Javier Del Vecchio

• MD, MBA, PhD(s)
• Unidad de Pie y Tobillo at iMove Trauma - Mi Tres Torres

Background: Percutaneous surgery is experiencing sustained growth based on third-generation techniques. This cadaveric study was designed with the main goal of exploring the risk of iatrogenic tendon and neurovascular lesions and defining the safe zones in a percutaneous, intra-articular, chevron osteotomy (PeICO) procedure, as well as assessing th...

Minimally invasive (MIS) or percutaneous surgery has evolved rapidly through the development of novel techniques with precise description, correct indications, and the incorporation of modifications of safe and effective techniques described in open surgery. The correct term to describe these procedures should be percutaneous and MIS should be rese...

Background Lateral release (LR) for the treatment of hallux valgus is a routinely performed technique, either by means of open or minimally invasive (MI) surgery. Despite this, there is no available evidence of the efficacy and safety of MI lateral release. Our aim was to study 2 popular techniques for MI LR in cadavers by subsequently dissecting t...

PurposeTreatment for hallux valgus (HV) remains challenging. Third-generation percutaneous procedures try to reproduce chevron-type osteotomies to replicate their benefits, such as intrinsic stability and reproducibility. We report the first results using a percutaneous, intra-articular, chevron osteotomy (PeICO) technique that mimics the classic i...

Background Bunionette deformity is described as a painful bony prominence on the lateral aspect of the fifth metatarsal head. The present study prospectively assessed the clinical, functional, and radiographic outcomes of sliding distal metatarsal minimally invasive osteotomy (S-DMMO) used in a large series of patients with a midterm follow-up peri...

KEY POINTS Hallux rigidus (HR) is a degenerative condition of the first metatarsophalangeal joint. The minimally invasive procedures utilized are cheilectomy, metatarsal shortening osteotomies, phalanx procedures, and arthrodesis. Some authors recommended adding an arthroscopy before or after the minimally invasive surgery cheilectomy. Decompressio...

This issue reflects MIFAS’s global interest, extensive experience, and value for the long-term results of many MIS techniques. Each article was carefully selected to cover the full range of procedures, from the hindfoot to the forefoot. This issue will undoubtedly become a reference book for every surgeon who uses minimally invasive procedures. We...

Deformities of the lesser toes are a prevalent condition faced by orthopedic surgeons. Maintaining foot biomechanics during the different gait phases preserves the development and progressive evolution of the deformities. Various mechanisms are involved in the correct function of the foot, such as the ‘windlass’ and the ‘tie-bar’ mechanisms. Intrin...

Background Combining osteotomies and soft tissue procedures is believed to reduce sesamoids in their anatomical position and maintain long-term correction when treating hallux valgus deformity. This study determines if a radiologic association exists between a radiolucent sign and a full percutaneous adductor tendon release (PATR), including a cada...

Hallux rigidus is a degenerative condition of the first metatarsophalangeal joint resulting in stiffness and pain. Surgical treatments can be divided into joint-sparing and joint-sacrificing procedures. Cheilectomy has been recommended as an isolated procedure for the treatment of low-grade hallux rigidus (I and II, even III in some articles). Firs...

Background Percutaneous metatarsophalangeal arthrodesis is an option for the treatment of hallux rigidus in more advanced cases. The aim of this study was to investigate the clinical and radiographic results at least 2 years after percutaneous metatarsophalangeal arthrodesis in patients with hallux rigidus. Methods This is a case series of consecu...

Pronation of the first metatarsal is a risk factor for the formation and progression of the hallux valgus deformity. Recently, Yamaguchi et al. published a study that showed how the round sign increases on digitally reconstructed radiography taken from a CT scan when pronation is applied. In this study, the shape of the lateral edge of the first me...

Purpose: The expression “learning curve” indicates the relation between the time needed to learn a new technique and the technique-related outcome. Percutaneous surgery (also called “minimally invasive surgery”) has experienced sustained and respectable growth, especially in forefoot deformities. The main purpose was to assess the number of feet ne...

Cryptococcus neoformans is an encapsulated, yeast-like fungus that can cause a systemic mycosis, particularly in immunocompromised patients. Disseminated infections typically affect the central nervous system, and osseous lesions are infrequent. Only 5%–10% of disseminated cryptococcosis involves bones. A 69-year-old female presented pain, swelling...

Purpose Aims of this study are to evaluate the current terminology and assess the influence of the latest proposals on the terminology used for Achilles tendon-related disorders in both daily practice and literature. Methods (1) All orthopedic surgeons experienced in the field of foot and ankle surgery of the Ankleplatform Study Group were invited...

Complete disinsertion of the Achilles tendon is relatively rare but is an injury of considerable clinical significance. A 50-year-old non-smoking man presented with complete disinsertion of the Achilles tendon due to an indirect low-energy trauma shortly after administration of local corticosteroid injections (LCI) for treatment of deep retrocalcan...

Osteotomies are commonly used in order to correct hallux valgus deformity. However, soft tissue structures also play an essential role in the etiology, progression, and treatment of hallux valgus (HV). The purpose of the present study was to analyze the correcting power (varus), reduction strength (sesamoid) and rotation of metatarsal and proximal...

Percutaneous (also called minimally invasive surgery) surgery has advanced and, nowadays, is a valid option for the treatment of hallux valgus deformities. This fact is strongly supported by different studies. Early results of the third-generation procedures seem very promising with at least comparable deformity correction and less postoperative st...

Inadvertent perioperative hypothermia is a frequent problem associated with surgical patients which can have significant consequences during surgery and in the immediate postoperative period. We compared 35 randomised patients using over vs. under body forced air heating. There were no statistically significant differences between some demographic...

In the last decade, minimally invasive or percutaneous surgery has evolved rapidly through the development of novel techniques. Treatment of hallux valgus deformity is one of the indications for percutaneous surgery, both for bony and soft tissue correction. The release of the structures on the lateral part of the first metatarsophalangeal joint (l...

We present the case of a 43-year-old boy who presented with progressive pain as a result of a history of lateral avascular necrosis of the talus secondary to traumatic open ankle luxation 20 years ago. Conservative treatment (12-month period) prior to surgery failed. It consisted of psychokinetic treatment, insoles, and analgesic medication. A diag...

Acute Achilles tendon rupture can be treated either surgically or nonsurgically. The flexor hallucis longus (FHL) has been used successfully in patients with large chronic Achilles tendon defects. The aim of this study was to describe the clinical outcomes of isolated endoscopic FHL transfer in patients with acute Achilles tendon ruptures at a mini...

Many procedures have been described for operative treatment of chronic Achilles tendon ruptures (CATR) and insertional calcificant achilles tendinosis (ICAT).This technical note describes a novel technique for the treatment or augmentation of different Achilles disorders such as CATR and ICAT, among others. A retrospective study was designed. Fifte...

Osteochondral lesions of the ankle are lesions that involve the cartilage and the subchondral bone of the talus. The aim of this study is to describe the clinical results of a consecutive case series of posterior osteochondral lesions of the talus treated with debridement and bone marrow stimulation by means of posterior ankle arthroscopy. We hypot...

Objetivo: Restaurar la estabilidad lateral del tobillo y correjir la deformidad en varo inframaleolar subyacente. Métodos: El estudio se realizó en 15 pacientes consecutivos (15 tobillos) con inestabilidad lateral crónica del tobillo y deformidad cavo-varo, a los que se realizó una reparación endoscópica del ligamento lateral del tobillo, con un Ar...

Hallux valgus is one of the most common diseases that affects the foot. The primary symptom of this disease is usually pain. Although non-operative treatment should be attempted, some patients eventually need surgical treatment. There are numerous surgical procedures for correction of HV deformities. Some of these surgeries may be performed through...

Category Bunion Introduction/Purpose Percutaneous or minimally invasive surgery (MIS) forefoot surgery has experienced a vertiginous and sustained growth especially in the last decade. This is supported by numerous studies among which can be mentioned: clinical series, comparative studies, technique reports, radiological validations. Two cadaveric...

Category Midfoot/Forefoot Introduction/Purpose Bunionette refers to painful lateral prominence at the fifth metatarsal head. For refractory cases, surgical intervention is indicated. Several operative treatments have been used to treat this deformity. Open surgery has been associated with wound healing problems, symptomatic hardware and infection....

p>Una luxación peritalar implica la disrupción simultánea de las articulaciones talocalcanea y talonavicular. Es relativamente poco frecuente y representa aproximadamente del 1% al 1,5% de todas las lesiones traumáticas del pie. Las luxaciones peritalares laterales son menos frecuentes (17%) y las posteriores (2,5%) y anteriores son raras (1%). Ap...

La cirugía percutánea del pie, también conocida como cirugía MIS (del inglés minimal incision surgery), es un método quirúrgico que permite realizar intervenciones a través de incisiones mínimas, sin exposición directa de los planos quirúrgicos. Esta técnica ocasiona un trauma mínimo de los tejidos próximos y precisa un control radiológico durante...

Bunionette, or Tailor’s bunion, refers to a painful lateral prominence at the fifth metatarsal head. Metatarsal osteotomies have proved to be a successful treatment, and have been described at the distal, diaphyseal, and proximal levels. Distal metatarsal osteotomies have been reported as effective in bunionette correction in several clinical studi...

Background: The ankle arthroscopy complication ratesfrom7.6% to 13.6% anddeepvein thrombosis (DVT) is considered as a serious complication. The risk of DVT for patients with isolated foot and ankle conditions, even with plaster cast immobilization, and the possible benefits of mechanical and chemical prophylaxis are poorly studied. Nevertheless, so...

Introduction The effects of extracorporeal shock wave therapy (ESWT) have been investigated in: human osteoblasts, fracture foci, non union and periosteum cells. The best results of non union treatment with ESWT have been documented for hypertrophic type. The objective of this study is to investigate the effects of ESWT in an atrophic non union fo...

Calciphylaxis is vasculopathy characterized by ischemia and painful skin necrosis due to calcification and intimal fibroplasia of thrombosis of the panicular arterioles. It most frequently compromises patients with terminal chronic renal failure and has a high mortality rate. Biopsy of skin lesions is used as a diagnostic method. No specific labora...

Objective: Osteochondral injuries of the ankle are relatively rare lesions that primarily involve the cartilage and subchondral bone of the talus, and are presented with a variable incidence ranging from 0.09 to 4%. The aim of our study is to show the clinical results of a consecutive case series of osteochondral lesions of Zones 7,8,9 (Raikin) of...

Objectives: Injury to the lateral ligament complex of the ankle is one of the most common sports-related injury. Usually lateral ankle evolves with excellent clinical recovery with non surgical treatment, however, near about 30% develop a lateral chronic instability sequela. Several open and arthroscopic surgical techniques have been described to t...

First metatarsal Chevron osteotomy with minimally invasive surgery. Radiological evaluation Introduction: The aim of this study was to analyze the radiological results of a roof (Chevron) osteotomy with a minimally invasive surgery technique of the first metatarsal in a uniform population of patients with moderate hallux valgus. Methods: Between Oc...

Objectives: One of the most frequent lesions related to the sports activity is the ankle lateral ligament complex lesion. Generally, this lesion resolves favorably with medical and kinesiologic treatment; however, chronic lateral instability develops as a sequela in nearly 30% of patients. Several open and arthroscopic surgery techniques have been...

Objetivo: Existen muchas técnicas descriptas en la bibliografía para reparar rupturas crónicas del tendón de Aquiles. El propósito del presente trabajo es la evaluación clínica, funcional y radiológica (RMN) en pacientes tratados quirúrgicamente con injerto autologo libre de semitendinoso y recto interno en lesiónes crónicas del tendón de Aquiles....

Introduction: Symptomatic talar osteochondral lesions are about 50% refractory to conservative treatment requiring a surgical solution. In the case of large chronic lesions, the use of bone graft taken from tissue bank is an alternative that enables to fill the defect without causing donor site morbidity. Material and methods: Eight patients tre...

Background:In Achilles tendon rupture, there is controversy asregardsthetypeofsutureandrepairtechniquetouseinearlypatientrehabilitation. Aim: Analyze the behavior of the different suturetechniques which are commonly used in Achilles tendon repaircombined with the use of braided polyblend polyester suture.Determine the best suture technique and the...

Fracture dislocations involving the Lisfranc joint are rare; they represent only 0.2% of all the fractures. There is no consensus about the surgical management of these lesions in the medical literature. However, both anatomical reduction and tarsometatarsal stabilization are essential for a good outcome. In this clinical study, five consecutive pa...

Background: Up to 44% of ankle fractures have involvement of the posterior tibial margin. Fracture size and morphology are important factors to guide treatment of these fragments, but reliability of plain radiography in estimating size is low. The aim of the current study was to evaluate the accuracy of 2-dimensional computed tomography (2DCT) in...

p> Introducción. Las fracturas distales de tibia son un desafío para el tratamiento debido a la escasa cobertura y particular vascularización. Los objetivos del presente estudio son analizar los resultados clínicos y funcionales de los pacientes con fractura de tibia distal; tratados con técnica MIPO (minimally invasive plate osteosynthesis) con pl...

Endoscopy for the posterior region of the ankle through two portals is becoming more widespread for the treatment of a large number of conditions which used to be treated with open surgery years ago. The tendon of the flexor hallucis longus (FHL) travels along an osteofibrous tunnel between the posterolateral and posteromedial tubercles of the talu...

Ankle ligament injuries are one of the most frequent lesions identified in professional soccer players. In most cases, the ligaments involved are the anterior talofibular ligament and the calcaneal fibular ligament. In the present report, we describe a professional soccer player who sustained an ankle sprain that did not respond to initial therapy....

A few studies investigating the use of structural allograft in foot and ankle surgery are available. The purpose of this study is to analyze the clinical, functional and radiological results of patients treated with non-irradiated frozen structural bone allograft. We analyzed 20 reconstructive surgeries of the hindfoot and midfoot performed between...

Charcot neuroarthropathy (CN) is considered a major complication in diabetes mellitus (DM), and it is estimated that 1% of diabetic patients may develop this complication. Simultaneous kidney-pancreas transplantation (SKPT) is one of the most effective therapies for patients with type 1 DM and end-stage diabetic nephropathy. Some cases with a Charc...

INTRODUCCIÓN La subluxación o luxación de los tendones peroneos es una patología poco frecuente, que produce generalmente dolor en la región lateral del tobillo e incapacidad para realizar actividad física. Se produce habitualmente por una flexión dorsal forzada o una inversión del tobillo forzada.

Background: Plantar fasciitis is a common condition. In cases of non-response to conservative treatment, surgery is performed. The aim of the study was to determine the risk of injury to noble structures in percutaneous surgery, and to define a safety zone.Methods: In 11 fresh cadavers, percutaneous fasciotomy was performed according to the De Prad...

Introducción: La onicocriptosis es una patología de observación común en la especialidad. Se describieron múltiples tratamientos, con resultados variados, según consta en la bibliografía. El objetivo del presente estudio es comparar los resultados clínicos-funcionales de los pacientes tratados por onicocriptosis mediante dos técnicas diferentes: co...

Introduction: Akin osteotomy is used for treatment of hallux valgus combined with metatarsal osteotomy or others joint procedures. The aim of this study is to determine the safety and effectiveness of percutaneous Akin osteotomy and and if necesary or not fixation with osteosynthesis of it. Materials and methods: A retrospective study of 78 percuta...

INVESTIGACIÓN RESUMEN Introducción: La rotura del tendón de Aquiles es una pa-tología frecuente. Si bien el tratamiento quirúrgico es el de elección, existe controversia sobre el tipo de sutura y la técnica reparadora que se debe realizar para permitir la pronta rehabilitación del paciente. El objetivo del presente estudio es analizar el comporta-m...

HALLUX FLEXUS: SURGICAL TECHNIQUE NOTE. REPORT OF TWO CASES. Hallux flexus is characterised by the flexion deformity of the first metatarso-phalangeal joint. It is an infrequent condition which is usually seen in association with other foot deformities; a number of aetiologies and therapeutic approaches have been proposed. We here report the surgic...