Academic literature on the topic 'Resection cuneiforme'

Category: Midfoot/Forefoot Introduction/Purpose: The literature is replete with descriptions of metatarsus adductus (pediatric patients) and metatarsus primus varus (adult patients) deformities along with recommendations for treatment. For adult deformities isolated to the first ray, a technique involving a cuneiform-metatarsal arthrodesis (e.g. Lapidus procedure) is often employed. There is a paucity of literature describing adult manifestations of adduction deformities involving multiple metatarsals. The senior author has treated a number of adult patients with these types of deformities. This case series is presented here with a description of the deformity and a technique for surgical reconstruction. Methods: Five patients having undergone surgical reconstruction for symptomatic midfoot/forefoot deformities involving adduction of multiple metatarsals (and valgus metatarsophalangeal joints) were retrospectively reviewed. The first ray deformities were treated with arthrodesis of the first metatarsal to the medial cuneiform, along with a distal soft tissue release and medial eminence resection as appropriate. Lesser ray deformities were corrected with oblique osteotomies of the metatarsal shafts (and metatarsophalangeal joint capsulorraphies and/or pinning as appropriate). Results: All patients went on to radiographic union of their arthrodeses and osteotomies. The midfoot (metatarsus adductus) deformities, and hallux valgus deformities, maintained correction compared to preoperative alignment. There were some lesser metatarsophalangeal joint valgus recurrences. There were no severe complications of deep infection or revision surgery. Conclusion: The “AdductoValgus” foot deformity presents in adult patients with adduction of multiple metatarsals and corresponding metatarsophalangeal joint valgus. The deformity can result in pain with mobility and difficulty with shoewear. Surgical reconstruction including first ray tarsometatarsal arthrodesis and osteotomies of the involved lesser metatarsals appears a viable option for deformity correction and symptomatic relief.

Topicality. Widespread use of the method of I. Ponseti allows to significantly reduce the number of reconstructive surgeries and/or reduce their volume. However, if presence the rigid, severe deformities that cannot be corrected with staged plaster casts, or recurrences, surgical treatment is advisable. The literature describes many surgical techniques, the main purpose of which is to reduce the frequency of postoperative complications. And at the same time find the most convenient access to eliminate contractures, further wound healing by primary tension with minimal formation of connective tissue elements. Objective: to reduce the incidences of complications in the surgical treatment of congenital clubfoot by using a modified surgical approach. Materials and methods. In the Department of Orthopedics and Traumatology of NCSH «OKHMATDYT» 57 children (72 feet) with a diagnosis of congenital clubfoot underwent surgical treatment using a modified Carroll approach for the period from January 2014 to September 2018. The mean age of patients was 3±0.4 years. 41 of them boys and 16 girls. Bilateral deformity was observed in 12 patients. 48 patients (58 feet) were underwent surgical treatment after initial treatment with staged plaster casts according to the method of I. Ponseti. Recurrences of deformity after surgery was observed in 9 patients (14 feet). Results. When assessing the immediate results during surgery in all patients, complete correction of foot deformity was achieved. No postoperative complications were noted. Long-term treatment results 2 years after surgery showed that good results were in 12 patients (21±9.53%), satisfactory in 39 (68.4±27.14%) and unsatisfactory in 6 (7±2.18%). Four patients with unsatisfactory results and residual manifestations of deformity in the form of passively corrected isolated adduction of the anterior foot, subsequently underwent surgery to transplant the anterior tibialis tendon to the lateral cuneiform bone. And 2 patients – wedge-shaped resection of the cuboid bone. Indication of which was not the possibility of passive correction of deformity. Conclusions. The comparative analysis of the obtained results and literature data testifies to the effectiveness of the proposed method of treatment of idiopathic clubfoot in children (using three approaches), as well as in the presence of residual deformity after conservative and surgical treatment. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of participating institution. The informed consent of the patient was obtained for conducting the studies. Key words: clubfoot, children, posteromedial release, surgical treatment.