scholarly journals The Effect of “High-ankle Sprain” Taping on Ankle Syndesmosis Congruity: A Cadaveric Study

2020 ◽  
Vol 13 (1) ◽  
pp. 123-128
Author(s):  
Stéphanie Lamer ◽  
Jonah Hébert-Davies ◽  
Vincent Dubé ◽  
Stéphane Leduc ◽  
Émilie Sandman ◽  
...  
Keyword(s):  
Ankle Sprain ◽  
Weight Bearing ◽  
Axial Loading ◽  
Cadaveric Study ◽  
P Value ◽  
Level Of Evidence ◽  
Parametric Data ◽  
Custom Made ◽  
Significant Difference ◽  
High Ankle Sprain

Background: Different treatment options exist for dynamically unstable purely ligamentous syndesmotic injury, including surgery, walking boot, brace and taping. Objective: The main purpose of this study was to evaluate the effect of high-ankle sprain taping (ring taping) on syndesmotic stability in various ligament conditions when axial loading is applied. Methods: This controlled cadaveric laboratory study included ten cadaveric specimens installed in a custom-made device applying 750N of axial loading in order to simulate weight-bearing. Sectioning of syndesmotic ligaments, AiTFL and IOL, was done sequentially and CT scan images were taken with and without high-ankle sprain taping. A validated measurement system consisting of 3 lengths and 1 angle was used. Results were compared with Wilcoxon tests for paired samples and non-parametric data. Results: In every ligament condition (intact vs. cut), no statistically significant difference was observed between specimens, with or without high-ankle sprain taping and with or without axial loading. When the data from ankles with AiTFL and IOL ruptures were compared, the mean for length “b” without axial loading was 7.19 (±2.17), compared to 7.20 (±1.98) with axial loading (p-value = 0.905). With taping and the leg still in axial loading, the value was 7.17 (±2.09) (p-value = 0.721), which is not statistically significant. Conclusion: It is impossible to conclude regarding high-ankle sprain taping’s capacity to maintain syndesmosis congruity because no significant difference was observed, regardless of condition. The most important finding is that high-ankle sprain taping did not cause malreduction of the injured syndesmosis. Level of Evidence: Level V cadaveric study

scholarly journals Effect of CAM boot immobilization on weightbearing stability in syndesmotic injuries

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0030
Author(s):  
Stéphanie Lamer ◽  
Vincent Dube ◽  
Jonah Hebert-Davies ◽  
Leduc Stephane ◽  
Jeremie Menard ◽  
...  
Keyword(s):  
Internal Rotation ◽  
Weight Bearing ◽  
Axial Loading ◽  
Nonoperative Treatment ◽  
Ankle Injuries ◽  
Ligament Injury ◽  
Ankle Motion ◽  
Parametric Data ◽  
Custom Made ◽  
Significant Difference

Category: Trauma Introduction/Purpose: Ankle injuries are one of the most frequent traumas of the lower limb. They typically involve the lower lateral ligaments of the ankle, but the syndesmosis is also affected in up to 18% of cases. The degree of instability of syndesmotic joint depends on which ligaments are affected. Adequate management of syndesmotic injuries is crucial to avoid long term complications. The primary goal of our study was to evaluate the effect of simulated weightbearing on syndesmotic instability resulting from isolated AiTFL injury and from combined AiTFL/IOL injuries. The secondary goal was to evaluate the effect of a controlled ankle motion walking boot on syndesmosis stability following injury. We hypothesized that the CAM boot would prevent significant instability even in two ligaments injuries. Methods: Ten cadaveric specimens were dissected to expose the syndesmosis to create progressive iatrogenic syndesmosis ruptures. Uninjured syndesmoses were compared to isolated AiTFL and combined AiTFL/IOL ruptures. The specimens were fitted in a custom-made device to allow stabilization of the leg and apply a reproducible axial load (AL) of 750 N, equivalent to the weight of a 168-pound person. For each specimen and injury pattern, CT-scan images were obtained with and without AL, and with a CAM boot under AL. Distal tibio-fibular relationship was evaluated in three planes using a previously validated measurement system developed on CT. Wilcoxon tests for paired samples and non-parametric data were done to compare the different conditions. Results: For our first objective, when comparing ankles with isolated AiTFL to combined AiTFL/IOL rupture with and without AL, the only significant difference was an increase in internal rotation between the incisura and a line drawn in the axis of the fibula. Even with minimal statistical differences, it appears that axial loading does not impact syndesmotic stability apart from a slight increase in internal rotation with a single or two-ligament injury. As for our second end point, with the CAM orthopedic boot, no significant widening of the syndesmosis happened when either one or both ligaments were sectioned, in an axial loading state. We therefore confirmed our hypothesis that even with two syndesmotic ligament injuries, axial loading in a CAM boot does not affect distal tibio-fibular anatomy. Conclusion: This study reveals that weight bearing without rotational force does not affect the stability of the syndesmosis. Incomplete syndesmotic injuries can likely be treated with nonoperative treatment in a CAM boot and weight bearing as tolerated. Further clinical studies are needed to confirm these findings.

Müller-Weiss Disease: The Descriptive Factors of Failure Conservative Treatment

2021 ◽  
pp. 107110072110028
Author(s):  
Thos Harnroongroj ◽  
Theerawoot Tharmviboonsri ◽  
Bavornrit Chuckpaiwong
Keyword(s):  
Regression Analysis ◽  
Conservative Treatment ◽  
Demographic Characteristics ◽  
Classification Systems ◽  
Clinical Severity ◽  
P Value ◽  
Level Of Evidence ◽  
Factors Associated ◽  
Radiographic Parameters ◽  
Significant Difference

Background: Conservative treatment is the first-line approach for Müller-Weiss disease (MWD). However, factors associated with the failure of conservative treatment have never been reported. Our objectives were to compare the differences in demographic and radiographic parameters between “successful” and “failure” conservative treatment in patients with MWD and identify descriptive factors associated with failure conservative treatment. Methods: We retrospectively reviewed 68 patients with MWD divided into 29 “failure” and 39 “successful” conservative treatment groups. Demographic characteristics, Foot and Ankle Outcome Score (FAOS), visual analog scale (VAS) scores for pain and walking disability, and radiographic parameters such as calcaneal pitch, lateral Meary, anteroposterior (AP) Meary angle, and talonavicular-naviculocuneiform arthritis were compared. Logistic regression analysis was performed to identify descriptive factors of failure conservative treatment. A P value <.05 was considered a statistically significant difference. Results: We found more severe VAS pain and walking disability scores and FAOS for the pain, activities of daily living, and quality of life subscales in the failure group ( P < .05). Regression analysis demonstrated 2 significant descriptive factors associated with failure conservative treatment: abducted AP Meary angle >13.0 degrees and radiographic talonavicular arthritis. No demographic characteristics were found to be associated with failure conservative treatment. Conclusion: Midfoot abduction (AP Meary angle, >13 degrees) and radiographic talonavicular arthritis were factors associated with failure conservative treatment in MWD and should be determined concurrently with the clinical severity. Classification systems for MWD should include these factors. Level of evidence: Level III, retrospective comparative study.

scholarly journals Radiographic Recurrence of Hallux Valgus Based on Osteotomy Location

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0021
Author(s):  
Andrew Federer ◽  
Travis Dekker ◽  
David Tainter ◽  
Jordan Liles ◽  
Mark Easley ◽  
...  
Keyword(s):  
Hallux Valgus ◽  
Weight Bearing ◽  
Surgical Correction ◽  
P Value ◽  
Single Individual ◽  
Hallux Valgus Angle ◽  
Intermetatarsal Angle ◽  
Valgus Angle ◽  
Significant Difference

Category: Bunion Introduction/Purpose: Hallux valgus (HV) is one of the most common deformities of the foot resulting in pain and lifestyle modification of the patient. Recurrence rates of 10-47% have been documented in single individual osteotomy series. Unfortunately, surgical correction and recurrence are often defined as changes related to normal radiographs and not actually as the magnitude of correction lost with follow-up. Currently there have not been studies evaluating the percentage of recurrence of intermetatarsal angle (IMA) and hallux valgus angle (HVA). As there is substantial difference in starting IMA and HVA, as well as amount of surgical correction, our goal was to evaluate the percentage loss of correction over time comparing preoperative, initial postoperative and minimum of 2-year follow up radiographs among three different surgical correction techniques. Methods: This is a retrospective chart review study that examines the weight-bearing radiographic measurements of patients undergoing hallux valgus corrective surgery at a single institution over 5 years. Fifty-three patients were divided into first tarsometatarsal arthrodesis (i.e. Lapidus), mid-diaphyseal osteotomies (i.e. scarf), and distal metatarsal osteotomies (i.e. chevron). The preoperative, initial postoperative, and final follow up weight-bearing radiographs were measured for intermetatarsal angle (IMA) and hallux valgus angle (HVA). Primary outcome was percentage of recurrence of IMA and HVA, with the difference in angles between preoperative and initial postoperative weight-bearing films being considered 100% correction. The percentage of recurrence between initial postoperative and most recent follow up was then calculated (Figure 1A). A one-way analysis of variance (ANOVA) test and post-hoc Tukey-Kramer tests were used to compare preoperative IMA and HVA and percentage recurrence of IMA and HVA at most recent follow up. Results: There was no significant difference between Lapidus (14.3deg) and mid-diaphyseal osteotomies (12.7deg) in preoperative IMA (p-value=0.26). There was a significant difference between Lapidus (-0.3deg) and mid-diaphyseal (2.8deg) osteotomies for degree of hallux valgus recurrence as measured by IMA between initial postoperative films and final 2-year follow up (p-value=0.009). Lapidus procedure showed a greater magnitude decrease in IMA degrees from preoperation to final follow up compared to distal osteotomy (p-value=0.037) and trended toward significance compared to mid-diaphyseal (p-value=0.056). Mid-diaphyseal osteotomies (30%) showed a statistically significant higher percentage of IMA recurrence compared to Lapidus (-11%) (p-value=0.0014) (Figure 1B). When comparing percentage recurrence of HVA, distal osteotomies had a significantly smaller rate of recurrence when compared to the diaphyseal osteotomies (p-value=0.030). Conclusion: Though Lapidus and mid-diaphyseal osteotomies were performed for patients with a similar preoperative IMA, mid-diaphyseal osteotomies had a significantly higher percentage of recurrence at 2-year follow up compared to Lapidus procedures. Moreover, Lapidus procedures trended toward greater overall of IMA correction compared to mid-diaphyseal osteotomies. When either a Lapidus or mid-diaphyseal osteotomy is indicated, a Lapidus procedure may result in decreased rate of radiographic recurrence of hallux valgus at 2 years.

scholarly journals Ceramic Artificial Talus as the Initial Treatment for Comminuted Talar Fractures

2019 ◽  
Vol 41 (1) ◽  
pp. 79-83 ◽  
Author(s):  
Ryuhei Katsui ◽  
Yoshinori Takakura ◽  
Akira Taniguchi ◽  
Yasuhito Tanaka
Keyword(s):  
Range Of Motion ◽  
Initial Treatment ◽  
Weight Bearing ◽  
High Energy ◽  
Level Of Evidence ◽  
Custom Made ◽  
Sport Activities ◽  
Talar Fractures ◽  
American Orthopaedic ◽  
Retrospective Comparative Study

Background: Comminuted talar fractures are rare. Generally, this fracture occurs as a result of high-energy injuries. Therefore, this operation is challenging for the surgeon. We started to replace the whole talus with a total talar prosthesis in cases of aseptic talar necrosis in 2005. Based on these results, replacement with a ceramic artificial talus was performed as the initial treatment for comminuted talar fractures. Methods: From 2009 to 2016, a total of 6 feet of 6 patients with comminuted talar dome fractures or talar body defects were replaced with a ceramic artificial talus. The patients’ mean age was 40.3 years (range, 19-59). Postoperative assessments were performed in accordance with the American Orthopaedic Foot & Ankle Society (AOFAS) ankle/hindfoot score system. Postoperative range of motion and sports activities were also evaluated. Follow-up ranged from 12 to 84 (mean, 46.8) months. Results: The postoperative AOFAS score was on average 78.8 (64-100). The postoperative range of motion was on average 10 degrees (5-20) for dorsiflexion and 31 degrees (15-50) for plantarflexion. Three patients had returned to sport activities. Conclusion: Prosthetic total talar replacement was a useful procedure for patients with comminuted talar fractures, which had good congruency of the custom-made implant with the adjacent joints, resulting in stability, and maintained ankle function. Furthermore, this procedure could prevent the complications of long-term external fixation and non-weight-bearing walking seen after open reduction and arthrodesis. Level of Evidence: Level IV, retrospective comparative study.

scholarly journals Ultrasound-Guided Aspiration Does Not Reduce the Recurrence Rate of Ganglion Cysts of the Wrist

2018 ◽  
Vol 08 (02) ◽  
pp. 100-103 ◽  
Author(s):  
Gregory Kurkis ◽  
Albert Anastasio ◽  
Marijke DeVos ◽  
Michael Gottschalk
Keyword(s):  
Recurrence Rate ◽  
Ultrasound Guidance ◽  
Ganglion Cyst ◽  
High Recurrence Rate ◽  
P Value ◽  
Ultrasound Guided ◽  
Recurrence Rates ◽  
Level Of Evidence ◽  
Ganglion Cysts ◽  
Significant Difference

Background Ganglion cysts are the most frequent soft tissue tumor encountered in the upper extremity and are commonly treated by aspiration or by surgical excision. Ultrasound is a promising addition to traditional aspiration, as it allows for visualization of the needle within the ganglion before aspiration. Questions Are ganglion cysts of the wrist less likely to reoccur if they are aspirated under ultrasound guidance versus “blind” aspiration without the use of ultrasound guidance? Does patient functionality change based on whether or not the cyst recurred? Patients and Methods In total, 52 patients were successfully contacted and recurrence rates were compared between those whose cyst was treated with ultrasound-guided (13 patients) with those whose cyst was treated with blind aspiration (39 patients). Mean follow-up time was 2.9 years. Results Recurrence rates were 69% (9 patients) and 74% (29 patients) for the ultrasound-guided and blind aspiration groups, respectively (p-value: 0.73), showing no significant difference in recurrences of wrist ganglion between the two groups. A metric of functionality (Quick–DASH [Disabilities of the Arm, Shoulder, and Hand]) revealed worse outcomes in patients who experienced return of ganglion cyst after aspiration versus those who did not. Conclusion Additional studies with improved sample sizes are needed to demonstrate the superiority of ultrasound-guided aspiration versus blind aspiration. Due to a high recurrence rate following aspiration (both ultrasound-guided and blinded), a lower threshold for surgical intervention is likely reasonable. Level of Evidence This is a Level IIIb study.

Effects of Inversion Perturbation After Step-Down on the Latency of the Peroneus Longus and Peroneus Brevis

2011 ◽  
Vol 27 (4) ◽  
pp. 283-290 ◽  
Author(s):  
Adam C. Knight ◽  
Wendi H. Weimar
Keyword(s):  
Ankle Sprain ◽  
Ankle Sprains ◽  
Lateral Ankle Sprain ◽  
Lateral Ankle ◽  
Peroneus Longus ◽  
Significant Difference ◽  
History Of ◽  
Step Down ◽  
Peroneus Brevis ◽  
High Ankle Sprain

The purpose of this investigation was to determine the effect of different types of ankle sprains on the response latency of the peroneus longus and peroneus brevis to an inversion perturbation, as well as the time to complete the perturbation (time to maximum inversion). To create a forced inversion moment of the ankle, an outer sole with fulcrum was used to cause 25 degrees of inversion at the ankle upon landing from a 27 cm step-down task. Forty participants completed the study: 15 participants had no history of any ankle sprain, 15 participants had a history of a lateral ankle sprain, and 10 participants had a history of a high ankle sprain. There was not a significant difference between the injury groups for the latency measurements or the time to maximum inversion. These findings indicate that a previous lateral ankle sprain or high ankle sprain does not affect the latency of the peroneal muscles or the time to complete the inversion range of motion.

scholarly journals Comparison of Axial Ocular Measurements with Contact and Non-contact Biometry

2020 ◽  
Vol 36 (1) ◽  
Author(s):  
Muhammad Arslan Ashraf ◽  
Muhammad Suhail Sarwar ◽  
Muhammad Awais Afzal ◽  
Imran Khalid ◽  
Sehrish Shahid
Keyword(s):  
Corneal Thickness ◽  
Anterior Chamber Depth ◽  
Cross Sectional Study ◽  
P Value ◽  
Cross Sectional ◽  
Kappa Test ◽  
Parametric Data ◽  
Significant Difference ◽  
The Difference ◽  
Graphical Presentation

Purpose:  To compare between non-contact and contact biometry for measurements of central corneal thickness (CCT), anterior chamber depth (ACD), lens thickness (LT) and axial length (AL). Study Design: Descriptive Cross Sectional Study. Place and Duration of Study:  Mayo Hospital, Lahore from June 2018 to December 2018. Material and Methods:  Eighty-four subjects, (168 non-pathological eyes) visiting the eye outpatients department were recruited by non-probability convenience sampling. Patients with high refractive errors and suffering from any ocular pathology were excluded from the study. CCT, ACD, LT and AL were measured with non-contact Biometer (HAAG Streit) followed by Contact Biometer (Ultrasound) after taking consent from the patient. Data was entered and analyzed by using SPSS-21 and Medcalc software. Normality of quantitative data was checked with Shapiro Wilk test. Independent sample t test was used for parametric variable and Mann Whitney-U test was used for non-parametric data. For the agreement between two techniques Cohen’s Kappa test used and Bland-Altman plot was drawn for graphical presentation. P-value equal or less than 0.05 was taken as significant. Results:  Mean age of 84 subject (female: 45.24% and male: 54.76%) was 53.05 ± 13.56 years. The AL was significantly longer for the non-contact measurement with the difference of 0.53 ± 0.32 mm (p < 0.001). Contact pachymetry was significantly higher with the difference of 8.67 ± 20.83 µm (p = 0.046). ACD was significantly deeper for non-contact measurements with the difference of 0.51 ± 0.32 mm (p < 0.001). Contact ultrasound A-scan measured LT significantly thicker with the difference of 0.59 ± 0.56 mm (p < 0.001). Conclusion:  There is significant difference of axial ocular measurements (CCT, ACD, LT and AL) between contact (ultrasound A-scan) and non-contact (HAAG Streit) biometry (p < 0.05).

scholarly journals THE INFLUENCE OF ACE I/D GENE POLYMORPHISM IN AMATEUR AMERICAN FOOTBALL ATHLETES IN BRAZIL

2019 ◽  
Vol 25 (6) ◽  
pp. 460-463
Author(s):  
Gino Fellipe Santoro ◽  
Katlyn Duarte de Mello ◽  
Zair Cândido de Oliveira Netto ◽  
Gabrielle Pfutzenreuter ◽  
Julio Cesar Bassan ◽  
...  
Keyword(s):  
Diagnostic Test ◽  
American Football ◽  
Control Group ◽  
P Value ◽  
Genetic Profile ◽  
Chi Square ◽  
Level Of Evidence ◽  
Genotypic Distribution ◽  
Significant Difference ◽  
Chi Square Test

ABSTRACT Introduction Physical performance depends on a variety of biological and mechanical properties. These different phenotypes are related through the complex interaction between the environment and the individual genetic profile. The hypothesis is that there is a hereditary component that interferes in physical fitness. ACE stands out among the genes that may influence this response. Objectives The objective of this study is to analyze the polymorphism of the ACE gene in American football athletes. Methods: At the end of the study, the sample was composed of 45 male athletes and 72 non-athletes. DNA was extracted from the jugal mucosa. ACE polymorphisms were genotyped through polymerase chain reaction and analyzed using the electrophoresis process. To compare the frequency of genotypes between athletes and the control group, we used the Chi-square test. The association between the frequencies of alleles was verified through the 2X2 contingency tables analyzed using the Chi-square test with Yates correction. The type of study was diagnostic - Investigation of a diagnostic test, level of evidence II. A p-value of ≤0.05 was considered statistically significant for all the analyses. Results The results showed a greater frequency of the D allele in American football athletes when compared with non-athletes, and a significant difference in the genotypic distribution of the athletes being composed of a higher number of the DD genotype as compared to the control group. Conclusion The study provides evidence of the allelic and genotypic influence of ACE polymorphism in amateur American football players in Brazil. Level of evidence II; Investigation of a diagnostic test.

scholarly journals An Analysis of Sports Specialization in NCAA Division I Collegiate Athletics

2019 ◽  
Vol 7 (1) ◽  
pp. 232596711882117 ◽  
Author(s):  
Hasani W. Swindell ◽  
Melanie L. Marcille ◽  
David P. Trofa ◽  
Franklin E. Paulino ◽  
Natasha N. Desai ◽  
...  
Keyword(s):  
Ncaa Division I ◽  
Elite Athletes ◽  
Youth Sports ◽  
Team Sports ◽  
Division I ◽  
P Value ◽  
Level Of Evidence ◽  
Cross Sectional ◽  
Significant Difference ◽  
Individual Sports

Background: Youth sports specialization has become more prevalent despite consequences such as increased injury rates and burnout. Young athletes, coaches, and parents continue to have misconceptions about the necessity of sports specialization, giving athletes the encouragement to focus on a single sport at a younger age. Purpose: To characterize the motivations for specialization and determine when elite athletes in various individual and team sports made the decision to specialize. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A Likert-style survey was developed and distributed to athletes from two National Collegiate Athletic Association (NCAA) Division I institutions. The survey’s Flesch-Kincaid grade level was 6.3. Statistical analysis was performed via the Student t test, where a P value less than .05 was considered significant. Results: A total of 303 athletes with a mean ± SD age of 19.9 ± 1.52 years across 19 sports were surveyed; 94.7% of specialized athletes had previously played another organized sport prior to college, and 45% of athletes had played multiple sports up to age 16 years. The mean age of specialization was 14.9 years, with a significant difference between athletes competing in team (15.5 years) and individual (14.0 years) sports ( P = .008). Males in individual sports specialized earlier than those in team sports ( P ≤ .001). Nearly one-fifth (17.4%) of athletes reported specializing at age 12 years or earlier. Personal interest, skill level, time constraints, and potential scholarships were the most important reasons for specialization overall. For individual sports, the motivations for specialization were similar, but collegiate ( P < .001) or professional ( P < .001) ambitions were significantly larger contributing factors. Conclusion: Early sports specialization is uncommon among NCAA Division I athletes for most team sports, whereas individual sports tend to have athletes who specialize earlier and are more motivated by professional and collegiate goals. This study characterized the timing of specialization among elite athletes, providing a basis for understanding the motivations behind youth sports specialization. Physicians should be prepared to discuss the misconception that early sports specialization is necessary or common among most team-focused collegiate-level athletes. Knowing the motivations for sports specialization will guide clinicians in their discussions with youth athletes.

scholarly journals Percutaneous Chevron Akin (PECA) Correction of Hallux Valgus Deformity: Analysis of the Learning Curve

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0040
Author(s):  
Peter W. Robinson ◽  
Robbie Ray ◽  
Paul M. Dearden ◽  
Thomas A. Goff ◽  
Michael R. Whitehouse ◽  
...  
Keyword(s):  
Learning Curve ◽  
Hallux Valgus ◽  
Pearson Correlation ◽  
Weight Bearing ◽  
Learning Phase ◽  
Plateau Phase ◽  
Tourniquet Time ◽  
Hallux Valgus Deformity ◽  
Parametric Data ◽  
Significant Difference

Category: Bunion Introduction/Purpose: Percutaneous hallux valgus correction is increasing in popularity, with good correction of deformity and improvement in outcomes. The learning curve is reported as steep, based on arbitrary analysis. Methods: We performed a prospective study of a single surgeon series on the 1st 58 feet in 53 patients undergoing PECA hallux valgus correction, following cadaveric training and surgical observation. Pre- & post-operative (6 month) hallux valgus angles (HVA) & 1-2 intermetatarsal angles (IMA) were measured on weight bearing radiographs. Tourniquet time & number of fluoroscopy images were recorded. Complications were analysed. Parametric data was described with mean+-SD & non- parametric data with median+-interquartile range. Unpaired 2-tailed t tests were used to compare continuous data. The learning curve was calculated by plotting the tourniquet time against case number using a smoothed cubic spline with straight lines fitted to the slope. This was used to define a learning phase & a plateau phase. Results: Median age was 62 (IQR 56-66). The mean HVA improved from 32°+-4.7 to 9°--+-5.9 (p<0.0001). Mean IMA improved from 16°+-3.1 to 8°+-2.3 (p<0.0001). There were 6 re-operations (ostectomy & screw removal). The learning curve inflection point was between case 38 & 39. 38 were analysed in the learning phase & the remaining 20 in the plateau phase. No significant difference between the learning and plateau phases were seen for age, pre- & post-operative HMA or IMA, difference from normal angles or return to theatre. Pearson correlation revealed that only tourniquet time (p=0.001) & number of fluoroscopy shots (p=0.019) were significantly correlated with the learning or plateau phase. Conclusion: The learning curve for the PECA hallux valgus technique is around 40 cases, reflected by tourniquet time and number of fluoroscopy shots. It does not affect radiological correction or complications, showing that if taught properly this technique is reproducible and reliable.

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