OBJECTIVE:  This study aimed to compare the outcomes of traditional surgery (TS) with those of a 3-dimensional model-assisted surgery (3DS) in hallux valgus (HV) surgery with distal chevron osteotomy.
METHODS: This randomized controlled trial study included 30 patients randomly grouped as TS and 3DS. In the 3DS group, the surgery was simulated on the 3D model before surgery, and that simulation was used as a guide during surgery. Various parameters, such as angles of the HV, intermetatarsal (IM), and distal metatarsal articular, were measured pre-surgery and during the final follow-up. The extent of lateralization of the first metatarsal (FM) head and plantar displacement of the FM head were assessed. Metrics like the duration of the osteotomy+lateralization+K wire fixation, tourniquet time, and fluoroscopy usage were recorded. All assessments were conducted independently and blindly. Patients remained unaware of their group allocation and the randomization procedure.
RESULTS: Both groups showed no statistical differences in gender, operated side, age, or follow-up duration. For instance, in the 3DS group (n=15, age: 44.6 ± 9.6 years, male/female: 14/1, side right/left: 11/4, follow-up duration: 29.4 ± 8.7 months) and TS group (n=15, age: 44.8 ± 9.6 years, male/female: 13/2, side right/left: 10/5, follow-up duration: 28.8 ± 8.4 months). The 3DS group, however, showed better metrics with osteotomy+lateralization+K wire fixation, tourniquet duration, and number of fluoroscopies at 12.4 ± 1.2 minutes, 41.5 ± 3.8 minutes, 2.5 ± 0.6 times. In contrast, the TS group recorded 17.1 ± 1.5 minutes, 50.8 ± 3.4 minutes, and 3.3 ± 0.8 times, respectively (P <.001 for all). The 3DS group also achieved a more significant restoration of the IM angle (P < .001). Postsurgery, the 3DS group demonstrated superior outcomes in FM head lateralization, FM shortening, and plantar displacement (P <.001, P <.001 and P = .006, respectively, for all metrics). Only 1 patient in the 3DS group experienced a pin-tract infection, which was treated with wound care and oral antibiotics.
CONCLUSIONS: Simulating surgery on a 3D model and using it as a guide significantly enhances surgical outcomes. Benefits include reduced operation time, tourniquet duration, decreased fluoroscopy usage, and improved first-ray alignment. The 3DS method also ensures better lateralization of the first metatarsal head and correction of the IM. Although 3D model-assisted HV chevron osteotomy surgery provides ideal deformity correction, it does not significantly affect postoperative functional outcomes.
METHODS: Level I, Therapeutic Study. Cite this article as:Süer O, Özer MA, Govsa F, Öztürk AM, Aktuğlu SK. Impact of surgery simulation using a 3-dimensional printed model on outcomes of hallux valgus surgery with distal chevron osteotomy: A randomized controlled trial. Acta Orthop Traumatol Turc., 2024;58(2):95-101.

OBJECTIVE: Minimally invasive stabilization of metatarsal fractures to enable adequate fracture healing in a correct position to restore anatomy and biomechanics of the foot.
METHODS: A. Dislocated diaphyseal and subcapital fractures of the second to fifth metatarsal (> 3 mm, > 10° dislocation). B. Fifth metatarsal fracture at the metadiaphyseal junction (Lawrence and Botte type III).
METHODS: High grade soft tissue damage or infection at the implant insertion site.
METHODS: A. Fluoroscopically assisted closed reduction and antegrade intramedullary fixation of diaphyseal and subcapital fractures of the second to fifth metatarsal. B. Fluoroscopically assisted wire-guided intramedullary screw fixation of fifth metatarsal fractures at the metadiaphyseal junction.
METHODS: A. Mobilization with partial weight bearing (20 kg) for 6 weeks wearing a stiff sole; implant removal under local anesthesia after 6-8 weeks, followed by a free range of movement and weight-bearing as tolerated (WBAT). B. Early mobilization with weight-bearing as tolerated (WBAT); removal of the orthosis after 6 weeks, implant removal optional.
RESULTS: A. Antegrade nailing of subcapital and shaft fractures of metatarsals II-V achieves good clinical results with low complication rates both when using prepared Kirschner wires or elastically stable intramedullary nails (ESIN). B. According to current literature, intramedullary screw osteosynthesis of proximal metatarsal V fractures of zone II and III according to Lawrence and Botte leads to faster bony healing with a lower nonunion rate compared with conservative treatment. It is recommended especially, but not only, for active athletes.
UNASSIGNED: OPERATIONSZIEL: Minimal-invasive Stabilisierung von Mittelfußfrakturen zur Ermöglichung einer sicheren knöchernen Heilung in korrekter Stellung zur Wiederherstellung der Anatomie und Biomechanik des Fußes.
UNASSIGNED: A. Dislozierte diaphysäre und subkapitale Metatarsale(MT)-II- bis -V-Frakturen (> 3 mm, > 10° Achsdislokation). B. MT-5-Frakturen am metadiaphysären Übergang (Lawrence und Botte Typ III).
UNASSIGNED: Höhergradiger Weichteilschaden oder Infektion an der Insertionsstelle der Implantate.
UNASSIGNED: A. Bildwandlergestützte geschlossene Reposition und antegrade intramedulläre Schienung von diaphysären und subkapitalen Metatarsale-II- bis -V-Frakturen. B. Bildwandlergestützte drahtgeführte intramedulläre Schraubenosteosynthese von Metatarsale-V-Frakturen am metadiaphysären Übergang.
UNASSIGNED: A. Bei fester Sohle Mobilisation unter 20 kg Teilbelastung für 6 Wochen; Implantatentfernung in Lokalanästhesie nach 6 bis 8 Wochen, danach Bewegungs- und Belastungsfreigabe. B. Bei fester Sohle zügige Mobilisation unter schmerzadaptierter Belastung anstreben; nach 6 Wochen Entfernung der Orthese, Implantatentfernung fakultativ.
UNASSIGNED: A. Die antegrade Schienung subkapitaler und Schaftfrakturen von Metatarsale II–V führt sowohl bei Verwendung von präparierten Kirschner-Drähten als auch beim Einsatz von elastisch-stabilen intramedullären Nägeln (ESIN) zu guten klinischen Ergebnissen bei geringen Komplikationsraten. B. Die intramedulläre Schraubenosteosynthese von basalen Metatarsale-V-Frakturen der Zone II und III nach Lawrence und Botte führt im Vergleich zur konservativen Therapie nach aktueller Literaturlage zu einer schnelleren knöchernen Heilung bei geringerer Pseudarthroserate. Sie wird insbesondere, aber nicht nur bei aktiven Sportlern empfohlen.

OBJECTIVE: Chevron osteotomy offers near-excellent clinical results and adequate stability at lower shift percentages, among the techniques used to correct hallux valgus deformity. This cadaveric study aimed to compare the Chevron osteotomy with the reverse offset-L osteotomy, which may provide a greater surface area and a more stable geometry to withstand higher cantilever forces at higher shift percentages.
METHODS: Metatarsal bones obtained from 20 human cadavers with similar bone quality were divided into two groups: Chevron osteotomy was applied to the 1st group and reverse offset-L osteotomy was applied to the 2nd group. The load-to-failure, displacement in the y-axis, and total displacement values of both groups were compared statistically. Furthermore, bone densities were compared between the groups with computed tomography imaging.
RESULTS: When outliers in both groups were excluded, a statistically significant difference was found in favor of reverse offset-L (143 ± 42 vs. 204 ± 51.2 N, p = 0.02) in terms of failure load. The groups were similar in terms of displacement on the y-axis and total displacement values. Bone densities were similar.
CONCLUSIONS: The reverse offset-L osteotomy has been shown to withstand greater loads before failure compared to the standard Chevron osteotomy. This significant difference in load-to-failure may enable reverse offset-L to provide reliable stability in osteotomies performed in advanced HV cases requiring higher shifts.

BACKGROUND: Lisfranc joint injuries are common and often underdiagnosed. They occur during trauma of various mechanisms, high or low energy. Their management is difficult because of the wide spectrum of lesions and the management of associated lesions, particularly in the emergency stage. Their surgical treatment remains controversial. Therefore, the objective of this study was to evaluate and compare the management of Lisfranc injuries and to study their clinical, functional and radiologic evolution. We also wanted to assess the consequences of these lesions on the patient\'s quality of life.
METHODS: This was a retrospective multicenter study of 141 patients over 16 years at the time of the trauma. The patients included had presented a Lisfranc injury from January 2010 to June 2018. The epidemiological characteristics, the type of osteosynthesis, and the immediate and radiographic results at the last follow-up were collected. Functional assessment was analyzed by telephone review using the SF12, FAAM and AOFAS scores.
RESULTS: An associated M2 base fracture was found in almost 50 % of cases. A closed reduction and fixation was made in 25 % of cases. There was 69 % pins fixation. The reduction was not anatomical in 1/3 of the cases and was more difficult to achieve with an associated fracture. The FAAM score was statistically superior in the patients with internal fixation by screws compared to the treatment by pins. We found 18 % early complications. At least 1 year after the injury, C2M2 osteoarthritis was found in 45 % of patients.
CONCLUSIONS: Contrary to what is recommended in the literature, this study reported a high rate of osteosynthesis by pins whereas screws and plates were more recommended. Open reduction was also recommended and was the strategy of choice in this study. An M2 fracture was often associated with Lisfranc dislocations. The quality of reduction was essential and was better with open reduction and screw fixation.

Dorsal cheilectomy refers to a surgical resection of the dorsal osteophyte from the first metatarsal head. It is most often performed in patients with hallux rigidus, who have little to no midrange pain of the first metatarsophalangeal joint. The procedure is simple, quick, and maintains range of motion. Additional advantages of this procedure include low morbidity, quicker postoperative recovery, avoidance of costly implants, and the fact that the procedure does not inhibit future conversion to an arthrodesis. These proposed advantages have led some authors to advocate for the use of a cheilectomy, even in patients with more extensive disease.

The most widely used synthetic glucocorticoid, dexamethasone (DEX), causes stunted growth in children when used excessively or for long periods of time; however, there are still plenty of pediatric patients require long-term treatment with DEX. As an alternative, growth hormone is used in combination, but it has side effects, a high cost, and psychological factors, and it is not satisfactory in terms of effectiveness. It is necessary to develop a safe and affordable treatment that can replace it. The Korean Food and Drug Administration approved HT042, a standardized functional food ingredient, with the claim that it can help height growth of children. In this study, it was found that HT042 activated the Indian hedgehog/parathyroid hormone-related protein signaling pathway and enhanced the number of growth hormone receptors and insulin-like growth factor-1 receptors on the growth plate surface, which were reduced by DEX treatment, and restored growth retardation. In metatarsal bone and primary chondrocyte models, it was found that HT042 can promote the length of growth plate and recover DEX-induced growth retardation. It was also found that HT042 promotes cell proliferation using bromodeoxyuridine and terminal deoxynucleotidyl transferase dUTP nick end labeling assays; moreover, we verified increased expression of GHR/IGF-1R and Ihh/PTHrP pathway activity using qRT-PCR, western blotting, and siRNA analyses to verify its direct action on the growth plate. The anti-apoptotic effect of HT042 was identified by regulating the expression of apoptotic factors such as caspase-3, Bcl2, Bclx, and Bax. These results were identified using both ex vivo and in vitro models. Our study verified that co-administration of HT042 could recover the DEX induced growth retardation.

UNASSIGNED: To compare the effectiveness of small incision external articular minimally invasive osteotomy and traditional Chevron osteotomy in the treatment of hallux valgus.
UNASSIGNED: A retrospective analysis was conducted on the clinical data of 58 patients (58 feet) with hallux valgus who were admitted between April 2019 and June 2022 and met the selection criteria. Among them, 28 cases were treated with small incision external articular minimally invasive osteotomy (minimally invasive group), and 30 cases were treated with traditional Chevron osteotomy (traditional group). There was no significant difference in baseline data such as age, gender, disease duration, Mann classification, and preoperative inter metatarsal angle (IMA), hallux valgus angle (HVA), distal metatarsal articular angle (DMAA), forefoot width, tibial sesamoid position (TSP) score, American Orthopaedic Foot and Ankle Society (AOFAS) forefoot score, visual analogue scale (VAS) score, psychological score (SF-12 MCS score) and physiological score (SF-12 PCS score) of short-form 12 health survey scale, and range of motion (ROM) of metatarsophalangeal joint between the two groups ( P>0.05). The incision length, operation time, intraoperative blood loss, intraoperative fluoroscopy frequency, weight-bearing walking time, fracture healing time, and incidence of complications were recorded and compared between the two groups; as well as the changes of imaging indexes at last follow-up, and the clinical function score and ROM of metatarsophalangeal joint before operation, at 6 weeks after operation, and at last follow-up.
UNASSIGNED: All patients were followed up 11-31 months, with an average of 22 months. The incision length and intraoperative blood loss in the minimally invasive group were significantly less than those in the traditional group ( P<0.05), and the intraoperative fluoroscopy frequency and operation time in the minimally invasive group were significantly more than those in the traditional group ( P<0.05); but no significant difference was found in weight-bearing walking time and fracture healing time between the two groups ( P>0.05). There was 1 case of skin injury in the minimally invasive group and 3 cases of poor incision healing in the traditional group; all patients had good healing at the osteotomy site, and no complication such as infection, nerve injury, or metatarsal head necrosis occurred. At last follow-up, the imaging indexes of the two groups significantly improved when compared with those before operation ( P<0.05). The changes of DMAA and TSP score in the minimally invasive group were significantly better than those in the traditional group ( P<0.05), and there was no significant difference in the changes of IMA, HVA, and forefoot width between the two groups ( P>0.05). The clinical scores and ROM of metatarsophalangeal joint significantly improved in the two groups at 6 weeks after operation and at last follow-up when compared with preoperative ones ( P<0.05), and the indicators in the minimally invasive group were significantly better than those in the traditional group ( P<0.05).
UNASSIGNED: Compared with traditional Chevron osteotomy, small incision external articular minimally invasive osteotomy can effectively improve HVA, IMA, and forefoot width, correct foot deformities, and has less trauma. It can better correct the first metatarsal pronation deformity and restore the anatomical position of the sesamoid bone, resulting in better effectiveness.
UNASSIGNED: 比较小切口关节外微创截骨与传统Chevron截骨术治疗踇外翻的临床疗效。.
UNASSIGNED: 回顾分析2019年4月—2022年6月收治且符合选择标准的58例（58足）踇外翻患者临床资料，其中28例采用小切口关节外微创截骨（微创组），30例采用传统Chevron截骨术截骨（传统组）。两组患者年龄、性别、病程、Mann分型及术前第1、2跖骨间角（inter metatarsal angle，IMA）、踇外翻角（hallux valgus angle，HVA）、跖骨远端关节面角（distal metatarsal articular angle，DMAA）、前足宽度、胫侧籽骨位置（tibial sesamoid position，TSP）评分、美国矫形足踝协会（AOFAS）前足评分、疼痛视觉模拟评分（VAS）、健康调查 12 项简表的心理评分（SF-12 MCS评分）和生理评分（SF-12PCS评分）及跖趾关节活动度（range of motion，ROM）等基线资料比较差异均无统计学意义（ P>0.05）。记录并比较两组患者切口长度、手术时间、术中出血量、术中透视次数、负重行走时间、骨折愈合时间及并发症发生情况，末次随访时各影像学指标与术前比较的变化值，术前、术后6周及末次随访时临床评分以及跖趾关节ROM。.
UNASSIGNED: 所有患者均获随访，随访时间11～31个月，平均22个月。微创组患者切口长度、术中出血量小于传统组，术中透视次数、手术时间大于传统组，差异均有统计学意义（ P<0.05）；两组负重行走时间和骨折愈合时间比较差异无统计学意义（ P>0.05）。微创组出现1例皮肤损伤，传统组出现3例切口愈合不良；所有患者截骨处愈合良好，无感染、神经损伤及跖骨头坏死等并发症发生。末次随访时两组患者各影像学指标均较术前显著改善（ P<0.05）；末次随访时微创组DMAA和TSP评分变化值优于传统组（ P<0.05），两组间IMA、HVA及前足宽度变化值差异均无统计学意义（ P>0.05）。术后6周及末次随访时，两组患者各临床评分及跖趾关节ROM均较术前显著改善（ P<0.05）；微创组各指标均优于传统组，差异有统计学意义（ P<0.05）。.
UNASSIGNED: 与传统Chevron截骨术相比，小切口关节外微创截骨不仅可有效改善HVA、IMA、前足宽度，矫正足部畸形，且创伤小，能更好地纠正第1跖骨旋前畸形及恢复籽骨解剖位置，临床疗效更佳。.

UNASSIGNED: https://ota.org/education/ota-online-resources/video-library-procedures-techniques/lisfranc-open-reduction-and.

Scottish Fold cats (Felis catus, Linnaeus 1758) are one of the most well-known and popular cat breeds in the world, characterized by their folded ears attached to the head. Very frequently, cats fall prey of different trauma and accidents that can cause bone fractures especially in the metapodial bones. The method of radiometry is used in veterinary practice to visualize and measure different parts of the animal skeleton. The aim of this study was to assess the linear parameters derived from radiographic images of the metacarpals and metatarsals in Scottish Fold cats and additionally detecting potential sexual dimorphism. Radiographic images of 24 adult Scottish Fold cats (12 male and 12 females) of different ages and weights were analysed. Six linear measurements of the metapodial bones were evaluated to investigate any differences between the sexes. The linear radiometric measurements of the five metacarpals (MC1-5) and the four metatarsals (MT2-5) bones were larger in male metapodial bones than that of female cats. The maximum length (Ml) of the MC1 and MC2 was statistically different between sex, respectively, (p = 0.001) and (p = 0.05). The others metacarpal bones were different in mostly all linear parameters but not statistically significant. The most significant differences between sexes were observed in the parameter of width proximal end (Wp) of MC1-3 (p = 0.001) and MC4 (p = 0.05). More statistical different was MT2 and less MT3. The linear parameter of Bd of the MT4 was the most different statistically between sex (p = 0.001). The results of the study will be useful in function of comparative anatomy, in veterinary clinical practice, in zoo archaeology and in the veterinary forensic investigation.

The forced turnout has a perceived risk of development of hallux valgus (HV) in ballet dancers. We determined how the forced turnout affects the sagittal mobility of the first tarsometatarsal (TMT) joint, which is one of the pathogenic factors of HV development. Seventeen female ballet dancers (body mass index: 18.2 ± 1.8 kg/m2) were included and performed demi-plié in control, functional turnout, and forced turnout conditions. Ultrasound imaging synchronized with a three-dimensional motion analysis system was used for measuring the vertical locations of the first metatarsal and medial cuneiform (MC) to evaluate the first TMT joint mobility. Plantar displacement of MC and the first TMT joint mobility in the forced turnout were the greatest among the 3 conditions. Multiple regression analysis indicated that the greater extent of the forcing angle might increase the displacement of MC and the first TMT joint mobility. Evaluating the sagittal mobility of the first TMT joint in the forced turnout can assist in understanding the association between inappropriate techniques including the forced turnout and HV development in ballet dancers. Since the excessive mobility of the first TMT joint is a factor in HV development, the acquirement of adequate active turnout may have the potential to prevent HV development in ballet dancers.