Hallux rigidus is a degenerative condition of the first metatarsophalangeal (MTP) joint that causes pain and stiffness. It is graded from I to III based on decreased range of motion and radiographic findings. Conservative treatments include orthotics, injections, and physical therapy. Surgical options range from cheilectomy and proximal phalangeal osteotomy for mild cases to joint replacement or arthrodesis for more severe cases. Arthrodesis has shown success rates over 90% with the use of plates, screws, and proper positioning of the fused joint. Complications can include nonunion, malalignment, and increased risk of arthritis in the interphalangeal joint.
High tibial osteotomy (HTO) is a common and widely accepted procedure in orthopaedic surgery. In the literature, we find descriptions of the technique dating back to the 50s, with Jackson (Jackson, 1958). However, it was not until the 70s, with the publications of Conventry (Coventry, 1969 and 1973) and Insall (Insall, 1975), that proximal tibial osteotomy became common practice as a treatment option for medial compartment osteoarthritis of the knee usually associated to varus deformity. At that time, closing wedge osteotomies were performed, despite the greater technical difficulty and risks involved, as there were no fixation materials available that could enable opening wedge osteotomy. Only after the development of medial wedge plate fixation that opening wedge osteotomy became applicable (Puddu, 2004).
The goals of HTO are:
1. To reduce knee pain by transferring weight-bearing loads to the relatively unaffected compartment;
2. To increase the life span of the knee joint, by slowing or stopping the destruction of the medial joint compartment. This could delay the need of a joint replacement.
High tibial osteotomy in osteoarthritis knee & genu varumdocortho Patel
indian population is prone for osteoarthritis of knee. also in indian children due to rickets genu varum is common. high tibial osteotomy is a procedure to correct the deformity & resolve unicompartmental arthritis
Proximal Fibular Osteotomy for Knee Osteoarthritis - What is the evidence?Dr Saseendar MD
Proximal Fibular Osteotomy for Knee Osteoarthritis - What is the evidence?
knee osteoarthritis, knee surgery, total knee replacement, osteoarthritis, knee pain, elderly,
https://kneesurgrelatres.biomedcentral.com/articles/10.1186/s43019-019-0016-0
Knee Osteoarthritis, a common cause of knee pain and treatment ranges from exercises,tablets,arthroscopy,deformity correction to total knee replacement (TKR).
Complications after surgery can even be corrected if occurs by proper evaluation,planning and execution of the Revision Surgery.
Knee osteoarthritis basics to reconstruction to replacement dr.sandeep c agrawal agraesn hospital gondia india
High tibial osteotomy (HTO) is a common and widely accepted procedure in orthopaedic surgery. In the literature, we find descriptions of the technique dating back to the 50s, with Jackson (Jackson, 1958). However, it was not until the 70s, with the publications of Conventry (Coventry, 1969 and 1973) and Insall (Insall, 1975), that proximal tibial osteotomy became common practice as a treatment option for medial compartment osteoarthritis of the knee usually associated to varus deformity. At that time, closing wedge osteotomies were performed, despite the greater technical difficulty and risks involved, as there were no fixation materials available that could enable opening wedge osteotomy. Only after the development of medial wedge plate fixation that opening wedge osteotomy became applicable (Puddu, 2004).
The goals of HTO are:
1. To reduce knee pain by transferring weight-bearing loads to the relatively unaffected compartment;
2. To increase the life span of the knee joint, by slowing or stopping the destruction of the medial joint compartment. This could delay the need of a joint replacement.
High tibial osteotomy in osteoarthritis knee & genu varumdocortho Patel
indian population is prone for osteoarthritis of knee. also in indian children due to rickets genu varum is common. high tibial osteotomy is a procedure to correct the deformity & resolve unicompartmental arthritis
Proximal Fibular Osteotomy for Knee Osteoarthritis - What is the evidence?Dr Saseendar MD
Proximal Fibular Osteotomy for Knee Osteoarthritis - What is the evidence?
knee osteoarthritis, knee surgery, total knee replacement, osteoarthritis, knee pain, elderly,
https://kneesurgrelatres.biomedcentral.com/articles/10.1186/s43019-019-0016-0
Knee Osteoarthritis, a common cause of knee pain and treatment ranges from exercises,tablets,arthroscopy,deformity correction to total knee replacement (TKR).
Complications after surgery can even be corrected if occurs by proper evaluation,planning and execution of the Revision Surgery.
Knee osteoarthritis basics to reconstruction to replacement dr.sandeep c agrawal agraesn hospital gondia india
Hallux rigidus:
A condition characterized by loss of motion of first MTP joint in adults due to degenerative arthritis
second most common condition affecting the big toe after hallux valgus
most common arthritic condition in the foot.
Disorders of the Great toe (hallux) are very important as they are very painful, causes many clinical symptoms,and very difficult to treat.The presentation compiled from various important orthopedic textbooks and international journals.
Richard Schuster: Life Lessons and LegacySteve Pribut
Richard Schuster trained many fellows in biomechanics. The fellows have left their marks in a variety of specializations from running injuries, dance, baseball, pediatrics, neurological to gait impairments. Schuster in many senses was an ideal clinician. We examine what makes an ideal clinician and set Schuster in his time and locale.
Proximal physeal and SOH Fractures in pediatrics can be managed conservatively irrespective of alignment and reduction as it has great remodeling potential
The younger the age more deformity is acceptable in femur fracture
Treatment Modalities in pediatric femur fracture depends on the age and fracture pattern
Proximal tibia fracture will develop valgus deformity irrespective of treatment so counselling is must
Soft tissue status in the shaft of tibia factor determines the outcome in tibia fracture
Distal femur fractures what makes it complex ,dr mohamed ashraf,hod orthopae...drashraf369
distal femur fractures are notorious for post operative complications due to malreduction and improper fixation.unless plan and execute a sound and stable fixation,this injury will lead to undesirable results.dr mohamed ashraf HOD orthopaedics govt TD medical college is presenting how to avoid complications in surgical management of these fractures..
Intramedullary nailing of fractures.dr mohamed ashraf.HOD.govt TD medical co...drashraf369
presentation of biology,biomechanics and practice of intramedullary nailing of long bone fractures by dr mohamed ashraf,govt TD medical college,alleppey,kerala,india
The treatment of maxillary transverse deficiency in post-pubertal patients has been an area of disagreement among orthodontists. Much of the controversy is over the timing of when it is appropriate for these patients to be referred to an oral and maxillofacial surgeon for an adjunctive surgical procedure or whether traditional orthodontic mechanics should be attempted. The decision, therefore, by an orthodontist of when to refer a patient for surgery
appears to be an individual one. The question then becomes which of the three basic surgical procedures would be most appropriate for the patient. Specifically, consideration must be given to surgically assisted rapid palatal expansion, segmental LeFort I osteotomy, or mandibular midline osteotomy with constriction.
Objectives:
-Recognize the anatomy of the proximal tibia
-Describe initial evaluation and management
-Identify common fracture patterns
-Apply treatment principles and strategies for Partial articular fractures and Complete articular fractures
-Discuss rehabilitation and complications
-Learn Management in selected tibial plateau case scenarios
1. Hallux Rigidus
Selene G. Parekh, MD, MBA
Associate Professor of Surgery
Partner, North Carolina Orthopaedic Clinic
Department of Orthopaedic Surgery
Adjunct Faculty Fuqua Business School
Duke University
Durham, NC
919.471.9622
http://seleneparekhmd.com
Twitter: @seleneparekhmd
3. Epidemiology
• One in 40 over age 50 (Gould N, 1980)
• Occurs bilaterally approximately 50% of the time
• Females probably greater than males
• Early onset associated with positive family
history
Boney & MacNab, 1952
4. Etiology
• Trauma (acute, chronic)
• Turf toe
• Suggested anatomical abnormalities include:
• Flat MT Head
• Long/Short 1st MT
• Pes Planus
• Metatarsus Primus Elevatus (controversial)
• Dorsal elevation of 1st MT in relation to lesser MT
7. Grade Pain Decrease
ROM (Total°)
Radiographs
I Occ Mild
(<55°)
Mild Spur; No/Slight
Narrowing
II Constant Moderate (40°) Mod Spur; Narrowing
III Constant Severe
(<20°)
Extensive
Osteophytes; ±LB;
Severe Narrowing
Classification
9. Proximal Phalangeal
Osteotomy
• Moberg Procedure
• Indications
• Adolescents w/ grade I
• Older pt’s w/ grade I
• If grade II, add cheilectomy
• Technique
• Osteotomy needs to permit
• DF 35° (1st MT)
• 15° (bottom of foot)
10. Cheilectomy
• Indications
• Grades I & II (pain relief in 93% of pt’s*)
• Lower success for grade III (29%*)
• Extent of dorsal MT head excision
• Depends on extent of articular damage
• ~25%
• >30% can lead to subluxation
*Geldwart, 1992
19. Silicone Implants
• Long term failure rates: 57-74%
• Complications
• Implant failure due to repetitive loading
• Silicone synovitis due to foreign body reaction
• AVN
• Infection
• Metatarsalgia
• Delayed wound healing
• Recurrent deformity
• Bony proliferation
• Decreased mobility
• Fracture
• Osteolysis
• Recurrent pain
20. MTP Arthrodesis
•Indications
•Painful Grade II
•Grade III
•Salvage for failed HV
•Salvage for H Varus
•RA fot
•Results
•Dorsal plate w/ interfrag screw
•93-100% fusion rate
21. MTP Arthrodesis
• Few contraindications
• Requires careful explanation to patient,
re: no motion
• Multiple reports in literature ranging from 77 to
100% success
22. MTP Arthrodesis
• First described by Broca in 1852
• 1940 Thompson & McElveney - 15 cases
• 1952 McKeever successful in 33 patients --
becomes popular
25. MTP Arthrodesis
• Technique
• Planar coaptation vs. convex-concave
• Threaded Steinmann pins
• Screw or plate or screw & plate
26.
27. Biomechanics - Shortening
• 1987, Turan and Lindgren
• Planar cuts: 1.0 to 1.5 cm
• 1994, Coughlin
• Cone shaped reamers: 7.7 mm
• Cup shaped reamers: 3.8 mm
• 2006, Parekh
• No statistical difference 7.1mm v 5.7mm
28. Fixation Strength: Biomechanic
Studies
• 1986, Sykes & Hughes - Planar surfaces with
single cancellous screw gave best fixation
• 1993, Curtis - Conical surfaces with lag screw
was best
29.
30.
31.
32.
33.
34.
35. Position
• 10-15o DF above the horizontal
• 25o from 1st metatarsal axis
• 15-20o abduction in the transverse plane - avoid
2nd toe impingement
• 0o rotation
37. Can We do Better?
• Pocket technology
• Interfrag through plate
38. Can We do Better?
• 31.2% nonunion
• 6.3% partial union
• High nonunion & revision surgery rates
• Use w caution
39. Results: Reports of union >
90%
• 1994, Coughlin: Cup & cone surfaces with mini
fragment plate & K-wire
• 35 cases with 98% union
• 1992, Holmes: Interfragmentary screw added
to above with good results
40. Complications of Arthrodesis
• Malalignment: Varus-valgus, DF-PF, or rotation
• Nonunion: 0-7% with plate and interfragmentary
screw
• IP arthritis increases with less than 20o valgus
position
41. Complications
• IP arthrosis (progression in 6% )*
• Decrease in IP joint motion - 22o*
• Nonunion
• Callus formation
• Malposition
• Infection
• Subsequent plate removal: 7% to 46%
*Coughlin, 1994