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[Diaphysectomy of the proximal phalanx in quintus varus supraductus and hammer toe in children].

Abstract

The most frequent foot and ankle anatomical alterations in the pediatric population are found in the little toes. Several treatments are proposed for these conditions, ranging from total phalangeal resections, phalangeal osteotomies, osteosynthesis, and soft tissue management. We propose a surgical technique based on the diaphysectomy of the proximal phalanx and the release of soft tissues that are under tension. The purpose is to assess the functional foot results after surgical treatment consisting of proximal phalanx diaphysectomy and soft tissue release using the functional AOFAS scale in pediatric patients. A prospective, longitudinal, descriptive, non-comparative clinical study was conducted from March 2008 to December 2010, with a follow-up of up to six months. Twenty patients (35 toes) were included; 15 females and five males, with a mean age of 14.65 years. Fifteen (30 toes) had bilateral involvement; 88.56% had greater involvement of the fifth toe. The surgical indication was determined based on the degree of functional disability for gait and the type of footwear. The functional assessment was conducted using the AOFAS criteria and a subjective assessment scale with a total score of 100 to assess the metatarsophalangeal and the interphalangeal joints of the smallest toes. Scores were as follows: < 50 points, poor; 51-70 points, fair; 71-90, good, and > 91, excellent. The assessment was done preoperatively and at postoperative month six. The mean preoperative score was 73.55 and the mean postoperative score was 85.75, with a 12.2 point difference (p > 0.5). Results were: 11 excellent, seven good and two fair. There were four relapses, so a salvage procedure was performed with the Ruiz-Mora technique; excellent results were obtained in all four. One case had soft tissue infection. Proximal phalanx diaphysectomy and soft tissue release provides appropriate alignment of the affected toes and relief of soft tissues under tension, thus avoiding broad resections leading to both esthetic and functional alterations. This is a simple and effective technique for the treatment of little toe deformities as it improves function and alignment.

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    MeSH

    Adolescent
    Anesthesia, Local
    Diaphyses
    Female
    Foot
    Foot Deformities, Acquired
    Foot Deformities, Congenital
    Hammer Toe Syndrome
    Humans
    Male
    Orthopedic Procedures
    Prospective Studies
    Recovery of Function
    Reoperation
    Severity of Illness Index
    Toe Phalanges
    Toes
    Treatment Outcome

    Pub Type(s)

    Clinical Trial
    English Abstract
    Journal Article

    Language

    spa

    PubMed ID

    24701761

    Citation

    González-Rincón, J A., et al. "[Diaphysectomy of the Proximal Phalanx in Quintus Varus Supraductus and Hammer Toe in Children]." Acta Ortopedica Mexicana, vol. 27, no. 2, 2013, pp. 103-8.
    González-Rincón JA, Valle-de Lascurain G, Oribio-Gallegos JA. [Diaphysectomy of the proximal phalanx in quintus varus supraductus and hammer toe in children]. Acta Ortop Mex. 2013;27(2):103-8.
    González-Rincón, J. A., Valle-de Lascurain, G., & Oribio-Gallegos, J. A. (2013). [Diaphysectomy of the proximal phalanx in quintus varus supraductus and hammer toe in children]. Acta Ortopedica Mexicana, 27(2), pp. 103-8.
    González-Rincón JA, Valle-de Lascurain G, Oribio-Gallegos JA. [Diaphysectomy of the Proximal Phalanx in Quintus Varus Supraductus and Hammer Toe in Children]. Acta Ortop Mex. 2013;27(2):103-8. PubMed PMID: 24701761.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - [Diaphysectomy of the proximal phalanx in quintus varus supraductus and hammer toe in children]. AU - González-Rincón,J A, AU - Valle-de Lascurain,G, AU - Oribio-Gallegos,J A, PY - 2014/4/8/entrez PY - 2014/4/8/pubmed PY - 2014/5/14/medline SP - 103 EP - 8 JF - Acta ortopedica mexicana JO - Acta Ortop Mex VL - 27 IS - 2 N2 - The most frequent foot and ankle anatomical alterations in the pediatric population are found in the little toes. Several treatments are proposed for these conditions, ranging from total phalangeal resections, phalangeal osteotomies, osteosynthesis, and soft tissue management. We propose a surgical technique based on the diaphysectomy of the proximal phalanx and the release of soft tissues that are under tension. The purpose is to assess the functional foot results after surgical treatment consisting of proximal phalanx diaphysectomy and soft tissue release using the functional AOFAS scale in pediatric patients. A prospective, longitudinal, descriptive, non-comparative clinical study was conducted from March 2008 to December 2010, with a follow-up of up to six months. Twenty patients (35 toes) were included; 15 females and five males, with a mean age of 14.65 years. Fifteen (30 toes) had bilateral involvement; 88.56% had greater involvement of the fifth toe. The surgical indication was determined based on the degree of functional disability for gait and the type of footwear. The functional assessment was conducted using the AOFAS criteria and a subjective assessment scale with a total score of 100 to assess the metatarsophalangeal and the interphalangeal joints of the smallest toes. Scores were as follows: < 50 points, poor; 51-70 points, fair; 71-90, good, and > 91, excellent. The assessment was done preoperatively and at postoperative month six. The mean preoperative score was 73.55 and the mean postoperative score was 85.75, with a 12.2 point difference (p > 0.5). Results were: 11 excellent, seven good and two fair. There were four relapses, so a salvage procedure was performed with the Ruiz-Mora technique; excellent results were obtained in all four. One case had soft tissue infection. Proximal phalanx diaphysectomy and soft tissue release provides appropriate alignment of the affected toes and relief of soft tissues under tension, thus avoiding broad resections leading to both esthetic and functional alterations. This is a simple and effective technique for the treatment of little toe deformities as it improves function and alignment. SN - 2306-4102 UR - https://www.unboundmedicine.com/medline/citation/24701761/[Diaphysectomy_of_the_proximal_phalanx_in_quintus_varus_supraductus_and_hammer_toe_in_children] L2 - http://www.medigraphic.com/pdfs/ortope/or-2013/or132g.pdf DB - PRIME DP - Unbound Medicine ER -