Browsing by Author "Yercan, HS"

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    Clinical and radiological outcomes of chronic severe severe slipped capital epiphysis patients treated by surgical dislocation and modified Dunn osteotomy: Case series
    Hancioglu, S; Tosyali, HK; Erkan, S; Yercan, HS
    Objectives: This study aims to evaluate the clinical and radiological outcomes of patients with chronic severe slipped capital femoral epiphysis (SCFE) treated by surgical dislocation and modified Dunn osteotomy (MDO). Patients and methods: This retrospective study. conducted between January 2010 and December 2017. included nine patients (8 males. 1 female: mean age 12.6 years: range. 7 to 16 years) with nine hips. The degree of corrections in Southwick angle and alpha angle were measured on frog-leg views. Range of motion (ROM) of the hips was measured at each follow-up visit. Heyman and Herndon classification system and Harris Hip Score (HHS) were evaluated for clinical and functional outcomes at the latest follow-up visit. Results: The mean follow-up time was 34.8 months. Avascular necrosis complication was observed in one hip. Except two patients with lateral femoral cutaneous neuropathy, none of the patients suffered from any other complications. Mean preoperative Southwick angle of 59.1 degrees was corrected to an angle of -0.8 degrees postoperatively. Alpha angles were calculated as 44.6 degrees postoperatively. Modified Dunn osteotomy resulted in marked improvement in hip ROM in all directions and increased HHS. Conclusion: Our results encourage us to use this method in treating SCFE patients with chronic severe slips.
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    The role of hip arthroscopy in the management of osteonecrosis
    Papavasiliou, A; Yercan, HS; Koukoulias, N
    Hip arthroscopy has emerged as a diagnostic and therapeutic tool in the management of osteonecrosis (ON) of the femoral head. Direct visualization of the joint, aids the staging of the disease, while mechanical symptoms and pain can be alleviated by addressing the often coexisting intra-articular pathology (labral tears, chondral delamination, loose bodies and synovitis) thereby improving the clinical outcome in some patients. The article explores the role and possible value of hip arthroscopy as a surgical technique in the treatment of hip ON.
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    Chronic fixed-permanent lateral patellar dislocation can be successfully corrected in skeletally mature patients, with satisfactory midterm outcomes
    Teküstün, F; Tosyali, HK; Yercan, HS
    BackgroundChronic permenant lateral patellar dislocation is a rare, complex condition that affects an adult's entire lower extremity and may cause functional impairment. This study aimed to identify single-stage surgery for functional recovery in patients and to assess the radiological and functional outcomes of our technique, particularly concerning patellofemoral osteoarthrosis, at mid-term follow-up.MethodsThe study retrospectively analyzed eight patients with eleven afflicted knees who had our novel surgical method, termed the all-in-one treatment, from 2011 to 2017. The average follow-up duration was 11.3 years, with a range of 6 to 12 years. An analysis was conducted on the files of patients who satisfied the specified criteria. Data, comprising questionnaires, clinical examinations, radiographs, and functional assessments, were recorded. All patients underwent assessments of the lateral patellofemoral angle, compliance angle, Iwano classification, sulcus angle, and Wiberg-Patellar type. We classified all patients according to the Outerbridge chondromalacia classification, and conducted additional clinical assessment using the Kujala et al. patellofemoral impairment score.ResultsAll patients experienced functional improvement, with a mean preoperative Kujala score of 40.89 and a mean postoperative Kujala score of 68.3. No instances of bone nonunion, skin necrosis, or periprostatic fractures were identified in our investigation. No significant degenerative alterations were observed on tomography throughout follow-up, except in one patient who had undergone trochleoplasty. During the postoperative period, no patient experienced any instability.ConclusionOur study's primary finding is that the functional gain of knees with chronic dislocations, on which we performed our surgical approach, demonstrated a significant long-term improvement. However, further research is needed to compare single-stage and multi-stage treatments and to assess the long-term outcomes of these treatments and the associated risk of patellafemoral osteoarthritis, re-dislocation, and loss of functional gain.
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    Tibiofemoral instability in primary total knee replacement: A review, Part 1: Basic principles and classification
    Yercan, HS; Selmi, TAS; Sugun, TS; Neyret, P
    Tibiofemoral instability following total knee replacement has received little attention. However it is a cause of early and late failure and usually requires revision surgery. Several factors may be implicated including improper soft tissue balancing, flexion -extension gap mismatch and acute ligamentous injuries. Meticulous surgical technique and proper prosthetic selection at the primary procedure avoids this complication. (C) 2005 Elsevier B.V. All rights reserved.
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    Synovial hemangiohamartomas of the knee joint
    Yercan, HS; Okcu, G; Erkan, S
    Hemangioma or vascular malformation of the synovium is rare and presents a difficult problem in diagnosis and treatment. A long history of joint pain and recurrent non-traumatic hemarthrosis usually draws attention to the hemangioma of the knee joint. The lesion can be seen in two different formations; the synovial hemangioma or the arteriovenous malformation named as hemangiohamartomas, both of which involve the synovium and cause non-traumatic episodes of hemarthrosis. MRI scanning together with arthroscopy is a diagnostic tool to demonstrate the extent and the nature of the lesion. We treated the three patients at different ages. All patients underwent standard radiographic examination, CT scans, MRI and diagnostic arthroscopy. After frozen section taken via arthroscopically, the lesions were excised by arthrotomy. The mean follow-up was 38 months (31-45) and all patients are asymptomatic postoperatively. Three additional cases and a review of the literature are presented because of the rarity of the lesion.
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    A novel technique for reconstruction of the medial patellofemoral ligament in skeletally immature patients
    Yercan, HS; Erkan, S; Okcu, G; Özalp, RT
    Habitual or recurrent dislocation of the patella in the skeletally immature patient is a particularly demanding problem since the etiology is frequently multifactorial. The surgical techniques successfully performed in adults with patellar instability may risk injury to an open growth plate if applied to children. We present a technique that preserves femoral and patellar insertion anatomy of medial patellofemoral ligament (MPFL) using a free semitendinosus autograft together with tenodesis to the adductor magnus tendon without damaging open physis on the patellar attachment of MPFL. A 3-cm long longitudinal skin incision is performed 10 mm distal to the tibial tuberosity on the anteromedial side. The semitendinosus tendon is harvested with the stripper. The semitendinosus tendon is placed on a preparation board and cleaned of muscle tissue. The usable part of the tendon should be at least 20 cm long and 4 mm wide. The two free ends of the graft are sutured with Krakow technique. A medial longitudinal incision 2 cm in length is made to expose the MPFL and to abrade the patellar attachment of vastus medialis obliquus. The first patellar tunnel is created with 4.5 mm drill at the mid aspect of the medial patella in the anteroposterior and proximal-distal direction. The drill hole is formed parallel to the articular surface of the center of the patella. The second tunnel is created with 3.2 mm drill and the entry point is localized at the center of the patella. These two tunnels intersect to form a single tunnel. The semitendinosus autograft is run through the bone tunnel in the patella. Double-stranded semitendinosus autograft is placed in the presynovial fatty plane between the second and the third layer of the medial retinaculum, and tenodesis to adductor magnus tendon is applied by a moderate medial force with the knee flexed at 30A degrees. Aftercare includes immobilization of the joint limited to 30A degrees flexion using an above-knee splint for 2 weeks. No recurrent dislocation was observed in three patients (4 knees) at a mean follow-up time of 17.7 months. Both range of motion and radiological finding were restored to normal limits.
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    Evaluation of injection techniques in the treatment of lateral epicondylitis: a prospective randomized clinical trial
    Okçu, G; Erkan, S; Sentürk, M; Özalp, RT; Yercan, HS
    Objective: We aimed to compare the efficacy of two different injection techniques of local corticosteroid and local anesthetic in the management of lateral epicondylitis. Methods: This prospective study followed 80 consecutive patients who were diagnosed with lateral epicondylitis at our hospital outpatient clinic between 2005 and 2006. Patients were randomly assigned into two equal groups. Group 1 received a single injection of 1 ml betamethasone and 1 ml prilocaine on the lateral epicondyle at the point of maximum tenderness. Group 2 patients received an injection of the same drug mixture. Following the initial injection, the needle tip was redirected and reinserted down the bone approximately 30 to 40 times without emerging from the skin, creating a hematoma. Patients were evaluated with the Turkish version of the Disabilities of the Arm, Shoulder and Hand questionnaire before injection and at the final follow-up. The unpaired t-test and chi-square tests were used to compare results. Results: Sixteen patients in Group 1 and 15 patients in Group 2 were lost during follow-up. The average follow-up period of the remaining 49 patients was 21.6 months. There were no significant differences between the two groups with regard to gender, age, follow-up period, symptom duration, involvement side and number of dominant limbs. The Turkish DASH scores of Group 2 were significantly lower than those of Group 1 (p=0.017). Conclusion: Long-term clinical success in the treatment of lateral epicondylitis depends on the injection method. The peppering technique appears to be more effective than the single injection technique in the long-term.
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    Is it possible to decrease skin temperature with ice packs under casts and bandages? A cross-sectional, randomized trial on normal and swollen ankles
    Okcu, G; Yercan, HS
    Introduction There is a general belief that the presence of a cast or a bandage eliminates the lowering effects of skin temperature when local cold therapy applied on the surface of the cast or bandage. The purpose of this study is to determine the magnitude of temperature changes at the skin of the ankle after the application of frozen ice packs to the surface of various casts and bandages both in normal and swollen ankles. Materials and Methods Thirty-two healthy subjects (Group A) and 12 patients with Grade III inversion type acute ankle sprain (Group B) were randomly divided into four groups. The sensor of the digital thermometer was secured to the ankle over the anterior talo-fibular ligament in every subject before placement of a bandage or cast. Robert Jones bandage, elastic support bandage, a below-knee plaster cast and synthetic below-knee cast were applied in groups 1, 2, 3 and 4, respectively. Two frozen ice packs were placed around the cast or bandage at the level of sensor, and skin temperatures were recorded. Results The skin temperature under dressings and casts decreased significantly relative to the baseline temperatures with local cold therapy in all groups. The fall in the temperature with cryotherapy in group A showed a three-phase pattern of change between groups 1 and 2, groups 2 and 3 and groups 2 and 4 during the experiment. The fall in the skin temperature with ice packs differed significantly between groups 1 and 3, and also groups 1 and 4 from the beginning till the end of the experiment. There was no significant difference between groups 3 and 4 in terms of skin temperature fall with cryotherapy during the whole experiment. The results were similar in group B. Conclusion A bandage or cast does not prevent measurable skin temperature lowering by frozen ice packs both in normal and swollen ankles.
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    An unusual rotational injury: pantibial ligamentous injury
    Yercan, HS; Okcu, G; Erkan, S; Ozic, U
    Pantibial ligamentous injury including knee dislocation and tibiotalar joint subluxation is an uncommon severe rotational injury. A 21-year-old male injured his right knee falling from a motorcycle. Physical examination revealed effusion on the right knee and ankle, and posterior translation of the tibia as well. The MRI of the right knee and ankle demonstrated the following findings: a complete disruption of cruciate ligaments, the medial collateral ligament, posteromedial corner injury together with a peripheric tear in the medial meniscus, the ruptured deltoid ligament, ankle syndesmosis space widening (> 5 mm) and lateral subluxation of talus. Deltoid ligament of the right ankle was repaired and ankle syndesmosis was fixed with a cortical screw. The PCL and ACL were reconstructed arthroscopically with autogeneous bone-patellar tendon-bone graft. The midsubstance tear of MCL, posteromedial corner and medial meniscus tear were primarily repaired with nonabsorbable sutures. 3 years after the surgery, the patient was called for the final examination. MRI and X-ray findings of the knee and ankle joint demonstrated the continuity of ACL, PCL, MCL, and deltoid ligament. The patient, who is a farmer, can go back to his job and perform his daily activities. We presented a previously unreported case that involves both simultaneous occurrence of knee dislocation and tibiotalar joint subluxation. We used the term Pantibial ligamentous injury for this case.
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    The influence of sagittal cervical profile, gender and age on the thoracic kyphosis
    Erkan, S; Yercan, HS; Okcu, G; Özalp, RT
    The objective of this prospective consecutive cohort study was to investigate the effect of sagittal cervical profile, gender and age on the thoracic kyphosis in 228 subjects, mainly adults, free of spinal complaints and with a thoracic kyphosis of less than 50 degrees. The subjects, who were actually treated for lower extremity problems, were divided into two groups : the 68 subjects in group 1 (30%) had loss of cervical lordosis, while the 160 subjects in group 2 (70%) had a physiological cervical lordosis. In group 1 (loss of cervical lordosis) the mean angles of the upper (T1T6), lower (T7T12), and whole (T1T12) thoracic kyphosis were 8 degrees +/- 2 (range : 3-28 degrees), 15 degrees +/- 4 (range : 6-40 degrees), and 24 degrees +/- 6 (range : 10-46 degrees), respectively. In group 2 the normal cervical lordosis seemed to lead to a compensatory increase in these values : 13 degrees +/- 4 (range, 4-35 degrees) (p = 0.008), 21 degrees +/- 5 (range : 6-45 degrees) (p = 0.012), and 34 degrees +/- 8 (range : 12-50 degrees) (p = 0.007). In both groups gender had no significant effect on the values of the thoracic kyphosis (p > 0.05). Also age had no influence, neither in group 1 nor in group 2 as a whole, but in group 2 advanced age (>50 years) was correlated with a significant increase in the lower (T7T12) (p = 0.009) and whole (T1T12) thoracic kyphosis (p = 0.007). This study yields standards for reference for the normal curvatures of the spine in the sagittal plane. The literature is quite controversial on this matter.
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    The incidence and location of corona mortis - A study on 75 cadavers
    Okcu, G; Erkan, S; Yercan, HS; Ozic, U
    We dissected 150 fresh cadaver halves by ilioinguinal exposure, and counted all vessels more than 2 mm in diameter, connecting the obturator system to the external iliac system. The distance between the symphysis pubis and the anastomotic vessels was measured. We found vascular anastomoses between the obturator and external iliac systems in 91 of 150 sides (61%), and anastomotic veins in 78 of 150 exposures (52%). Arterial connections were seen in 29 of the exposures (19%). The mean distance between the anastomotic arteries and the symphysis pubis was 64 (45-90) mm, and 56 (37-80) mm for the communicating veins. There seemed to be no significant difference between genders in the incidence of corona mortis and the distance between communicating vessels and the symphysis pubis.
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    The treatment of Kienbock disease with vascularized bone graft from dorsal radius
    Özalp, T; Yercan, HS; Okçu, G
    Numerous surgical treatment options are proposed for the Kienbock disease but there has not been a consensus on the most appropriate method yet. The aim of this study is to present our experience and preliminary results of the use of vascularized bone graft from dorsal radius. Second and third intercompartmental supraretinacular artery pedicled bone graft has been used to treat 11 patients with Kienbock disease between 2001 and 2006. The average follow-up period was 37 months (range 19-77 months). Pre- and post-operative range of motion, pain and grip strength, radiologic parameters such as carpal height ratio, Stahl index and scapholunate angle were evaluated. Eleven patients were composed of two stage II, one stage IIIA and eight stage IIIB patients according to Lichtmann classification. At the end of the observation period, five excellent, four good, one fair and one poor results were observed. There were no or little changes in carpal height ratio and Stahl index. Pain has diminished considerably. We believe that the treatment of Kienbock disease with vascularized bone graft from the dorsum of the radius has encouraging results and need no other additional procedures.
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    Reconstruction of diabetic foot ulcers by lateral supramalleolar flap
    Yercan, HS; Ozalp, T; Okcu, G
    Objective: To report a series of 8 diabetic patients in whom the reconstruction of large-sized defect of the foot was performed using lateral supramalleolar flap. Methods: Coverage of the soft tissue defect was carried out by a lateral supramalleolar flap in 8 patients who had large-sized, non-healing ulcers at the Celal Bayax University, Department of Orthopedics and Traumatology, Manisa, Turkey, between 1998-2003. The mean age was 54 years. Preoperatively Doppler flowmeter evaluation was performed, and the ischemic index was calculated in all patients. Results: The flaps survived except for one patient who had a large defect on the heel with low ischemic index. The average healing time of the ulcer region and recovery of regular walking status was 34 days. The average healing period of the donor site was 35 days. After the average follow-up period of 40 months, neither infection nor a recurrence of the ulcer was encountered. The major problem of the donor area was skin graft breakdown and its non-aesthetic appearance due to hypertrophic granulation tissue. Conclusion: The lateral supramalleolar flap is a reliable option for the reconstruction of large-sized diabetic ulcers involving the dorsal aspect of the foot. This can also be used in conjunction with local muscle flaps, such as abductor hallucis for covering deep and large heel defects when the sural neurocutaneous flap is contraindicated.
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    Arthroscopic removal of the osteoid osteoma on the neck of the talus
    Yercan, HS; Okcu, G; Ozalp, T; Osiç, U
    Juxta-articular osteoid osteomas arising around the ankle are unusual. Tumors arising on the neck of the talus will commonly produce symptoms mimicking monoarticular arthritis or trauma. Patients are usually treated for arthritis or ankle sprain, which often leads to a delay in definitive diagnosis. We present an arthroscopic removal of an osteoid osteoma on the neck of talus, and review the literature.
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    Does timing matter in performing kyphoplasty ? Acute versus chronic compression fractures
    Erkan, S; Özalp, TR; Yercan, HS; Okcu, G
    The objective of this prospective consecutive cohort study was to compare the clinical outcomes, the radiographic outcomes and the complication rates of symptomatic acute (< 10 weeks) and chronic (> 16 weeks) osteoporotic vertebral compression fractures (VCFs) treated with kyphoplasty. Twenty-eight consecutive patients had 52 symptomatic osteoporotic VCFs treated with kyphoplasty; 5 of these patients were treated in two sessions. The Oswestry Disability Index (0131) for back pain, a Visual Analog Scale for pain assessment, a patients' satisfaction scale, and medication usage served to evaluate the clinical outcomes. All these variables improved significantly in both groups, and more so in the acute group, but the difference was most often not significant. Vertebral height, local kyphosis angle, global sagittal alignment and dynamic fracture mobility significantly improved in both groups (except global sagittal alignment), and again more so in the acute group (except global sagittal alignment); the difference between groups was significant regarding radiological variables, except global sagittal alignment. Timing of kyphoplasty certainly matters, as the clinical and radiological outcomes were mostly better in acute fractures than in chronic fractures, which somehow responded satisfactorily. Controlled studies (kyphoplasty versus natural history) are needed to establish the real value of the procedure.
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    Closed reduction and casting versus Kapandji technique for the treatment of Colles fractures
    Vural, Ö; Okçu, G; Özalp, RT; Akkaya, MG; Yercan, HS
    Objectives To compare the outcome of closed reduction and cast immobilization with Kapandji method for the treatment of the Colles fractures. Patients and methods Between 2003-2006, 33 patients with 33 Colles fractures that referred and followed in the Orthopaedics and Traumatology department or emergency service were included into the study. The patients were randomly allocated into the closed reduction and cast immobilization and Kapandji method groups. Radiological and clinical results were evaluated. Nine patients were male, twenty-four were female and the mean age was 51.9 years (23-76). The mean follow up period was 14 months (6-30). Results There were 14 patients treated with the Kapandji method. The functional outcome was good or excellent in %85.7 of these patients according to the Gartland-Werley evaluation score. There were 19 patients treated with closed reduction and casting. The functional outcome was good or excellent in %94.7 of them. There were no significant difference between the two treatment groups (p=0,971). In radiological evaluation, the palmar inclination angle was found to be preserved much more better in the Kapandji group than the closed reduction and cast immobilization group (p=0,003). There were no significant difference between two groups according to the radial length (p=0,524) and radial inclination angle (p=0,594). Conclusion Closed reduction and cast immobilization is an effective treatment method in Colles fractures. In spite of the need for fluoroscopic examination, Kapandji method is an easily applicable treatment modality with very low cost and morbidity. As the functional results are similar, Kapandji method is a reliable option for older patients who refuse cast immobilization or noncompliable with casting.
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    Factors causing stiff knee after total knee arthroplasty
    Erkan, S; Yercan, HS; Okcu, G; Özalp, RT
    Objectives: In this study, the factors causing stiff knee after primary total knee arthroplasty (TKA) in patients with medial compartment osteoarthrosis were evaluated. Patients and methods: Primary TKA surgery was performed in fifty-three knees in 48 patients (42 females, 6 males; mean age 67.2 +/- 8.5; range 59 to 76 years) diagnosed with medial compartment osteoarthrosis. Five patients (10%) out of forty-eight underwent bilateral primary TKA. In the patients who had bilateral TKA, the second operation was performed six months later. Patello-femoral arthroplasty was performed in none of the patients. In the final follow-up, the knees, which had more than 10 degrees of extension limitation and less than 95 degrees of flexion, were defined as post-TKA stiff knee. The patients who developed stiff knee were classified as group 1 and the patients who did not develop stiff knee were classified as group 2. The possible factors that may cause stiff knee after TKA such as age, gender, range of knee flexion and extension, flexion arc, tibiofemoral angle, tibial slope angle, the change in the height of the joint line, the length of the patellar tendon, the change in the American Knee Society scores, body mass index, and the sizes and positions of the components were evaluated and compared pre- and postoperatively within and between both groups. Results: Stiff knee was found in eight knees of six patients (16%) after TKA. In group 1, the mean extension range was 14.9 degrees +/- 4.6 degrees and the mean flexion range was 82.6 degrees +/- 7.4 degrees. In group 1, among the factors that may cause knee stiffness; preoperative flexion range and American Knee Society scores were found to be significant (p=0.028 and p=0.036, respectively). The American Knee Society scores were observed to be significantly lower in group 1 when compared to group 2 postoperatively (p=0.018). Conclusion: If the preoperative flexion range is limited and the American Knee Society scores are low, then the stiff knee is more likely to occur in patients who will undergo TKA. Age, gender, tibiofemoral angle, tibial slope angle, the change in the height of the joint line, the length of the patellar tendon, and the sizes and positions of the components have no significant effect on the development of stiff knee after TKA.
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    A pediatric case of pyomyositis presenting with septic pulmonary emboli
    Yuksel, H; Yimaz, O; Orguc, S; Yercan, HS; Aydogan, D
    Pyomyositis is a suppurative infection of skeletal muscle most commonly caused by Staphylococcus aureus. It is mainly encountered in children and immunocompromised. Eight year old previously healthy girl presented with confusion, fever and swelling of the right knee two days after a trauma. Abdominal ultrasonography and computerized tomography taken upon development of hematemesis revealed no pathology in the abdomen, but potential bleeding sites in lung sections. Thorax CT images were interpreted in favor of septic pulmonary emboli due to the presence of peripheral nodular consolidation areas with central cavitation, mostly pathchy in medial areas. S. aureus was isolated in the blood culture. At the end of third week of hospitalization, gadolinium enhanced contrast MRI of right extremity was taken to evaluate right extremity swelling and revealed abcess formation as expected in the clinical progress of pyomyositis. Pyomyositis and septic pulmonary emboli are a rare association. This case demonstrates that the high index of suspicion in pediatric cases with muscle findings and septic pulmonary findings and early institution of therapy may improve the prognosis. (c) 2007 Elsevier Masson SAS. All rights reserved.
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    The clinical and radiographic results of closed wedge proximal metatarsal osteotomy for the treatment of hallux valgus
    Erkan, S; Yercan, HS; Okcu, G
    Objectives: We evaluated the clinical and radiographic results of closed wedge proximal metatarsal osteotomy (PMO) for the treatment of hallux valgus. Patients and methods: Fourteen patients (12 females, 2 males; mean age 42 years; range 18 to 62 years) underwent closed wedge PMO for hallux valgus in 16 feet. Bilateral cases were treated with a three-month interval. For fixation, Kirschner wires were used in 12 feet, and mini cortical screws in four feet. Radiographic measurements included hallux valgus angle, intermetatarsal angle, distal metatarsal articular angle, congruency angle, and the length of the first metatarsal bone on anteroposterior radiographs, and the angle between first metatarsal bone and diaphysis of the first proximal phalanx on lateral radiographs. Clinical results were evaluated using the AOFAS scoring system. The mean follow-up was 36 months (range 7 to 80 months). Results: Union was obtained in a mean of seven weeks. The following decreases were seen postoperatively: hallux valgus angle by 22 degrees, intermetatarsal angle by 7, distal metatarsal articular angle by 7, congruency angle by 11 degrees, the length of the first metatarsal bone by 6 mm, and the angle between first metatarsal bone and diaphysis of the first proximal phalanx by 6 degrees. The mean AOFAS score increased by 46 points. Postoperative changes in the congruency angle and the length of the first metatarsal bone were significant (p < 0.05). Increase in the AOFAS score was significant in patients in whom the length of the first metatarsal bone decreased by less than 3 mm (9 feet) and in those in whom the congruency angle was smaller than 8 degrees (9 feet) (p < 0.05). Conclusion: Preoperative planning is of particular importance for hallux valgus surgery. It should be considered that closed wedge PMO may result in undesirable shortness particularly in advanced cases.