reduced tibial a.p. translation in relation to the femur in the bearing group compared to the natural joint. In the Z-axis, between 110° and 50° of flexion, linear movement decreases towards caudal movement under extension. Admittedly, the study did not show differences in the movement pattern between “mobile-bearing” and “fixed-bearing” prostheses.ConclusionResults of this study cannot prove functional advantages of mobile-bearing prostheses for the knee joint kinematic after TKA. Both types of prostheses show typical kinematics of an anterior instability, hence they were incapable of performing physiological movement.

Hemiarthroplasty and Distal Oblique First Metatarsal Osteotomy for Hallux Rigidus

Background: In a retrospective study, we evaluated the effect of the addition of a decompressive osteotomy to hemiarthroplasty of the great toe in terms of clinical and radiographic outcomes. Material and Methods: Twenty-one consecutive patients affected by Grade III hallux rigidus underwent distal oblique osteotomy of the first metatarsal and hemiarthroplasty of the hallux metatarsophalageal joint. Clinical evaluation included the American Orthopaedic Foot and Ankle Society scoring system (AOFAS) and the Short Form 36 questionnaire (SF-36), preoperatively and at followup visits. Standard weightbearing radiographs were performed to assess implant alignment, loosening, and bone loss. The mean followup was (range, 16 to 29) months. Results: The mean AOFAS score improved from 47.5 ± 11.5 preoperatively to 76.0 ± postoperatively (p < 0.01). At the last followup the SF-36 subscales Physical functioning, Bodily pain and Emotional role scores were increased from baseline. At the last followup, six patients (28.5%) were very satisfied with the outcome, ten patients (47.6%) were satisfied and five patients (23.8%) were dissatisfied. In the dissatisfied group, two patients had persistent joint pain with stiffness and subluxation of the prosthesis. Dorsal subsidence of the implant was present in ten patients at the last radiographic followup. Conclusion: Hemiarthroplasty of the proximal phalanx and distal oblique metatarsal osteotomy for Grade III hallux rigidus at 2-years followup yielded mixed patient satisfaction and unsatisfactory radiographic outcome. Level of Evidence: IV, Case Series

Starting with ultrasonography decreases popliteal block performance time in inexperienced hands: a prospective randomized study.

BackgroundThe widespread of hallux valgus surgery in a day care setting enhanced the role of regional anaesthesia in the last few years. Sciatic nerve block at popliteal fossa has been shown to provide safe and effective analgesia. Our purpose was to compare the success rate and performance time of popliteal block during resident’s training for regional anaesthesia by using nerve stimulation (NS) or combined nerve stimulation and ultrasound (NS + US).Methods70 adult patients undergoing hallux valgus surgery were randomly assigned to receive sciatic nerve block at popliteal fossa with US+NS or NS alone with a double injection technique for peroneal and tibial branches, respectively. Two residents experienced with nerve stimulator performed the procedures after a learning phase concerning ultrasonography. A local anaesthetic solution, containing 10 mL of 0.75% ropivacaine and 10 mL of 2% lidocaine was used: 12 mL were infiltrated close the tibial nerve, and 8mL were infiltrated close the common peroneal nerve. Block success rate, sensory block onset time, block performance time were evaluated. Recourse to general anaesthesia was considered as failure.ResultsNo differences were detected in success rate and onset time of sensory block between the two groups (P > 0.05). The time to block tibial nerve and the overall block time were significantly faster in US+NS group (P < 0.05).ConclusionsUltrasound guidance for popliteal nerve block resulted in similar success rate with a faster procedure time when compared with nerve stimulator, thus providing a possible effect on resident education and operating room efficiency.

Compression Neuropathy of the Motor Fibers of the Median Nerve at Wrist Level

Selective electrophysiological involvement of median motor fibers is rare in carpal tunnel syndrome. We report a patient with compression neuropathy of the median nerve who presented with isolated motor signs and symptoms without macroscopic evidence of compressive pathologies.

Hallux Valgus Correction in a Patient with Metatarsus Adductus with Multiple Distal Oblique Osteotomies

Metatarsus adductus is a structural foot deformity that is rarely associated with hallux valgus deformity. Surgical treatment is challenging, and multiple osteotomies are often required to correct both deformities. However, surgical impact must be considered, especially in elderly patients. We present a clinical case of a 76-year-old woman affected by hallux valgus and metatarsus adductus deformity. Multiple distal oblique osteotomies were performed on the first, second, and third metatarsals, coupled with Z-lengthening of the extensor digitorum longus tendons.

Recreational Sports Activities After Calcaneal Fractures and Subsequent Subtalar Joint Arthrodesis.

Subtalar joint arthrodesis is a common treatment for the management of hindfoot pathologic entities. Despite pain reduction, hindfoot stiffness is a common concern of active patients, who wish to continue or start exercising for fitness. The purpose of the present retrospective observational clinical study was to assess the rate and type of recreational sports activities in patients before and after subtalar joint arthrodesis and to correlate the clinical outcome and the level of sports activities. In 33 patients (22 males, 11 females) treated with subtalar joint arthrodesis, the pre- and postoperative participation in sports and recreational activities was evaluated. The American Orthopaedic Foot and Ankle Society hindfoot scale score, 36-item Short Form Health Survey, and a visual analog scale for pain were used as clinical outcome measures. The weekly session number, session time, and interval to activity recovery after surgery were registered. Patients with a subtalar joint arthrodesis returned to a satisfactory level of activity postoperatively. The sports participation almost reached levels similar to those preoperatively but with a shift from high- to low-impact activities.

Acute rupture of the tibialis posterior tendon without fracture: a case report.

The acute rupture of the tibialis posterior (TP) tendon, compared to an acute rupture of the Achilles tendon, is a quite uncommon disease to be diagnosed in the emergency department setting. In most cases symptoms related to a TP dysfunction, like weakness, pain along the course of the tendon, swelling in the region of the medial malleolus, and the partial or complete loss of the medial arch with a flatfoot deformity precede the complete rupture of the tendon. In this case report, we describe an acute rupture of the TP tendon following a pronation-external rotation injury of the ankle with no association of a medial malleolus fracture and with no history of a prior flatfoot deformity or symptoms.

Return to sport activities after subtalar arthroereisis for correction of pediatric flexible flatfoot.

The aim of this study was to establish whether children treated with subtalar arthroereisis for flexible flatfoot were able to return to sport activities. We reviewed 49 patients with a mean age at the time of surgery of 10.7 years. The type of sport activities, the number of sessions per week, the time dedicated to each session, and the level achieved were assessed preoperatively and at the last follow-up. Overall, 45 patients returned to sports after surgery. Surgery did not alter the duration, frequency, and type of sporting activities, but the participation in physical activities as well as the emotional status and footwear issues improved.