AIM:To evaluate the functional outcomes of the Bristow-Latarjet procedure in patients with recurrent anterior glenohumeral instability.PATIENTS AND METHODS:Personal clinical records of 42 patients with 45 operated shoulders were reviewed retrospectively. Patient age at time of first dislocation, injury mechanism, and number of recurring dislocations before surgery were recorded. The overall function and stability of the shoulder was evaluated.RESULTS:Thirty five (78%) of the scapulohumeral humeral instabilities were caused by trauma. The mean number of recurring dislocations was 9 (95% confidence interval [CI], 0–18); one patient had had 17 recurrences. Mean follow-up 46 months (95% CI, 16-88). No dislocation happened postoperatively. Four patients have fibrous union (9%). Only two had clinical sign of pain and discomfort. One of them was reoperated for screw removal with very good post-operative result. The overall functional outcome was good, with a mean Rowe score of 88 points (95% CI, 78–100). Scores of 27 (64%) of the patients were excellent, 9 (22%) were good, 4 (9.5%) were fair, and 2 (4.5%) were poor.CONCLUSION:The Bristow-Latarjet procedure is a very good surgical treatment for recurrent anterior-inferior instability of the glenohumeral joint. It must not be used for multidirectional instability or psychogenic habitual dislocations.

The purpose of this study is to evaluate which of the methods selected in patients with moderate or severe hallux valgus a result in a better correction of hallux valgus angle (HVA) and intermetatarsal angle (IMA) in Scarf osteotomy as compared to Chevron osteotomy. Material and methods; In our study, we selected 36 patients, 16 scarf and 20 chevron osteotomies, with all surgical options from skin incision, capsular and bunionectomy to bone reorientation. Deformities of patients were classified as mild, moderate and severe according to clinical and radiological findings. The results were measured using radiographic HVA, IMA and distal metatarsal articular angle (DMAA). Results: No statistical differences were found in HVA, IMA and DMAA between scarf and chevron osteotomy in mild to moderate hallux valgus. In severe hallux valgus, Scarf osteotomy corrected HVA better than Chevron, although this group consisted of twelve patients. Two patients in the Chevron group and three in the Scarf group developed subluxation of the metatarsophalangeal joint. Conclusion: In patients with moderate and severe hallux valgus the results of Scarf and Chevron osteotomy have no specific difference. Change to IMA angle with the subluxation of the first metatarsophalangeal joint some months after operation were the main cause for insufficient correction. We favor the Scarf osteotomy because it is more profitable, with correction of HVA and IMA.

Introduction; Many procedures are described in the literature for the surgical management of hallux valgus. There are over 130 surgical procedures described. There is ever rising enthusiasm among orthopedic surgeons regarding diaphyseal osteotomy ever since Burutaran described the procedure in 1973. We report our experience of treating severe cases of Hallux Valgus deformity with a SCARF osteotomy at the last three years follow-up, at patients diagnosed and operated in the University Hospital of Trauma, from January 2015 - February 2018. The technique we are presenting, provides the correction of moderate to severe hallux valgus deformities. Material and Methods: Correction of hallux valgus deformities was achieved using a Z step osteotomy cut to realign the first metatarsal bone. A retrospective analysis was undertaken in 38 consecutive patients (54 feet).  All results were analyzed by clinical examination, a questionnaire including the AOFAS forefoot score, modified, and plain roentgenograms. Results: Hallux valgus and intermetatarsal angle improved at mean 19.6° and 6.9°, respectively. Mean forefoot score improved from 50.1 to 91 points out of 100 possible points. Satisfactory healing time was expressed by an average return back to their attitude of 6-12 weeks, without including physiotherapy. Persistence or recurrence of hallux valgus was seen in 3 patients (8%). The complication rate was 5.4% including superficial wound infection, atrophy of the muscles, traumatic dislocation of the distal fragment. Conclusion: Scarf osteotomy is a powerful and versatile procedure to correct hallux valgus deformity,  and  provides a predictable and satisfying result. Scarfs are not considered as a single osteotomy but as a combination of several procedures and displacement in several planes are possible.

IntroductionLeg length discrepancy (LLD) is an infrequent diagnosis, most commonly occurring congenitally in children and rarely in traumatic incidents in adults. Circumferential external fixators are considered the optimal treatment method, but can be very costly and are not always readily available in less developed nations. The unilateral external fixator predates the circumferential but is more easily available and accessible worldwide and less expensive. This study sought primarily to characterize treatment outcomes using a unilateral external fixator where more advanced forms of treatment for LLD are not available. Secondary objectives included the site of the discrepancy and comparison of etiologies. MethodsData were retrospectively reviewed from January 2010 to December 2017 on patients undergoing unilateral external fixation at our institution. Nineteen patients met the criteria, 14 with congenital LLD and five with lower leg bone loss from trauma. Patient demographics (including gender and age), initial presentation, physical examination findings, radiographic findings, and treatment were collected and saved in an electronic medical record. ResultsThere were 19 cases of LLD overall, with 14 cases on the tibia and 5 on the femur. Three of the five femur cases occurred in the trauma subgroup. There were 15 cases of congenital LLD and five cases of traumatic LLD. The mean overall LLD was 3.9 cm (2.3-5.2). The mean follow-up until healing for the entire cohort was 10 months (5-22). Patients with congenital LLD were younger than those with traumatic LLD (10.2 years versus 22.5 years, p=0.000013), more likely to have a tibial discrepancy (p=0.034), and had a shorter time frame until full healing (7.6 months versus 19 months, p 0.00001). Patients with a tibial LLD were more likely to have a congenital etiology (p=0.0374) and had a shorter time until full healing compared to patients with a femur LLD (8.5 months versus 14 months, p=0.03541). ConclusionWe conclude that bone lengthening utilizing the unilateral external fixator is a good method and is costeffective for bone lengthening where more advanced techniques are not available or cost-prohibitive. It is simple, and patients and families can collaborate with the surgeon to get a good final result. Patients are generally satisfied and can ambulate well after healing. In a resource-limited environment with cost as a barrier, if used correctly and judiciously, the unilateral external fixator can yield good results.

The aim of this study is to evaluate the outcomes of the surgical treatment in patients with osteoporosis with moderate or severe hallux valgus regarding the correction of Hallux Valgus Angle (HVA) and Intermetatarsal Angle (IMA) compared to non-osteoporotic patients. Materials and Methods: The timeline of the study was from 2015 to 2020 with 20 patients with the mean age of 61.6±4.1 within the osteoporotic group and 63.5±5.0 within the non-osteoporotic group. 12 osteotomies in osteoporotic patients and eight osteotomies in non-osteoporotic patients were seen at follow-up after 2 years after surgery. Preoperative bone density of T-Score 2.5 SD or more below is named osteoporosis and IMA and was used to define patient groups; mild hallux valgus was defined with IMA of 11-16 degrees, moderate hallux valgus was defined with IMA from 16 to twenty degrees, and severe hallux valgus was defined with IMA from 20 degrees or more. Results: No statistical differences were found in HVA, IMA and between the osteoporotic patients and non-osteoporotic patients preoperatively, postoperatively, and therefore the final follow-up in mild to moderate hallux valgus. The mean AOFAS score ameliorated from 52.6 preoperatively to 89.1. Regarding satisfaction, ~ 83 you look after patients were very satisfied or satisfied. No evidence of complications and every one of the patients resulted with complete union of the osteotomy. Conclusion: We believed that the surgical treatment is a safe, effective procedure for the correction of elderly patients with osteoporosis. In patients with moderate and severe hallux valgus the results of osteotomy have not any specific difference between the osteoporotic and non-osteoporotic groups