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Use of the lapidus bunionectomy in first ray insufficiency.

Surgical management of first ray insufficiency in HAV or hallux limitus is crucial to long-term success. Although technically demanding, the Lapidus fusion serves to address the deformity at its apex and restores normal weight bearing to the foot. This arthrodesis offers predictable, durable results in addressing various first ray deformities and occupies an important place in the foot and ankle surgeon's armamentarium. The authors' technique is described herein for the interest of and evaluation by surgeons performing this procedure. As clinicians recognize the importance of addressing proximal components of the HAV deformity, the Lapidus and other procedures will likely see increased use in the surgical management of first ray deformities.

Arthrodesis↗

[A case of non-familial ulcer mutilating acropathy of the foot].

A case of non-familial pseudo-syringomyelic acropathy is presented; in view of its rarity, numerous hypotheses had to be considered with regard both to diagnosis and to pathogenesis. It was first taken to be an undoubted case of osteomyelitis, but the rapid advance of the osteolytic form, which resisted all treatment both local and general, whether antibiotic, surgical or orthopaedic, led to consideration of the possibility of sarcoma or some other benign tumoral form. The conclusion was reached that doubtful diagnosis can be settled only by bioptic examination, whereas aetiopathogenetic doubts still remain within the field of hypotheses (Lattuada).

Adult↗

[The effect of a treatment protocol on the prognosis of equine laminitis].

All horses and ponies with laminitis treated at the Department of Equine Sciences, Faculty of Veterinary Medicine, Utrecht University, between 1995 and 1998 were analysed retrospectively (n = 152). Based on the results of this study and on the world-wide knowledge on laminitis a standardised treatment protocol was adopted in 1999. Fifty-eight patients have been treated for laminitis between 1999 and 2001 following the treatment protocol. Compared to our hospital-population (orthopaedic patients), mares and ponies are at higher risk developing laminitis, but the prognosis does not differ between sexes as between breeds. Radiological evidence of rotation of the third phalanx seems to be of minor importance for the prognosis. Distal displacement of the third phalanx, however, seems to worsen the prognosis. The outcome of the acute cases is significantly better in the group treated following the protocol, than in the group without protocol. The outcome of the chronic cases is not influenced by the treatment protocol. Although the cases in both groups differ, as they are all clinical cases, our data suggest that the standardised treatment protocol results in a better outcome for cases of acute laminitis.

Acute Disease↗

[Use of grommet for Swanson flexible hinge toe implant arthroplasty for hallux valgus deformity of rheumatoid arthritis].

OBJECTIVES: We reviewed the results of arthroplasty of the great toe with hallux valgus in rheumatoid patients, using a Swanson flexible hinge toe implant protected by grommet. MATERIALS AND METHODS: Sixteen patients (26 feet) with rheumatoid arthritis were operated on from 1996 to 1999. (fifteen women, one man). The average age was 59.8 years (range, 48-73 years). The average follow-up period was 3.0 years (range, 1.0-4.5 years). In each patient, the hallux valgus angle (HVA) was measured before and after surgery, and implant breakage and radiolucency around the implant were evaluated on radiographs. RESULTS: Average HVA was 47.7 degrees preoperatively and 19.3 degrees postoperatively. No implant breakage was observed in 76.9% of the feet. Radiolucency of more than 2 mm was observed in only 3.8% of the feet. CONCLUSIONS: These findings suggest that arthroplasty using a Swanson flexible hinge toe implant with a grommet is useful for treatment of hallux valgus in rheumatoid patients.

Aged↗

[Contemporary possibilities of thumb reconstruction. II. microsurgical methods].

Microsurgery has revolutionised thumb reconstruction procedures, not only allowing addition of new structures, but also performing whole reconstruction during a single, one stage procedure. This paper presents only the fundamental techniques: toe transfers (great and second toe), the wrap--around technique, trimmed-toe transfer, twisted-two-toes, free vascular joint transfer. Indications, surgical techniques, results and complications are discussed.

Humans↗

The big toe.

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Fracture Fixation↗

Preliminary report: modifications of the Regnauld osteochondral autogenous graft.

The enclavement procedure was originally described by Bernard Regnauld in 1968. The basal portion of the proximal phalanx of the hallux is used as an osteochondral autogenous graft in the treatment of hallux limitus, hallux rigidus, and hallux valgus. This paper presents a review of Regnauld's techniques, emphasizing an in situ modification of the inverted graft that allows for greater technical ease, increased stability, and improved graft viability, with more rapid incorporation.

Aged↗

Digital arthrodesis: an alternate method for correction of hammer toe deformity.

A technique of internal wire fixation in end-to-end digital arthrodesis is illustrated and described for correction of hammer toe deformity. A clinical study involving 25 patients and 62 digital fusions are evaluated. All patients interviewed considered their hammer toe surgery successful in eliminating their chief complaint. All patients examined showed solid fusion of the arthrodesed digit. This procedure offers an effective means for digital fusion in correction of the hammer toe deformity. It is easily performed and presents few complications.

Adult↗

[A rare localization of erysipeloid].

A female patient aged 56 is described, suffering from a cutaneoarticular form of erysipeloid, that developed after application of raw fat at the site of injury to the third toe of the left foot. The process completely regressed within a week after a single intake of sulfalene in a dose of 2.0 g.

Erysipeloid↗