PURPOSE OF THE STUDY Total arthroplasty of the first metatarsophalangeal joint is one of the surgical treatment options for patients with advanced hallux rigidus. This study evaluates the pressure changes in the propulsion phase of the gait cycle using dynamic pedobarography after the total arthroplasty of the first metatarsophalangeal joint by Medin PH-Flex and their comparison with the control groups of patients with hallux rigidus and with asymptomatic patients. MATERIAL AND METHODS Dynamic pedobarograph was used to evaluate 15 first MTP joint replacements by Medin PH-Flex implants in 12 female patients, the average time since joint replacement was 3.5 years (1.5 to 5.5 years). The control group consisted of 13 forefeet in 12 patients with hallux rigidus of Grade 3 and Grade 4 according to the Coughlin classification and 17 healthy patients with no clear foot deformity, i.e. of a total of 34 forefeet. A zone for each metatarsal (M1-M5) and the big toe area (T1) were defined with the use of an integrated software. The difference between the pressure under the big toe area and the first metatarsal bone - hallux stiffness (T1-M1) and the forefoot balance parameter, i.e. the difference between the pressures under the medial and lateral half of the forefoot ((M1+M2)-(M3+M4+M5)), was obtained. The parameters were evaluated for each group during the propulsion phase of the gait, i.e. from 55% to 100% of the stance phase and from 75% to 100% of the stance phase, i.e. that part of propulsion when the greatest pressure is exerted on the big toe. RESULTS For the HS parameter (T1-M1) in 55% to 100% of the stance phase, the median value was -0.66 ± 1.22 (-1.90 to 1.45) in the control group, -0.85 ± 1.94 (-1.40 to 3.80) in patients with hallux rigidus, and -0.10 ± 1.48 (-1.30 to 2.40) in patients after the first MTP joint replacement. The median forefoot balance parameter from 55% of the stance phase was -3.48 ± 2.45 (-6.90 to 0.68) in healthy patients and -4.43 ± 2.72 (-6.98 to 0.23) in hallux rigidus patients. In patients after the joint replacement, the value was -3.00 ± 2.46 (-6.20 to 0.40). The data were statistically analysed by the Dunnett's and Tukey's multiple comparison tests. The hallux stiffness parameter showed a significant improvement after the joint replacement compared to patients with hallux rigidus (p<0.0001). No statistical significance was confirmed when comparing the joint replacement cases and the healthy patients from the control group (p=0.0007 and p=0.0010, respectively). As concerns the forefoot balance parameter, a significant difference was reported in patients with joint replacement compared to healthy patients from the control group and patients with hallux rigidus (p <0.0001). DISCUSSION The published pedobarographic studies differ in terms of the methodology used, the patient population and the parameters examined. The pedobarographic studies after the replacement of the first MTP joint or after its arthrodesis present inconclusive outcomes. According to the available literature, the joint replacement has the potential to improve mediolateral forefoot loading and to partially restore the weight-bearing function of the first ray. Our analysis of the HS parameter suggests that the MTP joint replacement can improve the big toe function compared to patients with hallux rigidus but fails to achieve the functional outcomes of healthy patients. When evaluating the forefoot balance (FB) parameter, we can observe less loading on the lateral half of the forefoot in the propulsion phase compared to hallux rigidus. Nonetheless, the joint replacement is unable to restore the physiological loading of the foot. CONCLUSIONS The first MTP joint replacement has the potential to improve forefoot function and to bring it closer to that of a healthy person, even though achieving physiological loading of the forefoot is unrealistic. Additional studies will be needed to confirm that the indication for the first MTP joint replacement is justified in hallux rigidus in terms of the effect on forefoot biomechanics. Key words: hallux rigidus, total replacement of the first MTP joint, dynamic pedobarography, footscan.
- MeSH
- biomechanika MeSH
- chůze (způsob) MeSH
- hallux rigidus * chirurgie MeSH
- lidé MeSH
- noha (od hlezna dolů) MeSH
- palec nohy * MeSH
- Check Tag
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
The interpubic cavity (cleft) is a narrow, slit-like, oval-shaped cavity which has frequently been described within the fibrocartilaginous interpubic disc. The aim of this article is to thoroughly analyze what is known about the interpubic cavity. The following three scientific databases (PubMed, Web of Science and Google Scholar) were systematically searched. Combinations of the search terms "interpubic cleft", "interpubic cavity", "symphysis pubis cleft", "symphysis pubis cavity" and "symphysis cleft sign" were used. All databases were searched from inception until August of 2022. Searching of the three databases resulted in 711 hits, of which 280 remained after checking for duplicates. In the first step, 152 studies were excluded due to irrelevant content. Thus, 128 proceeded to the second step, of which 23 were finally selected for meeting the objectives of this review. Until now the reason for the cavity forming remains unclear. The interpubic cavity is present in the anterior portion of the interpubic disc, within 2 mm from its anterior margin. There is no predilection in the craniocaudal dimension. The secondary cavity is usually called a "cleft sign". The results of our scoping review summarize information about the interpubic cavity. Its composition and morphology are still not well understood.
- MeSH
- lidé MeSH
- symphysis pubica * anatomie a histologie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
- systematický přehled MeSH
- MeSH
- antibakteriální látky terapeutické užití MeSH
- artroplastiky kloubů škodlivé účinky využití MeSH
- chirurgie operační MeSH
- infekce spojené s protézou prevence a kontrola MeSH
- kyčelní kloub * patofyziologie ultrasonografie MeSH
- lidé MeSH
- ortopedické výkony MeSH
- ortopedie MeSH
- primární prevence MeSH
- rizikové faktory MeSH
- směrnice pro lékařskou praxi jako téma MeSH
- tromboembolie prevence a kontrola MeSH
- vývojová kyčelní dysplazie diagnóza klasifikace prevence a kontrola MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
PURPOSE OF THE STUDY The Minimally Invasive Chevron Akin (MICA) is a percutaneous technique used to correct hallux valgus deformity. The combination of distal osteotomy of the first metatarsal and the proximal phalanx of the big toe stabilized with internal fixation was used over the last decade. The retrospective study presents the results of measurements performed on preoperative and postoperative X-rays and offers a comparison with conventional osteotomies. MATERIAL AND METHODS The study population consists of 76 patients who underwent 93 operations between 2015 and 2018 at the Department of Orthopaedics, 1st Faculty of Medicine, Charles University in Prague. The mean age of patients was 50.2 years (range 18-74 years). The study evaluates and measures the parameters and the attributes of interest on weight-bearing X-rays of the foot before and after the operation at 6-week or 3-month follow-ups. The first intermetatarsal angle was measured according to the mechanical and the anatomic axis of the first metatarsal bone. Apart from that, the displacement of the first metatarsal head in the osteotomy, hallux valgus angle and distal metatarsal articular angle were analysed. The position of the medial sesamoid bone and the congruency of the first metatarsophalangeal joint were evaluated as well. RESULTS The mean hallux valgus angle was 33.2° ± 7.3° and 10.2° ± 5.8° postoperatively. The mean value of the first mechanical intermetatarsal angle decreased from 12.4° ± 2.8° to 7.4° ± 2.5° postoperatively. The mean value of the first anatomic intermetatarsal angle increased from 13.7° ± 3.6° to 17.4° ± 4.6°. The used technique restored the congruency of the first metatarsophalangeal joint in 85 cases (91%). The mean lateral displacement of the metatarsal head fragment was 50% of its width (range 18% to 84%). The mean X-ray exposure during the operation was 0.58 mGy and the personnel were exposed to radiation for 79 seconds on average. DISCUSSION One of many questions raised with regard to hallux valgus surgery is the choice of the right technique in order to achieve proper position of the big toe. The surgeon should have the opportunity to use a technique that provides the possibility to change orientation of the metatarsal head articular surface in three anatomic planes. Our study found out that the displacement of the metatarsal head using the MICA technique in transversal plane is from 4 mm to 18 mm (in 20 mm diameter of the head). The method thus offers a possibility to correct mild, moderate and partially severe deformities as well. The main disadvantage of the method is the necessity to use a C-arm at the operating theatre. CONCLUSIONS The Minimally Invasive Chevron Akin (MICA) is a percutaneous technique to correct hallux valgus deformity based on two extraarticular osteotomies of the proximal phalanx of the big toe and the distal part of the first metatarsal bone. The method using stable internal fixation with two screws offers a possibility to change the orientation of the articular surface of the metatarsal head in sagittal, transversal, and even in frontal plane, and is useful to correct mild and moderate deformities. Key words: hallux valgus, minimally invasive technique, percutaneous technique, chevron osteotomy, Akin osteotomy.
- MeSH
- bunion * MeSH
- dospělí MeSH
- hallux valgus * diagnostické zobrazování chirurgie MeSH
- lidé středního věku MeSH
- lidé MeSH
- metatarzální kosti * diagnostické zobrazování chirurgie MeSH
- metatarzofalangeální kloub * MeSH
- mladiství MeSH
- mladý dospělý MeSH
- retrospektivní studie MeSH
- senioři MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- senioři MeSH
- Publikační typ
- časopisecké články MeSH
- Klíčová slova
- klinika Canadian Medical Waltrovka,
- MeSH
- ambulantní chirurgické výkony * MeSH
- dolní končetina chirurgie MeSH
- lidé MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- rozhovory MeSH
PURPOSE OF THE STUDY Treatment of comminuted three- and four-part displaced proximal humerus fractures continues to be discussed in daily trauma practice. In fractures with metaphyseal comminuted fractures the anatomical reconstruction is often technically unfeasible. For cases of comminuted metaphyseal proximal humerus fractures we proposed the so called non-anatomical reconstruction with simple osteosynthesis. Even today, when nailing and plating are commonly used in osteosynthesis, the non-anatomical reconstruction plays an irreplaceable role. Its application is conditioned by at least partially preserved vascular blood supply of the head fragment. This paper describes our original technique to manage these fractures and provides an evaluation of results of the group of patients in whom this procedure was performed. MATERIAL AND METHODS Our group included a total of 72 patients (who underwent surgery in the period from 1 January 1989 to 22 March 2016), of whom 57 were clinically assessed (8 patients died, 7 patients failed to be traced back). The mean age at the time of procedure was 53.61 years (range 19-81 years). The mean follow-up was 14.3 years (range 0.3-26.3 years) after the surgery. The method consists in removing the comminution zone, impacted modified diaphyseal fragment to head spongiosis and osteosynthesis of greater and lesser tubercle or their remainders to diaphyseal fragment using tensile cerclage. RESULTS The mean post-operative Constant score was 81.4 (range 30-100 points). The mean abduction was 120.4 degrees (range 60-165 degrees) and ventral flexion was 129.2 degrees (range 70-170 degrees). Excellent clinical outcome according to the Constant score was achieved in 19 patients, good outcome in 23 patients, fair in 8 patients and poor in 7 patients. DISCUSSION We have been using our original method for 27 years. Compared to osteosynthesis by locking plates, minimally invasive procedures and trauma shoulder joint replacement, our method helps achieve very good clinical outcomes. Its main advantage, however, is the fact that by this technique the specific type of fractures can be treated, otherwise manageable exclusively by arthroplasty. CONCLUSIONS At our clinic, the non-anatomical reconstruction belongs to irreplaceable methods for treating certain proximal humerus fractures. The clinical outcomes of this method can be described as very good. The method of non-anatomical reconstruction eliminates the disadvantages and risks of arthroplasty. Nonetheless, it shall be stressed that this method can be successful exclusively when applied to precisely indicated types of fractures and when performed with technical precision. Its another advantage are the minimal financial requirements. Key words: non-anatomical reconstruction, osteosynthesis, proximal humerus, cerclage.
- MeSH
- fraktury proximálního humeru * diagnóza patofyziologie chirurgie MeSH
- lidé středního věku MeSH
- lidé MeSH
- následné studie MeSH
- pooperační komplikace diagnóza MeSH
- poranění ramene * diagnostické zobrazování chirurgie MeSH
- ramenní kloub patofyziologie chirurgie MeSH
- rozsah kloubních pohybů MeSH
- tříštivé fraktury MeSH
- vnitřní fixace fraktury * škodlivé účinky přístrojové vybavení metody MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Česká republika MeSH
- MeSH
- biopsie MeSH
- diferenciální diagnóza MeSH
- dospělí MeSH
- horní končetina patofyziologie patologie MeSH
- humerus * diagnostické zobrazování patofyziologie MeSH
- imunohistochemie MeSH
- lidé MeSH
- nádory kostí * diagnostické zobrazování diagnóza MeSH
- osteomalacie MeSH
- vzácné nemoci MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
- MeSH
- biopsie MeSH
- diferenciální diagnóza MeSH
- dospělí MeSH
- horní končetina patofyziologie patologie MeSH
- humerus * diagnostické zobrazování patofyziologie MeSH
- imunohistochemie MeSH
- lidé MeSH
- nádory kostí * diagnostické zobrazování diagnóza MeSH
- osteomalacie MeSH
- vzácné nemoci MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
- MeSH
- deformity nohy (od hlezna dolů) * diagnóza terapie MeSH
- hallux rigidus * diagnóza chirurgie terapie MeSH
- hallux valgus * diagnóza terapie MeSH
- lidé MeSH
- ortézy nohy (od hlezna dolů) MeSH
- ortopedické fixační pomůcky využití MeSH
- prsty nohy patofyziologie MeSH
- rentgendiagnostika metody MeSH
- syndrom kladívkového prstu * diagnóza etiologie terapie MeSH
- Check Tag
- lidé MeSH
