WAGNER HITSCHFFELD, EMILIO
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WAGNER HITSCHFFELD, EMILIO
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e.wagner@udd.cl, emiliowagner@gmail.com
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16445066700

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Flexor-to-Extensor tendon transfer for flexible hammer toe deformity

2012 , Wagner, E. , WAGNER HITSCHFFELD, EMILIO

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Current Concepts in Treatment of Ligament Incompetence in the Acquired Flatfoot

2021 , WAGNER, EMILIO , WAGNER HITSCHFELD, PABLO

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Preface

2022 , WAGNER HITSCHFFELD, EMILIO , WAGNER HITSCHFELD, PABLO

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Cost effectiveness of different techniques in hallux valgus surgery

2016 , WAGNER, EMILIO , Cristian Ortiz , Karen Torres , Ivan Contesse , Omar Vela , Diego Zanolli

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Republication of “Proximal Rotational Metatarsal Osteotomy for Hallux Valgus (PROMO): Short-term Prospective Case Series With a Novel Technique and Topic Review”

2023 , WAGNER HITSCHFELD, PABLO , WAGNER HITSCHFFELD, EMILIO

Background: Hallux valgus deformity consists of a lateral deviation of the great toe, metatarsus varus, and pronation of the first metatarsal. Most osteotomies only correct varus, but not the pronation of the metatarsal. Persistent postoperative pronation has been shown to increase deformity recurrence and have worse functional outcomes. The proximal rotational metatarsal osteotomy (PROMO) technique reliably corrects pronation and varus through a stable osteotomy, avoiding fusing any healthy joints. The objective of this research is to show a prospective series of the PROMO technique. Methods: Twenty-five patients (30 feet) were operated with the PROMO technique. The sample included 22 women and 3 men, average age 46 years (range 22-59), for a mean prospective follow-up of 1 year (range 9-14 months). Inclusion criteria included symptomatic hallux valgus deformities, absence of severe joint arthritis, or inflammatory arthropathies, with a metatarsal malrotation of 10 degrees or more, with no tarsometatarsal subluxation or arthritis on the anteroposterior or lateral foot radiograph views. The mean preoperative and postoperative Lower Extremity Functional Scale (LEFS) score, metatarsophalangeal angle, intermetatarsal angle, metatarsal malrotation, complications, satisfaction, and recurrence were recorded. Results: The mean preoperative and postoperative LEFS scores were 56 and 73. The median pre-/postoperative metatarsophalangeal angle was 32.5/4 degrees and the intermetatarsal angle 15.5/5 degrees. The metatarsal rotation was satisfactorily corrected in 24 of 25 patients. An Akin osteotomy was needed in 27 of 30 feet. All patients were satisfied with the surgery, and no recurrence or complications were found. Conclusions: PROMO is a reliable technique, with good short-term results in terms of angular correction, satisfaction, and recurrence. Long-term studies are needed to determine if a lower hallux recurrence rate occurs with the correction of metatarsal rotation in comparison with conventional osteotomies. Level of evidence: IV, prospective case series.

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Evidence-Based Treatment Algorithm for Freiberg Disease

2023 , Ichiro Yoshimura , Masato Takao , WAGNER HITSCHFFELD, EMILIO , Sjoerd Stufkens , Jari Dahmen , Gino M.M.J. Kerkhoffs , Mark Glazebrook

Freiberg disease is a type of osteonecrosis of the metatarsal head that predominantly occurs in young females and adolescents, although it may occur at any age. The pathophysiology is multifactorial and may involve trauma, altered foot biomechanics, systemic disorders, and arterial insufficiency. The most typical location is the second metatarsal head, but Freiberg disease may also occur in other lesser toes. Nonoperative treatment is best applied in the early stage of the disease; if this is ineffective, surgical treatment is recommended. Currently available surgical procedures include debridement, osteotomy, osteochondral grafting, microfracture, interposition arthroplasty, implant arthroplasty, and metatarsal shortening arthroplasty. In this article, we propose a treatment algorithm for Freiberg disease based on the current literature and expert opinion.

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Preface

2022 , WAGNER HITSCHFFELD, EMILIO , WAGNER HITSCHFELD, PABLO

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Biomechanical Cadaveric Evaluation of the Role of Medial Column Instability in Hallux Valgus Deformity

2022 , WAGNER, EMILIO , WAGNER HITSCHFELD, PABLO , Florencia Pacheco , Mario López , Felipe Palma , Rodrigo Guzmán-Venegas , Francisco Jose Berral-de la Rosa

Background: Medial column instability is a frequent finding in patients with flatfeet and hallux valgus, within others. The etiology of hallux valgus is multifactorial, and medial ray axial rotation has been mentioned as having an individual role. Our objective was to design a novel cadaveric foot model where we could re-create through progressive medial column ligament damage some components of a hallux valgus deformity. Methods: Ten fresh-frozen lower leg specimens were used, and fluorescent markers were attached in a multisegment foot model. Constant axial load and cyclic tibial rotation (to simulate foot pronation) were applied, including pull on the flexor hallucis longus tendon (FHL). We first damaged the intercuneiform (C1-C2) ligaments, second the naviculocuneiform (NC) ligaments, and third the first tarsometatarsal ligaments, leaving the plantar ligaments unharmed. Bony axial and coronal alignment was measured after each ligament damage. Statistical analysis was performed. Results: A significant increase in pronation of multiple segments was observed after sectioning the NC ligaments. Damaging the tarsometatarsal ligament generated small supination and varus changes mainly in the medial ray. No significant change was observed in axial or frontal plane alignment after damaging the C1-C2 ligaments. The FHL pull exerted a small valgus change in segments of the first ray. Discussion: In this biomechanical cadaveric model, the naviculocuneiform joint was the most important one responsible for pronation of the medial column. Bone pronation occurs along the whole medial column, not isolated to a certain joint. Flexor hallucis longus pull appears to play some role in frontal plane alignment, but not in bone rotation. This model will be of great help to further study medial column instability as one of the factors influencing medial column pronation and its relevance in pathologies like hallux valgus. Clinical Relevance: This cadaveric model suggests a possible influence of medial column instability in first metatarsal pronation. With a thorough understanding of a condition’s origin, better treatment strategies can be developed.

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Achilles insertional tendinopathy: state of the art

2019 , Nicola Maffulli , Amol Saxena , WAGNER, EMILIO , Guglielmo Torre

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Biomechanical Evaluation With a Novel Cadaveric Model Using Supination and Pronation Testing of a Lisfranc Ligament Injury

2020 , WAGNER, EMILIO , WAGNER HITSCHFELD, PABLO , Tiago Baumfeld , Marcelo Pires Prado , Daniel Baumfeld , Caio Nery

Background: Lisfranc joint injuries can be due to direct or indirect trauma and while the precise mechanisms are unknown, twisting or axial force through the foot is a suspected contributor. Cadaveric models are a useful way to evaluate injury patterns and models of fixation, but a frequent limitation is the amount of joint displacement after injury. The purpose of this study was to test a cadaveric model that includes axial load, foot plantarflexion and pronation-supination motion, which could re-create bone diastasis similar to what is seen in subtle Lisfranc injuries. Our hypothesis was that applying pronation and supination motion to a cadaveric model would produce reliable and measurable bone displacements. Methods: Twenty-four fresh-frozen lower leg cadaveric specimens were used. The medial (C1) and intermediate (C2) cuneiforms and the first (M1) and second (M2) metatarsal bones were marked. A complete ligament injury was performed between C1-C2 and C1-M2 in 12 specimens (group 1), and between C1-C2, C1-M2, C1-M1, and C2-M2 in 12 matched specimens (group 2). Foot pronation and supination in addition to an axial load of 400 N was applied to the specimens. A 3D digitizer was used to measure bone distances. Results: After ligament injury, distances changed as follows: C1-C2 increased 3 mm (23%) with supination; C1-M2 increased 4 mm (21%) with pronation (no differences between groups). As expected, distances between C1-M1 and C2-M2 only changed in group 2, increasing 3 mm (14%) and 2 mm (16%), respectively (no differences between pronation and supination). M1-M2 and C2-M1 distances did not reach significant difference for any condition. Conclusions: Pronation or supination in addition to axial load produced measurable bone displacements in a cadaveric model of Lisfranc injury using sectioned ligaments. Distances M1-M2 and C2-M1 were not reliable to detect injury in this model. Clinical Relevance: This new cadaveric Lisfranc model included foot pronation-supination in addition to axial load delivering measurable bone diastasis. It was a reliable Lisfranc cadaveric model that could be used to test different Lisfranc reconstructions.

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