RESUMO
BACKGROUND: The purpose of this study is to translate, culturally adapt, and validate the VISA-A questionnaire for Chilean Spanish speakers with Achilles tendinopathy (AT), which has been originally developed for English-speaking population. METHODS: According to the guidelines published by Beaton et al., the questionnaire was translated and culturally adapted to Chilean patients in six steps: initial translation, synthesis of the translation, back translation, expert committee review, test of the pre-final version (cohort n = 35), and development of VISA-A-CH. The resulting Chilean version was tested for validity on 60 patients: 20 healthy individuals (group 1), 20 patients with a recently diagnosed AT (group 2), and 20 with a severe AT that already initiated conservative treatment with no clinical improvement (group 3). The questionnaire was completed three times by each participant: at the time of study enrollment, after an hour, and after a week of the initial test. RESULTS: All six steps were successfully completed for the translation and cultural adaptation of the VISA-A-CH. VISA-A-CH final mean scores in the healthy group was significantly higher than those in the other groups. Group 3 had the lowest scores. Validity showed excellent test-retest reliability (rho c = 0.999; Pearson's r = 1.000) within an hour and within a week (rho c = 0.837; Pearson's r = 0.840). CONCLUSIONS: VISA-A was translated and validated to Chilean Spanish speakers successfully, being comparable to the original version. We believe that VISA-A-CH can be recommended as an important tool for clinical and research settings in Chilean and probably Latin-American Spanish speakers.
Assuntos
Comparação Transcultural , Tendinopatia , Humanos , Psicometria , Reprodutibilidade dos Testes , Índice de Gravidade de Doença , Inquéritos e Questionários , Tendinopatia/diagnóstico , Tendinopatia/cirurgiaRESUMO
Proximal metatarsal osteotomies are inherently unstable and difficult to fix. The purpose of this study was to compare the mechanical stiffness in sawbone models of medially versus dorsally placed plates and then to compare semilocked versus nonlocked plates in different osteotomy configurations. Thirty sawbone models were constructed, fixed either with titanium self-locking or steel mini-fragment plates. They were divided in groups and their stiffness was measured. The stiffness of any model fixed with medial titanium or steel plates was on average 158% and 228% greater, respectively, compared to dorsal plates. Adding a dorsal shelf of bone to a proximal closing wedge osteotomy increases its stiffness. Using locked plates increased the mechanical stiffness in only one configuration. The article suggests that models fixed with medial plates have greater resistance to failure than models fixed with dorsal plates. Using locked plates does not increase the mechanical stiffness of the construct.
Assuntos
Placas Ósseas , Ossos do Metatarso/cirurgia , Modelos Anatômicos , Osteotomia/instrumentação , Titânio , Fenômenos Biomecânicos , Desenho de Equipamento , Humanos , Teste de MateriaisRESUMO
BACKGROUND: The proximal oblique sliding closing wedge osteotomy (POSCOW) technique was developed to address moderate to severe hallux valgus deformity. We present a retrospective multicenter study to analyze the midterm radiological and clinical outcomes of patients treated with this type of proximal osteotomy fixed with plates. MATERIALS AND METHODS: One hundred and forty-four patients (187 feet) were operated on between May 2005 and June 2010 in 2 separate centers. Inclusion criteria were symptomatic moderate to severe incongruent hallux valgus deformity, no significant restriction in the first metatarsophalangeal joint movement, none to minimal degenerative changes in the first metatarsophalangeal or the tarsometatarsal joints, and no hypermobility. The median age was 60 years. The preoperative hallux valgus angle (HV) was 35.6 degrees, intermetatarsal angle (IM) was 15.3 degrees, AOFAS score was 53 points. The median follow-up was 35 months (range, 12-73). A POSCOW osteotomy was performed in all patients and fixed with plates. We recorded the satisfaction rate, postoperative clinical and radiological results, and complications. RESULTS: The patient satisfaction rate was 87%. The mean postoperative HV angle was 12.3 degrees, IM angle 4.8 degrees, AOFAS score 89 points. The mean decrease in the first metatarsal length was 2.2 mm (range, 0-8). Twelve feet (6.4%) with recurrence of the deformity required revision surgeries. Removal of complete or partial hardware was needed in 23 feet (12.3%) for symptomatic hardware. Five feet (2.6%) developed hallux varus but only 2 required surgery. Transfer metatarsalgia was noted in 9 feet (4.8%). CONCLUSIONS: The POSCOW osteotomy was an effective and reliable method for relieving pain and improving function. A learning curve was present, as most of the complications happened in the initial cases. To our knowledge, this is the largest reported series of proximal closing wedge osteotomy for hallux valgus deformities. LEVEL OF EVIDENCE: Level IV, case series.
Assuntos
Hallux Valgus/cirurgia , Osteotomia/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Placas Ósseas , Feminino , Seguimentos , Hallux Valgus/diagnóstico por imagem , Hallux Varus/etiologia , Humanos , Masculino , Ossos do Metatarso/diagnóstico por imagem , Ossos do Metatarso/cirurgia , Metatarsalgia/etiologia , Articulação Metatarsofalângica/cirurgia , Pessoa de Meia-Idade , Satisfação do Paciente/estatística & dados numéricos , Complicações Pós-Operatórias , Radiografia , Recidiva , Reoperação , Estudos Retrospectivos , Índice de Gravidade de Doença , Adulto JovemRESUMO
BACKGROUND: Anatomic restoration and postoperative rehabilitation of displaced fracture-dislocations of the tarsometatarsal junction of the foot are essential. Our objective was to report percutaneous reduction and screw fixation results in low-energy Lisfranc fracture dislocation injuries that were treated with early weight-bearing and rehabilitation. METHODS: We retrospectively evaluated patients with low-energy Lisfranc injuries who underwent surgery between May 2007 and April 2011. The study reviewed 22 patients (12 men and 10 women) with an average age of 36.2 years (range, 16-50 years) and an average follow-up of 33.2 months (range, 12-50 months). We report the mechanism of trauma; quality of reduction in the postoperative digital radiographs; subjective satisfaction; AOFAS score; time required to return to work, recreational activities, and low-impact sports; and complications. Postoperatively, all of the patients were instructed to be non-weight-bearing for 3 weeks, and the stitches were removed after 2 weeks. At the third postoperative week, the patients were encouraged to bear weight as tolerated. RESULTS: Quality of reduction was anatomic or near anatomic in 100% of cases. The subjective satisfaction reported by patients was very good, with complete satisfaction in 20 of them (90.9%). The AOFAS average was 94 points (range, 90-100 points). Average return to work was at 7 weeks (range, 6-9 weeks), recreational activities 7.2 weeks (range, 6-9 weeks), training for low-impact sports 7.6 weeks (range, 7-8 weeks), and symptom-free sport activities 12.4 weeks (range, 11-13 weeks). CONCLUSION: In this selected group of patients with low-energy Lisfranc fracture dislocation, anatomic or near-anatomic reduction can be achieved with percutaneous reduction and screw fixation. Early weight-bearing is possible in these patients, and early return to regular activities and low-impact sport can be expected. LEVEL OF EVIDENCE: Level IV, retrospective case series.
Assuntos
Parafusos Ósseos , Fixação Interna de Fraturas , Fraturas Intra-Articulares/cirurgia , Luxações Articulares/cirurgia , Articulações Tarsianas/lesões , Suporte de Carga/fisiologia , Adolescente , Adulto , Feminino , Consolidação da Fratura , Humanos , Fraturas Intra-Articulares/diagnóstico por imagem , Fraturas Intra-Articulares/fisiopatologia , Luxações Articulares/diagnóstico por imagem , Luxações Articulares/fisiopatologia , Masculino , Ossos do Metatarso/lesões , Pessoa de Meia-Idade , Radiografia , Recuperação de Função Fisiológica , Fatores de Tempo , Resultado do Tratamento , Adulto JovemRESUMO
For metatarsalgia and lesser toe deformities, a commonly performed procedure is the Weil osteotomy, which inevitably depresses the metatarsal head, changing the intrinsic muscle axis and generating phalanx extension. The objective of this study is to present a new metatarsal osteotomy that shortens or lengthens and elevates the metatarsal head, the elevating metatarsal osteotomy (EMO), with its geometrical analysis and possible applications. A geometrical model was designed, planning an oblique subcapital osteotomy with slice resection and distal displacement. A trigonometric analysis was done to calculate how to shorten, elevate, or lengthen the metatarsal head. The EMO elevates the head in one-third of the width of the resected slice. Distal and dorsal displacement of the metatarsal head results in an elevation and lengthening of the metatarsal bone (60% elevation and 65% lengthening). Performing an elevating metatarsal osteotomy will lengthen and elevate the metatarsal head, which sometimes is necessary when treating toe deformities and instability.
Assuntos
Ossos do Metatarso/cirurgia , Osteotomia/métodos , Deformidades do Pé/cirurgia , Humanos , Metatarsalgia/cirurgiaRESUMO
This article presents a surgical protocol for surgical reconstruction from the subtle cavus foot described by Manoli to the most complicated cases. The goal is to merge together the available surgical options in a comprehensive way to guide surgical decisions.