Long-Term results of the modified Hoffman procedure in the rheumatoid forefoot. J Bone Joint Surg Am 87: 748-752

Department of Trauma and Orthopaedics, Ninewells Hospital, Dundee DD1 9SY, United Kingdom.
The Journal of Bone and Joint Surgery (Impact Factor: 5.28). 05/2005; 87(4):748-52. DOI: 10.2106/JBJS.C.01696
Source: PubMed


Rheumatoid arthritis commonly affects the forefoot, causing metatarsalgia, hallux valgus, and deformities of the lesser toes. Various types of surgical correction have been described, including resection of the lesser-toe metatarsal heads coupled with arthrodesis of the great toe, resection arthroplasty of the proximal phalanx or metatarsal head, and metatarsal osteotomy. We report the results at an average of five and a half years following thirty-seven consecutive forefoot arthroplasties performed in twenty patients by one surgeon using a technique involving resection of all five metatarsal heads.
All patients were treated with the same technique of resection of all five metatarsal heads through three dorsal incisions. All surviving patients were asked to return for follow-up, which included subjective assessment (with use of visual analogue pain scores, AOFAS [American Orthopaedic Foot and Ankle Society] foot scores, and SF-12 [Short Form-12] mental and physical disability scores), physical examination, and radiographic evaluation.
All results were satisfactory to excellent in the short term (six weeks postoperatively), and no patient sought additional surgical treatment for the feet. A superficial infection subsequently developed in two feet, and two feet had delayed wound-healing. At an average of 64.9 months postoperatively, the average AOFAS forefoot score was 64.5 points and the average hallux valgus angle was 22.3 degrees . There were no reoperations.
Resection of all five metatarsal heads in patients with metatarsalgia and hallux valgus associated with rheumatoid arthritis can be a safe procedure that provides reasonable, if rarely complete, relief of symptoms.

1 Follower
20 Reads
  • Source

  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: GASTRIC cancer is a major concern in every country for which valid data are available. The extreme high and low incidence rates predicate environmental factors as causative agents.A study by state and by region of the ten-year average-age adjusted mortality from gastric cancer in the United States showed a definite pattern, with substantial differences from region to region.10 North Dakota, South Dakota, Minnesota, and Louisiana have unusually high death rates. Death rates for men are generally twice those for women; non-whites in the United States have higher rates than whites (Fig 1).Information on incidence of gastric cancer in 69 population groups has become available.11 The 23-year unpublished personal study of six regions in Texas—covering 4 million people— Latin, Negro, and Anglo, also is available.The range is from a low incidence of cancer among Caucasian men; 7.9/100,000 persons for El Paso, Texas, to a high incidence, 95.3/
    JAMA The Journal of the American Medical Association 05/1974; 228(7):884-886. DOI:10.1001/jama.1974.03230320048037 · 35.29 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: In this paper, we analyze design options for implementing a fuse and a plasma opening switch on the Atlas generator for applications involving radiation production from a Z pinch. Transmission line circuit models of Atlas have been developed that include physics-based electrical models for the opening switches and Z pinch. The kinetic energy of the Atlas imploding Z pinch is calculated for the various design options. The results suggest that the fuse option is inefficient. The plasma opening switch option shows promise, but has scaling issues. This work points out the importance of appropriate values for current limiting resistors when altering the Atlas circuit. These analyses are not complete, but are a starting point from which these design options can be pursued further
    Pulsed Power Conference, 1997. Digest of Technical Papers. 1997 11th IEEE International; 01/1997
Show more


20 Reads
Available from