Weil osteotomy for the treatment of grade III hallux rigidus: a case series

Hallux rigidus (HR) is one of the most common pathologies of the forefoot. The conservative treatment is indicated for early stages, while surgical treatment is required for advanced osteoarthritis and rigidity. Surgical treatment of advanced stages of HR is still controversial and includes joint-destructive procedures such as arthrodesis and arthroplasty, Weil osteotomy for decompression of the joint space may be a safe and effective procedure for the treatment of grade III HR. Twenty-four patients that underwent Weil osteotomy for Grade III HR were retrospectively reviewed. American Orthopedic Foot and Ankle Score (AOFAS), ROM and a subjective 5-point satisfaction scale were evaluated preoperatively, at 1 year, and at a minimum follow-up of 2 years. Joint space width and metatarsal length were assessed through radiographic examination preoperatively, immediately postoperatively and at 2 years follow up. AOFAS score was 45.1±3.9 preoperatively, 84.9±6.4 at 1 year and 73.7±6.2 at two years of follow up. All patients were satisfied with the procedure at 2 years follow up. Mean ROM increased from 35.1° (range, 10°- 50°) preoperatively to 80.3° (range, 60°-90°) at 1 year. Mean dorsiflexion increased from 5° (range 0° to 10°) preoperatively to 15° (range 7° to 23°) at 1 year. Both total ROM and dorsiflexion values remained constant at 2 years. The joint space was 0.5±0.9 mm preoperatively, 2.0±1.9 mm at 1 year and 1.5±1.2 mm at 2 years. The average metatarsal shortening was 2±1.4 mm. Weil osteotomy alone can be beneficial for the treatment of patients affected by advanced HR. It can improve clinical and radiological outcomes at 2 years follow up in a series of patients affected by grade III HR. Therefore, the sliding oblique osteotomy represent a valid alternative to delay more aggressive procedures.

[Current trends and future perspectives in the therapy of the osteoporosis]

Osteoporosis is a pathology of considerable social impact for its high frequency in the elderly and for serious complications of the fragility fracture. Osteoporosis prevention requires high bone mass peak during growth age, adult and elder people must limit the bone loss by taking specific daily behavior and nutritional measures. The pharmacological treatment is based on drugs which are able to change bone metabolism, among which the bisphosphonates result to have a good efficacy with few collateral effects, the last generation (Alendronate and Risedronate) may be taken once a week. Promising for the next future is the Recombinante Parathormon, recently approved from the Food and Drug Administration for osteoporosis treatment. Leptin and l'Osteoprogerin are new experimental molecules under study able to act on the mechanism of central and local regulation of bone remodeling.

Hearing thresholds in patients affected by rheumatoid arthritis

The aim of the study was to evaluate hearing thresholds in 38 patients with rheumatoid arthritis, divided according to disease activity into active (group A, n = 20) and non-active (group B, n = 18) patients. Pure tone audiometry, tympanometry and complete rheumatological assessment were performed. All patients presented poorer auditory thresholds compared with controls. Patients of group A had both air and bone conduction thresholds poorer than group B (although not statistically significant), and most patients of both groups presented an air-bone (a-b) gap. No significant difference in middle ear pressure was noticed between patients and controls. No correlation between hearing impairment and duration of the disease or patients' age was found. The high prevalence of hearing loss in autoimmune diseases supports the importance of audiometric evaluation in such patients. The auditory recovery through middle ear surgery before cranial nerve involvement could be considered in selected patients. Further investigations are needed for a better knowledge of the middle and inner ear involvement in patients with rheumatoid arthritis.

[Effectiveness and tolerability of celecoxib in outpatient department practice]

OBJECTIVES

Object of this work is to evaluate activity and tolerance of Celecoxib in out-patient's department practice.

PATIENTS AND METHODS

In this study we enlisted 46 patients, affected by pain of inflammatory or degenerative origin; any of them ever did continued therapy with NSAIDs before. We administered 200 mg daily dose of Celecoxib for at least three months. Each patient has been evaluated by the Visual Analogic Score (VAS) Scale before and after the therapy.

RESULTS

The data We obtained agree with those of multicenter studies like CLASS. Celecoxib had similar efficacy respect with traditional NSAIDs, with good control of pain in both osteoarthrosic and arthritic pain (p < 0.000). Not good results were obtained for control of acute-onset pain. In our population We didn't find side-effects different from those included in the technical-form of the drug. The only patient who complained of epigastric pain did not stop the treatment, because the symptom resolved with assumption of the drug during meals.

CONCLUSIONS

By the analysis of the results We consider Celecoxib useful for the control of pain in the treatment of osteoarthrosis and autoimmune diseases like Rheumatoid Arthritis. Anyway, treatment with Celecoxib (as with all Coxib-family drugs) should be reserved for long-lasting treatments in patients at risk for gastrointestinal bleeding.