Hallux Interphalangeus

Fig. 11c2. P1 Shaft osteotomy is more unstable than for basal location.

It requires strong fixation: Some result of unsatisfactory fixation in our early experience.

Fig. 11c3. P1 screw fixation is technical demanding.

1, 2, 3. The screw location has to be very accurate (1). 4. The use of a K-wire guide improves the screw setting. Therefore the scarf screw may be used for P1 fixation.

Depuy Bipolar

Fig. 11c4. Use of the special memory staple (DePuy) in fixation of shaft osteotomy. Generalities.

2. This memory staple provides bicortical compression: Lateral on the prong extremities, medial on the oval part.

3. Anatomical adaptation of the oval part on the medial surface.

4. 7. Principles of setting the memory staple.

5, 6. The staple can be shaped when it is cool; (7) bicortical compression at the body temperature.

Fig. 11c4. Use of the special memory staple (DePuy) in fixation of shaft osteotomy. Generalities.

2. This memory staple provides bicortical compression: Lateral on the prong extremities, medial on the oval part.

3. Anatomical adaptation of the oval part on the medial surface.

4. 7. Principles of setting the memory staple.

5, 6. The staple can be shaped when it is cool; (7) bicortical compression at the body temperature.

Memory Staples Depuy

Fig. 11c5. Use of the special memory staple (DePuy) in fixation of shaft osteotomy: Technique. 1, 2. First : setting the proximal K wire, between the two medial and proximal tubercules.

3. Around the K wire, the cannulated drill.

4. Around the canulated drill, we set the guide ; the saw is located at an equal distance of the two guide drills.

5. Setting the distal drill, after performed the osteotomy.

6. 7. Setting of the staple.

Fig. 11c5. Use of the special memory staple (DePuy) in fixation of shaft osteotomy: Technique. 1, 2. First : setting the proximal K wire, between the two medial and proximal tubercules.

3. Around the K wire, the cannulated drill.

4. Around the canulated drill, we set the guide ; the saw is located at an equal distance of the two guide drills.

5. Setting the distal drill, after performed the osteotomy.

6. 7. Setting of the staple.

Memory Staples Depuy

Fig. 11c6a. Varisation with the memory staple.

1. The K wire is directed distally an laterally.

2, 3. Around the K wire, the cannulated drill, then the guide : the distal prong of the guide has to be 2 or 3 mm separated from the medial face of the bone, in order to be applied after varisation.

4, 5. Clinical and radiological aspects before and after varisation.

Hallux Valgus Interphalangeus Surgery

Fig. 11c6b. Varisation in case of hallux valgus interphalangeus.

In this case, the cut (and the staple) are located in the middle of the shaft. i.e. slightly more distal than for usual varisation.

Fig. 11c6b. Varisation in case of hallux valgus interphalangeus.

In this case, the cut (and the staple) are located in the middle of the shaft. i.e. slightly more distal than for usual varisation.

Fig. 11c6c. Shaft osteotomy for derotation.

Derotation : great toe derotation is accurately performed with a diaphyseal cut perpendicular to the shaft. After derotation, the distal prong should be too much dorsal (D). Therefore the proximal drill has already to be set more dorsally (P2). Derotation result (3).

Hallux Valgus Interphalangeus

Fig. 11c6d1. Why shorten the great toe?

1, 2. Egyptian type foot as well as too large big toe increase the rate of hallux valgus deformity or recurrence with ladies shoes.

3. This test is an assessment of the forefoot shape which is compatible with ladies footwear: We note that the great toe doesn't have to be Egyptian.

4, 5. Egyptian type foot and hallux rigidus (or arthritic hallux valgus). 4. Decreasing the sagittal lever arm by P1 shortening increases the global dorsal flexion on the great toe.

5. Egyptian type foot remaining increases the longitudinal pressure in the MTP joint (shoe longitudinal pressure). However, the first metatarsal shortening provides much more longitudinal decompression of the MTP joint (Scarf with shortening weil of the first metatarsal).

6, 7. Undercorrection of hallux valgus on the foot with Egyptian type remaining.

Fig. 11c6d1. Why shorten the great toe?

1, 2. Egyptian type foot as well as too large big toe increase the rate of hallux valgus deformity or recurrence with ladies shoes.

3. This test is an assessment of the forefoot shape which is compatible with ladies footwear: We note that the great toe doesn't have to be Egyptian.

4, 5. Egyptian type foot and hallux rigidus (or arthritic hallux valgus). 4. Decreasing the sagittal lever arm by P1 shortening increases the global dorsal flexion on the great toe.

5. Egyptian type foot remaining increases the longitudinal pressure in the MTP joint (shoe longitudinal pressure). However, the first metatarsal shortening provides much more longitudinal decompression of the MTP joint (Scarf with shortening weil of the first metatarsal).

6, 7. Undercorrection of hallux valgus on the foot with Egyptian type remaining.

Fig. 11c6d2. Shaft osteotomy for shortening.

1. Longitudinal K wiring is required, close to the dorsal cortex, not to disturb the prongs setting.

2. Care has to be taken to have both dorsal and medial fragment congruence.

3. Note the operator thumb location under the metatarsal head.

4. Result of the great toe shortening.

Fig. 11c6d2. Shaft osteotomy for shortening.

1. Longitudinal K wiring is required, close to the dorsal cortex, not to disturb the prongs setting.

2. Care has to be taken to have both dorsal and medial fragment congruence.

3. Note the operator thumb location under the metatarsal head.

4. Result of the great toe shortening.

The fixation may be performed by the "12" memory staple, but, for osteoporotic bone, fixation by an oblique screw is preferable.

Memory Staple

Fig. 11c7. Shaft osteotomy with memory staple: General results.

1. Immediate aspect and one month postoperative: The bicortical compression with memory staple.

2. The strong fixation allows early functional recovery.

3. Good tolerance (five years follow-up).

4. Elasticity remaining when removing the staple six years after setting.

Fig. 11c7. Shaft osteotomy with memory staple: General results.

1. Immediate aspect and one month postoperative: The bicortical compression with memory staple.

2. The strong fixation allows early functional recovery.

3. Good tolerance (five years follow-up).

4. Elasticity remaining when removing the staple six years after setting.

How To Reduce Acne Scarring

How To Reduce Acne Scarring

Acne is a name that is famous in its own right, but for all of the wrong reasons. Most teenagers know, and dread, the very word, as it so prevalently wrecks havoc on their faces throughout their adolescent years.

Get My Free Ebook


Post a comment