Biomedical subjects
Publications and source records attributed to R Viladot.
A patient with a total hip arthroplasty developed an aggressive infection with group G Streptococcus. Very few similar cases have been reported, but they all resolved with antibiotics or drainage. A Girdlestone resection was necessary in our case because of loosening and extensive bony destruction. The true incidence may be greater than that reported and the prognosis may be worse.
Sixty-six feet operated on for hallux valgus in 1984 were reviewed. Keller-Brandes' operation was performed in all cases, together with Lelièvre's "fibrous cerclage" and flexor hallucis longus tendon anchoring to the sesamoid pad, as described by A. Viladot. In most cases, satisfactory clinical correction was achieved and the patients could wear standard shoes. More than half of the cases presented partial limitation of movement at the first metatarsophalangeal joint; however, flexion power of the big toe was preserved, and the range of motion was wide enough to allow a painless and limp-free gait. Radiologically, good correction of the angle between the first and second metatarsals and the metatarsophalangeal angle was obtained, but all cases presented proximal displacement of sesamoid bones. A baropodometric study showed that the toe-off phase of the gait does not change after this operation. In our series, central metatarsalgia was present in 17 feet; however, it did not compromise the functional result and was easily relieved with orthopaedic devices. Four feet showed radiographic images, suggesting necrosis of the first metatarsal head; all four were asymptomatic. The only case that required reoperation was the one that developed hallux varus deformity. The Keller-Brandes-Lelièvre-Viladot procedure is still a simple and effective method for the surgical treatment of hallux valgus in elderly people with osteoarthritis at the first metatarsophalangeal joint.
Using standard lateral x rays of 32 congenital flat feet (CFF) treated in our institutions, we studied the alignment in the sagittal plane of the tarsal and metatarsal bones. All feet presented with a complete dislocation of the talonavicular joint and a vertical talus. In some cases, however, the alignment of the calcaneocuboid joint was abnormal. In these, both the talus and the calcaneus appeared verticalized with no apparent subtalar joint subluxation (type I). Other cases, by contrast, had a normally aligned calcaneus thus implying subluxation of the subtalar joint (type II). Between the two types, a spectrum of clinical forms combining features from both categories exists. Recognition of the different varieties of CFF is of importance when planning surgery. Type I CFF requires reduction and stabilization of the whole midtarsal joint, while in type II CFF attention must be given to both the subtalar and calcaneocuboid joints.
After reviewing the literature the authors discuss the aetiology and pathogenesis of gluteal fibrosis. We believe that the condition occurs more frequently than is thought. If this is borne in mind when dealing with children from four to six years old, presenting with abnormal gaits, an early diagnosis can be made. As regards treatment, we agree with those authors who maintain that if diagnosed early the lesion can be treated successfully by physiotherapy alone. In more advanced cases, Z lengthening of the tendon is indicated.