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Patel R, Siddiqui N, Dreyer MA, Lam K, Ayyagari V, Onica A. Radiographic and Cadaveric Analysis of Minimally Invasive Bunionectomy Osteotomy Position-"MIS Bunion Sweet Spot". Foot Ankle Spec 2024; 17:358-364. [PMID: 35730534 DOI: 10.1177/19386400221101950] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Minimally invasive surgery (MIS) is a growing technique that favors faster recovery and cosmetic results. We propose a recommended osteotomy position or "MIS Sweet Spot" to make the procedure more reproducible and lessen the learning curve to improve outcomes. A total of 211 patients from 3 surgeons between 2 different study centers were included in a retrospective radiograph measurement analysis and a cadaveric dissection to confirm the safety of nearby anatomical structures. An average distance of 2.2 cm proximal from the first metatarsophalangeal joint was found as the "Sweet Spot" to perform the transverse osteotomy. At this distance, neurovascular and tendinous structures were unharmed and the osteotomy remained extracapsular. Furthermore, an average of 10.7° of intermetatarsal angle reduction and a reduction of tibial sesamoid position of 3 points were achieved. A predictable and measurable distance for osteotomy placement will help to provide more confidence in producing the bunionectomy osteotomy with the specialized tools used in MIS and can help to reduce operative time and improve results.Level of Clinical Evidence (LOCE): 3.
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Affiliation(s)
- Rikhil Patel
- Family Foot and Leg Center, Naples, Florida
- FFLC Reconstruction and Limb Salvage Surgical Fellowship Program, Naples, Florida
- Annapolis Foot and Ankle Center, Annapolis, Maryland
| | - Noman Siddiqui
- Rubin Institute for Advanced Orthopaedics, Baltimore, Maryland
| | - Mark A Dreyer
- Family Foot and Leg Center, Naples, Florida
- FFLC Reconstruction and Limb Salvage Surgical Fellowship Program, Naples, Florida
| | - Kevin Lam
- Family Foot and Leg Center, Naples, Florida
- FFLC Reconstruction and Limb Salvage Surgical Fellowship Program, Naples, Florida
| | - Vineela Ayyagari
- DVA Maryland/Sinai Rubin Institute for Advanced Orthopaedics Residency Program, Baltimore, Maryland
| | - Alexandru Onica
- Temple University School of Podiatric Medicine, Philadelphia, Pennsylvania
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Zanchini F, Catani O, Sergio F, Boemio A, Sieczak A, Piscopo D, Risitano S, Colò G, Fusini F. Role of lateral soft tissues release in percutaneous hallux valgus correction: A medium term retrospective study. World J Orthop 2023; 14:843-852. [PMID: 38173806 PMCID: PMC10758593 DOI: 10.5312/wjo.v14.i12.843] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 10/12/2023] [Accepted: 11/17/2023] [Indexed: 12/15/2023] Open
Abstract
BACKGROUND In the field of minimally invasive surgery (MIS) for the treatment of hallux valgus (HV), different techniques have begun to emerge in the literature concerning the distal osteotomy of the first metatarsal bone, the synthesis or not of the metatarsal head, the possible association with lateral soft tissues release (LSTR) and osteotomy of the base of the first phalanx. AIM To evaluate the role of LSTR on percutaneous HV correction, evaluating functional and radiographical results. METHODS From January 2012 to May 2016 a total of 396 patients with mild to moderate symptomatic HV treated with the MIS technique were included in this retrospective study. The technique provides no internal fixation (WOS). Patients were divided into the LSTR group and no LSTR group (LSTR N). This surgical procedure (LSTR) was reserved for insufficient HV angle (HVA) correction during fluoroscopic control. Patients were evaluated at each follow-up by two other authors after appropriate training by senior authors (first practitioners). Clinical evaluation was performed before surgery, 6 mo after surgery, and 48 mo follow-up. American Orthopaedic Foot and Ankle Society (AOFAS) and visual analog scale (VAS) score was used to evaluate pain and function, and complications were recorded. In addition, the incidence of relapses and the degree of joint range of motion (ROM) with the association with the LSTR (capsule, adductor tendon, phalanx-sesamoid ligament, and the deep transverse metatarsal ligament) were evaluated. Radiological parameters included HVA and intermetatarsal angle (IMA). Patient satisfaction was assessed. Student t-test and Fisher exact test were used to assess statistical analysis. RESULTS From our study it is clear that no differences in term of HVA, VAS, IMA correction, rate of complications, and AOFAS score were found between groups, while a significant improvement of the same variables was found in each group between pre and postoperative values. A significant improvement in ROM at 6 mo (P = 0.018) and 48 mo (P = 0.02) of follow-up was found in LSTR N group. Complications were rare in both groups. CONCLUSION LSTR procedure on percutaneous HV correction seems to increase postoperative joint stiffness with a comparable incidence of relapse and a low incidence of complications.
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Affiliation(s)
- Fabio Zanchini
- Division of Orthopaedics and Traumatology, Multidisciplinary Department of Medical-Surgical and Dental Specialties, Clinical Orthopeadics, University of Campania “Luigi Vanvitelli”, Naples 80138, Italy
| | - Ottorino Catani
- Department of Foot Surgery, Casa di cura Santa Maria, Santa Maria Capua Vetere 81055, Italy
| | - Fabrizio Sergio
- Department of Foot an Ankle Surgery, Casa di cura Santa Maria, Santa Maria Capua Vetere 81055, Italy
| | - Alessia Boemio
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, Clinical Orthopeadics, AOU Luigi Vanvitelli, Napoli 80138, Italy
| | - Angelo Sieczak
- Clinical Orthopeadics, University of Campania Luigi Vanvitelli, Naples 80138, Italy
| | - Davide Piscopo
- Clinical Orthopeadics, University of Campania Luigi Vanvitelli, Naples 80138, Italy
| | - Salvatore Risitano
- Department of Orthopaedic and Traumatology, Orthopaedic and Trauma Centre, Città della Salute e della Scienza di Torino, Turin 10126, Italy
| | - Gabriele Colò
- Department of Orthopaedics and Traumatology, Regional Center for Joint Arthroplasty, ASO Alessandria, Alessandria 15121, Italy
| | - Federico Fusini
- Department of Orthopaedic and Traumatology, Regina Montis Regalis Hospital, Cuneo 12084, Italy
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Gong XF, Sun N, Li H, Li Y, Lai LP, Li WJ, Wang Y, Wu Y. Modified Chevron Osteotomy with Distal Soft Tissue Release for Treating Moderate to Severe Hallux Valgus Deformity: A Minimal Clinical Important Difference Values Study. Orthop Surg 2022; 14:1369-1377. [PMID: 35633110 PMCID: PMC9251292 DOI: 10.1111/os.13242] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 02/13/2022] [Accepted: 02/18/2022] [Indexed: 11/27/2022] Open
Abstract
Objective To explore whether modified Chevron osteotomy together with distal soft tissue release would correct moderate to severe HV deformity and what is the minimal clinical important difference (MCID) for objective and subjective evaluating parameters. Methods From March 2018 to January 2019, 40 hallux valgus patients (including moderate to severe) were enrolled in this retrospective study. The cohort included four males and 36 females. The average age at surgery was 50.95 (range 22–75) years. All patients underwent modified Chevron osteotomy together with distal soft tissue release and completed at least one follow‐up at clinic. The American Orthopaedic Foot and Ankle forefoot score (AOFAS, forefoot), Visual Analog Scale (VAS), and Foot Function Index (FFI) were all collected before and after surgery. Besides, the hallux valgus angle (HVA), 1st–2nd intermetatarsal angle (IMA) and distal metatarsal articular angle (DMAA) were measured both before surgery and at last follow‐up. All MCID values were calculated by employing distribution‐based method. Results Thirty‐seven patients (92.5%) showed satisfied result at a mean 14.3‐month follow‐up (range 13–22 month). Two patients complained about residual pain at the bunion, and overcorrection (hallux varus) occurred in one patient. Meanwhile, no patient observed nonunion. Being female, age more than 60, residual HVA deformity (>15°), and post IMA more than 9° showed no statistical relationship with the post‐operation residual pain (P > 0.05). However, high VAS score before surgery (more than 7) showed strong correlation with residual pain (P < 0.01). The subjective MCID value was 9.50 for AOFAS, 18.92 for FFI, and 1.27 for VAS, respectively. Conclusion The modified Chevron osteotomy together with distal soft tissue release could achieve a satisfied result for moderate to severe HV deformity at early follow‐up. The residual pain was associated with severe pain before surgery (VAS more than 7).
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Affiliation(s)
- Xiao-Feng Gong
- Department of Foot and Ankle Surgery, Beijing Jishuitan Hospital, Peking University Fourth School of Clinical Medicine, Beijing, China
| | - Ning Sun
- Department of Foot and Ankle Surgery, Beijing Jishuitan Hospital, Peking University Fourth School of Clinical Medicine, Beijing, China
| | - Heng Li
- Department of Foot and Ankle Surgery, Beijing Jishuitan Hospital, Peking University Fourth School of Clinical Medicine, Beijing, China
| | - Ying Li
- Department of Foot and Ankle Surgery, Beijing Jishuitan Hospital, Peking University Fourth School of Clinical Medicine, Beijing, China
| | - Liang-Peng Lai
- Department of Foot and Ankle Surgery, Beijing Jishuitan Hospital, Peking University Fourth School of Clinical Medicine, Beijing, China
| | - Wen-Jing Li
- Department of Foot and Ankle Surgery, Beijing Jishuitan Hospital, Peking University Fourth School of Clinical Medicine, Beijing, China
| | - Yan Wang
- Department of Foot and Ankle Surgery, Beijing Jishuitan Hospital, Peking University Fourth School of Clinical Medicine, Beijing, China
| | - Yong Wu
- Department of Foot and Ankle Surgery, Beijing Jishuitan Hospital, Peking University Fourth School of Clinical Medicine, Beijing, China
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GÜL D, Akpancar S. Proximal crescentric osteotomy in the treatment of severe hallux valgus deformity. Chirurgia (Bucur) 2020. [DOI: 10.23736/s0394-9508.19.04978-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Kıyak G, Esemenli T. Should We Use Intermetatarsal Angle as Primary Determinant to Define the Limits of Distal Chevron Osteotomy? J Foot Ankle Surg 2019; 58:880-885. [PMID: 31345758 DOI: 10.1053/j.jfas.2018.12.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Indexed: 02/03/2023]
Abstract
Classic treatment algorithms limit the use of distal chevron osteotomy (DCO) to cases with an intermetatarsal angle (IMA) <14°. As the IMA increases, it is accepted that the contact between the metatarsal head and shaft will be insufficient. We have investigated the reliability of IMA to predict contact area percentage after DCO. Preoperative radiographs of patients with hallux valgus were subdivided as mild, moderate, and severe using traditional algorithms. After excluding the mild cases, we randomly selected 100 patients (50 moderate and 50 severe) and calculated the estimated bony contact (EBC) with our method and investigated the percentage of patients who could have >50% contact area if we perform a DCO. Thirty of 50 (60%) and 17 of 50 (34%) patients had >50% EBC in moderate and severe groups, respectively. We performed DCO for 24 patients (14 moderate and 10 severe cases). The 100-point American Orthopaedic Foot and Ankle Society (AOFAS) hallux-metatarso-phalangeal-interphalangeal scale was used to assess the clinical outcome. For the moderate group, we calculated mean IMA 16° (standard deviation [SD] ± 1.4°) and mean EBC 66.9% (SD ± 10.8%). For the severe group, we calculated mean IMA 20.9° (SD ± 0.7°) and mean EBC 63.1% (SD ± 10.4%). Paired t tests showed significant improvement comparing preoperative and postoperative AOFAS scores, IMA, hallux valgus angle, and sesamoid position for all operated patients (p < .001). We did not see any recurrence of hallux valgus or hallux varus and had only 1 minor complication that we managed conservatively. IMA may not always be a reliable parameter to predict the stability of DCO. Because the stability depends on the contact surfaces of osteotomy fragments, metatarsal head diameter and remaining bone contact should be the primary concerns. Two patients with the same IMA can have a different contact surface varying on a broad spectrum.
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Affiliation(s)
- Görkem Kıyak
- Orthopaedic Surgeon, Department of Orthopaedics and Traumatology, Academic Hospital, Istanbul, Turkey.
| | - Tanil Esemenli
- Professor, Department of Orthopaedics and Traumatology, Academic Hospital, Istanbul, Turkey
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de Las Heras-Romero J, Lledó-Alvarez AM, Andrés-Grau J, Picazo-Marín F, Moreno-Sánchez JF, Hernández-Torralba M. A new minimally extended distal Chevron osteotomy (MEDCO) with percutaneous soft tissue release (PSTR) for treatment of moderate hallux valgus. Foot (Edinb) 2019; 40:27-33. [PMID: 31055210 DOI: 10.1016/j.foot.2019.04.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Revised: 03/31/2019] [Accepted: 04/03/2019] [Indexed: 02/04/2023]
Abstract
PURPOSE Surgical treatment of moderate hallux valgus (HV) onwards by Chevron osteotomy and all variants described to date including the recent extended distal Chevron osteotomy (EDCO), yields improvable outcome but with recurrence rate. A new modification of this technique is needed to achieve better results. METHODS 34 consecutive female patients suffering from moderate HV underwent a new minimally extended distal Chevron osteotomy (MEDCO) with percutaneous soft tissue release (PSTR). Outcome was assessed using pre-post operative VAS-Pain, AOFAS Hallux Score and radiological measurements. Mean age was 53.7 years, follow-up 2.7 years and satisfaction score 8. RESULTS VAS improved from 7 to 1 (p < 0.001) and AOFAS score from 64 to 90.7 (p < 0.001). Comparing postoperative HV and intermetatarsal (IM) angles of previous studies (either employing a Chevron osteotomy alone or a double Chevron-Akin) with our results, an improvement from 15.6/14.8 to 9.1 and 8.2 /8.8 to 5.6 respectively (p < 0.05) was achieved. Complication and recurrence rates were both 5.8%, lower than the documented rates of other techniques. CONCLUSION The modified technique in the present study was found to be a more effective and reliable method of correcting hallux valgus when compared to other previous procedures. It provides a higher level of satisfaction and excellent outcomes with low complication and recurrence rates. Furthermore, the percutaneous lateral incision improved the cosmetic results by avoiding formation of a dorsal first web space scar. Medial incision is also shorter than the one used for EDCO. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- J de Las Heras-Romero
- Department of Orthopaedics and Traumatology, Reina Sofía Hospital, Avda. Intendente Jorge Palacios 1, Murcia, 30003, Spain.
| | - A M Lledó-Alvarez
- Regional Statistical Center, Avda. Teniente Flomesta, s/n, 3ª planta, Edif. Anexo, Murcia, 30001, Spain.
| | - J Andrés-Grau
- Department of Orthopaedics and Traumatology, Los Arcos Hospital, Paraje Torre Octavio 54, Pozo Aledo, Murcia, 30739, Spain.
| | - F Picazo-Marín
- Department of Orthopaedics and Traumatology, Los Arcos Hospital, Paraje Torre Octavio 54, Pozo Aledo, Murcia, 30739, Spain.
| | - J F Moreno-Sánchez
- Department of Orthopaedics and Traumatology, Reina Sofía Hospital, Avda. Intendente Jorge Palacios 1, Murcia, 30003, Spain.
| | - M Hernández-Torralba
- Department of Orthopaedics and Traumatology, Santa Lucía Hospital, C/ Mezquita, s/n, Paraje Los Arcos, Santa Lucía, Cartagena, Murcia, 30202, Spain.
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Li C, Lu L, Zhang Y, Ai-Xin-Jue-Luo QC, Wang ZT, Wang JF. F-Shaped Osteotomy Combined with Basal Opening Wedge Osteotomy for Severe Hallux Valgus. Orthop Surg 2019; 11:604-612. [PMID: 31419060 PMCID: PMC6712405 DOI: 10.1111/os.12505] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 06/03/2019] [Accepted: 06/17/2019] [Indexed: 12/16/2022] Open
Abstract
Objective To evaluate the safety and effectiveness of osteotomy adjacent to the articular surface of the metatarsal head combined with basal opening wedge osteotomy for severe hallux valgus. Methods The double osteotomy procedure was carried out in 56 patients (72 feet) with severe hallux valgus deformity, with an average follow‐up of 25 months from March 2010 to February 2019. Hallux valgus angle (HVA), distal metatarsal articular angle (DMAA), intermetatarsal angle (IMA), and distal articular set angle (DASA) were measured for all patients via weight‐bearing anteroposterior (AP) X‐ray images. In addition, the American Orthopedic Foot & Ankle Society (AOFAS) scale was used for evaluating the function of the hallux. Results The HVA, IMA, and DMAA reduced from 49.30 ± 6.60, 19.33 ± 4.70, and 29.85 ± 10.96 to 13.19 ± 6.10, 5.97 ± 3.13, and 5.63 ± 3.44, respectively (P < 0.01). DASA decreased from 4.33 ± 2.34 to 4.08 ± 1.91 and did not show a statistically significant difference (P = 0.48). Among the 72 feet, 69 feet healed normally, and 3 feet had bone resorption at the osteotomy edges. No cases of bone sclerosis, bone necrosis, bone nonunion, or ankylosis were observed. On average, the AOFAS score improved from 34.66 ± 12.07 (preoperative) to 88.78 ± 5.73 (postoperative). Conclusions The proposed double osteotomy procedure can maintain the match metatarsophalangeal joints without ischemic necrosis of bones, and is demonstrated to be safe, effective, and feasible for correcting severe hallux valgus.
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Affiliation(s)
- Chang Li
- Department of Hand and Foot Microsurgery, The Second Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia, China
| | - Liang Lu
- Department of Orthopaedics, Anhui Provincial Hospital, Hefei, Anhui, China
| | - Yu Zhang
- Department of Sports Medicine and Adult reconstructive surgery, Drum Tower Hospital, School of Medicine, Nanjing University, Nanjing, Jiangsu, China
| | - Qi-Cheng Ai-Xin-Jue-Luo
- Department of Hand and Foot Microsurgery, The Second Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia, China
| | - Zhen-Tang Wang
- Department of Hand and Foot Microsurgery, The Second Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia, China
| | - Jun-Feng Wang
- Department of Hand and Foot Microsurgery, The Second Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia, China
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Matsumoto T, Gross CE, Parekh SG. Short-Term Radiographic Outcome After Distal Chevron Osteotomy for Hallux Valgus Using Intramedullary Plates With an Amended Algorithm for the Surgical Management of Hallux Valgus. Foot Ankle Spec 2019. [PMID: 29532741 DOI: 10.1177/1938640018762474] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Distal Chevron osteotomy is a well-established surgical procedure for mild to moderate hallux valgus deformity. Many methods have been described for fixation of osteotomy site; secure fixation, enabling large displacement of the metatarsal head, is one of the essentials of this procedure. The purpose of the present study was to evaluate the short-term radiographic outcome of a distal Chevron osteotomy using an intramedullary plate for the correction of hallux valgus deformity. The present study evaluated 37 patients (40 feet) who underwent distal Chevron osteotomy using an intramedullary plate by periodic radiographs obtained preoperatively and at 4 weeks, 8 weeks, 3 months, and 6 months postoperatively. Correction of the hallux valgus angle averaged 17.8°, intermetatarsal angle 7.4°, distal metatarsal articular angle 2.7°, and sesamoid position 1.4 stages at 3 months postoperatively. The average lateral shift of the capital fragment was 6.5 mm. All patients achieved bone union, and there were no cases of dislocation, displacement, or avascular necrosis of the metatarsal head fragment. In conclusion, a distal Chevron osteotomy using an intramedullary plate was a favorable method for the correction of mild to moderate hallux valgus deformity. Levels of Evidence: Level IV: Case series.
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Affiliation(s)
- Takumi Matsumoto
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan (TM).,Department of Orthopaedic Surgery, Medical University of South Carolina, Charleston, South Carolina (CEG).,North Carolina Orthopaedic Clinic, Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina (SGP)
| | - Christopher E Gross
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan (TM).,Department of Orthopaedic Surgery, Medical University of South Carolina, Charleston, South Carolina (CEG).,North Carolina Orthopaedic Clinic, Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina (SGP)
| | - Selene G Parekh
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan (TM).,Department of Orthopaedic Surgery, Medical University of South Carolina, Charleston, South Carolina (CEG).,North Carolina Orthopaedic Clinic, Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina (SGP)
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Using the Center of Rotation of Angulation Concept in Hallux Valgus Correction: Why Do We Choose the Proximal Oblique Sliding Closing Wedge Osteotomy? Foot Ankle Clin 2018; 23:247-256. [PMID: 29729799 DOI: 10.1016/j.fcl.2018.01.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Many different surgeries have been proposed for hallux valgus treatment, osteotomies being the currently recommended ones. Because of high recurrence rates, distal, diaphyseal and proximal osteotomies have been used to improve alignment and sesamoid reduction. The center of rotation of angulation (CORA) concept applies to any deformity and helps to completely realign 2 bone segments. When used with proximal osteotomies, bone displacement and angulation is performed obtaining complete deformity correction. The proximal oblique sliding closing wedge (POSCOW) osteotomy follows the CORA concept and permits preoperative planning. Future directions must include the correction of the pronation deformity of the metatarsal.
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Biz C, Fosser M, Dalmau-Pastor M, Corradin M, Rodà MG, Aldegheri R, Ruggieri P. Functional and radiographic outcomes of hallux valgus correction by mini-invasive surgery with Reverdin-Isham and Akin percutaneous osteotomies: a longitudinal prospective study with a 48-month follow-up. J Orthop Surg Res 2016; 11:157. [PMID: 27919259 PMCID: PMC5139107 DOI: 10.1186/s13018-016-0491-x] [Citation(s) in RCA: 94] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 11/18/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Minimally invasive surgery (MIS) represents one of the most innovative surgical treatments of hallux valgus (HV). However, long-term outcomes still remain a matter of discussion within the orthopaedic community. The purpose of this longitudinal prospective study was to evaluate radiographic and functional outcomes in patients with mild-to-severe HV who underwent Reverdin-Isham and Akin percutaneous osteotomy, following exostosectomy and lateral release. METHODS Eighty patients with mild-to-severe symptomatic HV were treated by MIS. Clinical evaluation was assessed preoperatively, as well as at 3 and 12 months after surgery and at final follow-up of 48 months, using the American Orthopaedic Foot and Ankle Society (AOFAS) hallux grading system. Patient satisfaction and complications were recorded. Computer-assisted measurement of antero-posterior radiographs was taken preoperatively, as well as at 3 and 12 months after surgery and at 48-month follow-up, analysing the intermetatarsal angle (IMA), the hallux valgus angle (HVA), the distal metatarsal articular angle (DMAA) and the tibial sesamoid position. Also, the bridging bone/callus formation was evaluated at the different radiographic follow-ups, while the articular surface congruency and the metatarsal index were calculated only preoperatively and at the last follow-up. Patient satisfaction was assessed using the visual analogue score (VAS). Statistical analysis was carried out using the paired t test. Statistical significance was set at p < 0.05. RESULTS The mean AOFAS score was 87.15 points at the final follow-up of 48 months, and the VAS score was 8.35/10. The post-operative radiographic assessments showed a statistically significant improvement compared with preoperative values. The mean corrections of each angular value at the last follow-up were as follows: IMA 3.90°, HVA 12.50°, DMAA 4.72° and a tibial sesamoid position of 1.10. The articular surface was congruent in 77 (96.25%) cases and incongruent only in 3 (3.75%). The complete healing of the osteotomies was achieved in all series at 3-month follow-up. However, the results obtained in the correction of the severe HV deformities were less encouraging. CONCLUSIONS Minimally invasive surgery with Reverdin-Isham and Akin percutaneous osteotomy, in combination with previous exostosectomy and subsequent lateral soft-tissue release, is a safe, effective and reliable procedure for correction of mild-to-moderate HV. However, it requires a long learning curve because of the inherent difficulty of the mixed different surgical procedures. TRIAL REGISTRATION ClinicalTrials.gov PRS Protocol Registration and Results System: NCT02886221.
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Affiliation(s)
- Carlo Biz
- Orthopaedic Clinic, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padua, via Giustiniani 2, 35128, Padova, Italy.
| | - Michele Fosser
- Orthopaedic Clinic, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padua, via Giustiniani 2, 35128, Padova, Italy
| | - Miki Dalmau-Pastor
- Human Anatomy and Embryology Unit, Experimental Pathology and Therapeutics Department, University of Barcelona, Barcelona, Spain.,Health Sciences Faculty of Manresa, University of Vic-Central University of Catalunya, Barcelona, Spain
| | - Marco Corradin
- Orthopaedic Clinic, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padua, via Giustiniani 2, 35128, Padova, Italy
| | - Maria Grazia Rodà
- Orthopaedic and Trauma Unit, Padua Hospital, via Giustiniani 2, Padova, Italy
| | - Roberto Aldegheri
- Orthopaedic Clinic, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padua, via Giustiniani 2, 35128, Padova, Italy
| | - Pietro Ruggieri
- Orthopaedic Clinic, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padua, via Giustiniani 2, 35128, Padova, Italy
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Plaass C, Ettinger S, Sonnow L, Koenneker S, Noll Y, Weizbauer A, Reifenrath J, Claassen L, Daniilidis K, Stukenborg-Colsman C, Windhagen H. Early results using a biodegradable magnesium screw for modified chevron osteotomies. J Orthop Res 2016; 34:2207-2214. [PMID: 28005292 DOI: 10.1002/jor.23241] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Accepted: 03/17/2016] [Indexed: 02/04/2023]
Abstract
This is the first larger study analyzing the use of magnesium-based screws for fixation of modified Chevron osteotomies in hallux valgus surgery. Forty-four patients (45 feet) were included in this prospective study. A modified Chevron osteotomy was performed on every patient and a magnesium screw used for fixation. The mean clinical follow up was 21.4 weeks. The mean age of the patients was 45.5 years. Forty patients could be provided with the implant, in four patients the surgeon decided to change to a standard metallic implant. The AOFAS, FAAM and pain NRS-scale improved markedly. The hallux valgus angle, intermetatarsal angle and sesamoid position improved significantly. Seven patients showed dorsal subluxation, rotation or medial shifting of the metatarsal heads within the first 3 months. One of these patients was revised, in all others the findings were considered clinically not significant or the patients refused revision. This study shows the feasibility of using magnesium screws in hallux valgus-surgery. Surgeons starting with the use of these implants should be aware of the proper handling of these implants and should know about corrosion effects during healing and its radiographic appearance. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:2207-2214, 2016.
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Affiliation(s)
- Christian Plaass
- Department of Orthopedic Surgery, Hannover Medical School, Anna-von-Borries Strasse 1-7, 30625 Hannover, Germany
| | - Sarah Ettinger
- Department of Orthopedic Surgery, Hannover Medical School, Anna-von-Borries Strasse 1-7, 30625 Hannover, Germany
| | - Lena Sonnow
- Institute for Radiology, Hannover Medical School, Carl-Neuberg Strasse 1, 30625, Hannover, Germany
| | - Soeren Koenneker
- Department for Plastic, Aesthetic, Hand and Reconstructive Surgery, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany
| | - Yvonne Noll
- Department of Orthopedic Surgery, Hannover Medical School, Anna-von-Borries Strasse 1-7, 30625 Hannover, Germany
| | - Andreas Weizbauer
- Laboratory of Biomechanics and Biomaterials, Department of Orthopedic Surgery, Hannover Medical School, Anna-von-Borries-Strasse 1-7, Hannover, Germany.,CrossBIT, Centre for Biocompatibility and Implant-Immunology, Department of Orthopedic Surgery, Hannover Medical School, Carl-Neuberg-Strasse 1-7, 30625, Hannover, Germany
| | - Janin Reifenrath
- Laboratory of Biomechanics and Biomaterials, Department of Orthopedic Surgery, Hannover Medical School, Anna-von-Borries-Strasse 1-7, Hannover, Germany.,CrossBIT, Centre for Biocompatibility and Implant-Immunology, Department of Orthopedic Surgery, Hannover Medical School, Carl-Neuberg-Strasse 1-7, 30625, Hannover, Germany
| | - Leif Claassen
- Department of Orthopedic Surgery, Hannover Medical School, Anna-von-Borries Strasse 1-7, 30625 Hannover, Germany
| | - Kiriakos Daniilidis
- Department of Orthopedic Surgery, Hannover Medical School, Anna-von-Borries Strasse 1-7, 30625 Hannover, Germany
| | - Christina Stukenborg-Colsman
- Department of Orthopedic Surgery, Hannover Medical School, Anna-von-Borries Strasse 1-7, 30625 Hannover, Germany
| | - Henning Windhagen
- Department of Orthopedic Surgery, Hannover Medical School, Anna-von-Borries Strasse 1-7, 30625 Hannover, Germany
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12
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Abstract
UNLABELLED Hallux valgus is the most common disorder of the hallux and often results in pain, functional disability, and impaired gait patterns. The goals of surgical management are to correct the deformity while improving patients' pain and function. Traditional treatment of moderate to severe hallux valgus deformities consist of proximal osteotomy and/or arthrodesis given their powerful corrective ability. Despite their corrective power, proximal osteotomies are more technically demanding, have a higher rate of complications, and require a more restricted post-operative recovery. We present an alternative technique for the treatment of moderate to severe hallux valgus. With this operation, a single distal medial incision is utilized to create a chevron osteotomy and lateral release. This procedure can achieve and maintain the desired correction and outcome without the need for a protracted recovery period. LEVEL OF EVIDENCE Level V, expert opinion.
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Affiliation(s)
| | - Renee Herman
- Congress Orthopedic Associates, Pasadena, CA, USA
| | - Thomas G Harris
- Congress Orthopedic Associates, Pasadena, CA, USA Foot and Ankle Service, Harbor-UCLA Medical Center, Torrance, CA, USA
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13
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Giotis D, Paschos NK, Zampeli F, Giannoulis D, Gantsos A, Mantellos G. Modified Chevron osteotomy for hallux valgus deformity in female athletes. A 2-year follow-up study. Foot Ankle Surg 2016; 22:181-185. [PMID: 27502227 DOI: 10.1016/j.fas.2015.07.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Revised: 04/04/2015] [Accepted: 07/13/2015] [Indexed: 02/04/2023]
Abstract
BACKGROUND Hallux valgus is an increasingly common deformity in young female athletes that constricts their daily athletic activities and influences foot cosmesis. The aim of this study was to evaluate the outcome of modified Chevron osteotomy for hallux valgus deformity in this specific population. METHODS Forty-two cases of modified Chevron osteotomies were carried out in 33 patients with mild to moderate hallux valgus deformity. Each participant was evaluated for AOFAS score, pain, range of motion, cosmetic and radiological outcome. RESULTS Mean AOFAS score improved to 96.3 (p<0.001) while the mean range of motion of the metatarsophalangeal joint was maintained (p=0.138). The cosmetic result was excellent/good in 40 cases (95%). Mean metatarsophalangeal and intermetatarsal angles were decreased from 29.8° and 14.2° preoperatively to 12.2° and 8.1° postoperatively (p<0.001 and p<0.036), respectively. CONCLUSIONS Modified Chevron osteotomy could offer substantial correction of hallux valgus deformity in young female athletes, with excellent clinical outcome.
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Affiliation(s)
- Dimitrios Giotis
- Department of Orthopaedic Surgery, University of Ioannina, Ioannina, Greece
| | - Nikolaos K Paschos
- Department of Orthopaedic Surgery, University of Ioannina, Ioannina, Greece; Department of Biomedical Engineering, University of California, Davis, CA, USA.
| | | | | | - Apostolos Gantsos
- Department of Orthopaedic Surgery, University of Ioannina, Ioannina, Greece
| | - George Mantellos
- Orthopaedic Department of General Hospital of Arta, Arta, Greece
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14
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Wu DY. A retrospective study of 63 hallux valgus corrections using the osteodesis procedure. J Foot Ankle Surg 2014; 54:406-11. [PMID: 25435009 DOI: 10.1053/j.jfas.2014.09.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Indexed: 02/03/2023]
Abstract
Osteotomy procedures have been the most popular approach to hallux valgus deformity correction. Soft tissue approaches have, in general, been regarded as ineffective for moderate and severe hallux valgus deformities. Osteodesis is a soft tissue technique that has been shown to be effective in the past but is still seldom practiced. In the present report, we describe a retrospective study of 63 hallux valgus feet in 36 patients who had undergone the osteodesis procedure. Their mean age was 46 ± 12 years, and the mean follow-up period was 25.4 ± 9.6 months. The surgical technique consisted of metatarsus primus varus deformity correction by intermetatarsal cerclage sutures and hallux valgus deformity correction by rebalancing the ligaments. The first metatarsophalangeal angle improved from a mean of 32.5° ± 7.6° preoperatively to 18.4° ± 7° postoperatively, the first intermetatarsal angle improved from 14.6° ± 2.6° to 6.8° ± 1.8°, and the American Orthopaedic Foot and Ankle Society score improved from 59 ± 14 to 93 ± 8 points. The rate of patient satisfaction after surgery was 92% (33 of 36 patients, 59 of 63 feet). The complications included a second metatarsal stress fracture in 3 feet (5%), metatarsophalangeal joint medial subluxation in 3 feet (5%), and metatarsophalangeal joint stiffness in 5 feet (8%). This soft tissue, nonosteotomy procedure was a safe technique that effectively corrected hallux valgus and metatarsus primus varus deformities of various severities without osteotomy or fusion.
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Affiliation(s)
- Daniel Yiang Wu
- Center for Non-Bone-Breaking Bunion Surgery, Hong Kong, Special Administrative Region, China.
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15
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Park HW, Lee KB, Chung JY, Kim MS. Comparison of outcomes between proximal and distal chevron osteotomy, both with supplementary lateral soft-tissue release, for severe hallux valgus deformity. Bone Joint J 2013; 95-B:510-6. [DOI: 10.1302/0301-620x.95b4.30464] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Severe hallux valgus deformity is conventionally treated with proximal metatarsal osteotomy. Distal metatarsal osteotomy with an associated soft-tissue procedure can also be used in moderate to severe deformity. We compared the clinical and radiological outcomes of proximal and distal chevron osteotomy in severe hallux valgus deformity with a soft-tissue release in both. A total of 110 consecutive female patients (110 feet) were included in a prospective randomised controlled study. A total of 56 patients underwent a proximal procedure and 54 a distal operation. The mean follow-up was 39 months (24 to 54) in the proximal group and 38 months (24 to 52) in the distal group. At follow-up the hallux valgus angle, intermetatarsal angle, distal metatarsal articular angle, tibial sesamoid position, American Orthopaedic Foot and Ankle Society (AOFAS) hallux metatarsophalangeal-interphalangeal score, patient satisfaction level, and complications were similar in each group. Both methods showed significant post-operative improvement and high levels of patient satisfaction. Our results suggest that the distal chevron osteotomy with an associated distal soft-tissue procedure provides a satisfactory method for correcting severe hallux valgus deformity. Cite this article: Bone Joint J 2013;95-B:510–16.
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Affiliation(s)
- H-W. Park
- Chonnam National University Hospital and
Medical School, Department of Orthopaedic
Surgery, 42 Jebong-ro, Donggu, Gwang-ju
City 501-757, Korea
| | - K-B. Lee
- Chonnam National University Hospital and
Medical School, Department of Orthopaedic
Surgery, 42 Jebong-ro, Donggu, Gwang-ju
City 501-757, Korea
| | - J-Y. Chung
- Chonnam National University Hospital and
Medical School, Department of Orthopaedic
Surgery, 42 Jebong-ro, Donggu, Gwang-ju
City 501-757, Korea
| | - M-S. Kim
- Chonnam National University Hospital and
Medical School, Department of Orthopaedic
Surgery, 42 Jebong-ro, Donggu, Gwang-ju
City 501-757, Korea
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16
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Kim HN, Park YJ, Kim GL, Park YW. Distal chevron osteotomy with lateral soft tissue release for moderate to severe hallux valgus decided using intraoperative varus stress radiographs. J Foot Ankle Surg 2013; 52:303-10. [PMID: 23518230 DOI: 10.1053/j.jfas.2013.02.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2011] [Indexed: 02/03/2023]
Abstract
The purpose of the present study was to investigate the outcomes of distal chevron osteotomy with lateral soft tissue release for moderate to severe hallux valgus. The patients were selected using criteria that included the degree of lateral soft tissue contracture and metatarsocuneiform joint flexibility. The contracture and flexibility were determined from intraoperative varus stress radiographs. From April 2007 to May 2009, 56 feet in 51 consecutive patients with moderate to severe hallux valgus had undergone distal chevron osteotomy with lateral soft tissue release. This was done when the lateral soft tissue contracture was not so severe that passive correction of the hallux valgus deformity was not possible and when the metatarsocuneiform joint was flexible enough to permit additional correction of the first intermetatarsal angle after lateral soft tissue release. The mean patient age was 45.2 (range 23 to 54) years, and the duration of follow-up was 27.5 (range 24 to 46) months. The mean hallux abductus angle decreased from 33.5° ± 3.1° to 11.6° ± 3.3°, and the first intermetatarsal angle decreased from 16.4° ± 2.7° to 9.7° ± 2.1°. The mean American Orthopaedic Foot and Ankle Society hallux-interphalangeal scores increased from 66.6° ± 10.7° to 92.6° ± 9.4° points, and 46 of the 51 patients (90%) were either very satisfied or satisfied with the outcome. No recurrence of deformity or osteonecrosis of the metatarsal head occurred. When lateral soft tissue contracture is not severe and when the metatarsocuneiform joint is flexible enough, distal chevron osteotomy with lateral soft tissue release can be a useful and effective choice for moderate to severe hallux valgus deformity.
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Affiliation(s)
- Hyong-Nyun Kim
- Department of Orthopedic Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
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17
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Morandi A, Ungaro E, Fraccia A, Sansone V. Chevron osteotomy of the first metatarsal stabilized with an absorbable pin: our 5-year experience. Foot Ankle Int 2013; 34:380-5. [PMID: 23520296 DOI: 10.1177/1071100712464956] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The potential requirement for hardware removal originally fueled the development of bioabsorbable pins as an alternative to metal screws for fixing osteotomy sites in foot surgery. More recently, the concern regarding the adverse effects of metal implants may provide further grounds for using bioabsorbable rather than metal fixation. METHODS This is a prospective study of 383 consecutive patients (439 feet) who underwent a chevron osteotomy to correct a hallux valgus deformity performed between 2005 and 2010. In the study group of 251 patients (285 feet), the distal metatarsal osteotomy was fixed with a bioabsorbable pin made of poly-L-lactide and poly-DL-lactide (70:30 ratio). In the control group of 132 patients (154 feet), the osteotomy was fixed with a metal screw. The average follow-up was 27 months for the study group and 31 months for the control group. RESULTS We observed statistically significant improvements in the mean intermetatarsal angle of 6.1 ± 2.7 degrees in the study group and 5.2 ± 1.6 degrees in the control group (P < .001) and in the mean hallux valgus angle of 14.8 ± 4.7 degrees and 15.5 ± 3.7 degrees, respectively (P < .001). The mean ± SD improvement on the American Orthopaedic Foot and Ankle Society 100-point scale was 45 ± 11 points for the study group and 49 ± 15 points for the control (P < .001). Our complication rate was 0.7% for the study group. CONCLUSION Our study found that fixation with a bioabsorbable pin was as reliable as fixation with a metal screw and allowed major angular corrections. The bioabsorbable polymer was well tolerated, and the complication rate was low. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
- Alberto Morandi
- Orthopaedic Department, Università degli Studi di Milano, Istituto Ortopedico Galeazzi IRCCS, Milano, Italy
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18
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Smith SE, Landorf KB, Butterworth PA, Menz HB. Scarf versus chevron osteotomy for the correction of 1-2 intermetatarsal angle in hallux valgus: a systematic review and meta-analysis. J Foot Ankle Surg 2012; 51:437-44. [PMID: 22487651 DOI: 10.1053/j.jfas.2012.02.016] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2011] [Indexed: 02/03/2023]
Abstract
The chevron and scarf osteotomies are commonly used for the surgical management of hallux valgus (HV). However, there is debate as to whether one osteotomy provides more 1-2 intermetatarsal (1-2 IMA) correction than the other. The objective of this systematic review and meta-analysis was to compare the effectiveness of 3 types of first metatarsal osteotomy for reducing the 1-2 IMA in HV correction: the chevron osteotomy, the long plantar arm (modified) chevron osteotomy, and the scarf osteotomy. A systematic search for eligible studies was performed of the following databases: Medline, Embase (Ovid), CINAHL (EBSCO Host), and The Cochrane Database of Systematic Reviews and Cochrane Central Register of Controlled Clinical Trials. Only English-language studies previous to May 2010 were included in the review. Additional hand and electronic content searches of relevant foot and orthopaedic journals were performed. Criteria for inclusion in this analysis included systematic reviews of randomized controlled trials, prospective and retrospective cohort studies, and case-control studies, as well as case-series studies involving the chevron, scarf, or long plantar arm chevron osteotomy of >20 participants with a minimum of 80% follow-up. Quality of evidence of the included studies was assessed with the Grading of Recommendations Assessment, Development and Evaluation system. All pooled analyses were based on a fixed effects model. There was a total of 1351 participants who underwent either a chevron (n = 1028), scarf (n = 300), or long plantar arm chevron osteotomy (n = 23). Only one study for the long plantar arm chevron group fitted the eligibility criteria for this review; however, it was not amenable to meta-analysis. The chevron osteotomy was associated with a mean reduction of 1-2 IMA from preoperative to postoperative of 5.33° (95% confidence interval, 5.12 to 5.54, p < .001), and the scarf osteotomy was associated with a mean reduction of 6.21° (95% confidence interval, 5.70 to 6.72, p < .001). There was a statistically significant 0.88° increase in the correction of the 1-2 IMA in favor of the scarf osteotomy compared with the chevron osteotomy. The studies included in this review were of very low- to low-quality evidence. Our findings indicate that the scarf osteotomy provides greater correction of the 1-2 IMA when used for HV correction. However, only a weak recommendation in favor of the scarf osteotomy can be made based on the low quality of evidence of the studies included in this analysis.
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Affiliation(s)
- Simon E Smith
- Department of Podiatry and Musculoskeletal Research Centre, La Trobe University, Bundoora, Victoria, Australia.
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19
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Kayiaros S, Blankenhorn BD, Dehaven J, Van Lancker H, Sardella P, Pascalides JT, Digiovanni CW. Correction of metatarsus primus varus associated with hallux valgus deformity using the arthrex mini tightrope: a report of 44 cases. Foot Ankle Spec 2011; 4:212-7. [PMID: 21490180 DOI: 10.1177/1938640011402823] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Metatarsus primus varus must be addressed during correction of moderate to severe hallux valgus deformity. As an alternative to proximal osteotomy or first tarsometatarsal fusion for hallux valgus correction, this study presents a series of patients treated using the Arthrex Mini TightRope. A total of 36 patients (44 operations) with hallux valgus and metatarsus primus varus underwent correction using the Arthrex Mini TightRope. Assessment included measurement of radiographic parameters, the American Orthopaedic Foot and Ankle Society (AOFAS) midfoot outcomes score, and the SF-12. The average hallux valgus angle improved from 32.2° to 15.2° (P < .0001). The average first intermetatarsal angle improved from 14.6° to 8.2° (P < .0001). The average distal metatarsal articular angle improved from 17.0° to 9.6° (P < .0001). The average AOFAS midfoot outcomes scores improved from 45.44 to 84.72 (P < .0001). Postoperative SF-12 physical and mental scores averaged 52.99 and 56.63. Only one patient had recurrence of deformity. Correcting metatarsus primus varus in association with hallux valgus deformity using the Arthrex Mini TightRope should be considered a treatment option. This technique is less invasive and seems capable of maintaining correction while allowing for early weight bearing and avoiding the need for a proximal first metatarsal osteotomy or Lapidus procedure.
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Affiliation(s)
- Stephen Kayiaros
- Department of Orthopaedic Surgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA.
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20
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Ravenell RA, Camasta CA, Powell DR. The unreliability of the intermetatarsal angle in choosing a hallux abducto valgus surgical procedure. J Foot Ankle Surg 2011; 50:287-92. [PMID: 21435913 DOI: 10.1053/j.jfas.2011.02.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2010] [Indexed: 02/03/2023]
Abstract
Conventional thinking holds that high intermetatarsal and hallux abductus angles (>15° and >25°, respectively) are associated with a hypermobile first ray and require a Lapidus procedure to achieve satisfactory correction for the treatment of hallux valgus. However, normal first ray motion may be misinterpreted as hypermobility, and it is possible to take advantage of this motion to correct some portion of a large hallux abductovalgus deformity with distal procedures, such as the Austin or first metatarsophalangeal joint fusion. We retrospectively examined radiographs of 61 patients with first intermetatarsal and hallux abductus angles greater than 15° and greater than 25°, respectively, who had undergone hallux abductovalgus correction via Lapidus, Austin, or first metatarsophalangeal joint fusion. Preoperative and postoperative radiographic measurements of the intermetatarsal and hallux abductus angles were made. The results revealed no statistically significant differences in the amount of correction achieved by any of the 3 procedures in comparison with the others. We concluded that, given appropriate patient selection, an Austin or first MTPJ fusion could reliably correct large intermetatarsal and hallux abductus angles that, in the hands of many surgeons, are often treated by means of Lapidus arthrodesis.
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Affiliation(s)
- Rahn A Ravenell
- Associated Foot Specialists, PA, Mount Pleasant, SC 29464, USA.
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21
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Abstract
OBJECTIVE The purpose of proximal tarso-metatarsal joint resection is to provide early weight-loading for biomechanical realignment and correct weight imbalance across the MTP joint. Therefore, its main indications are all those metatarsalgia in which previous orthopaedic treatment has failed. MATERIAL AND METHODS We report our experience in metatarsalgia management with proximal metatarsal resection. This is a retrospective study between April 1997 and December 2005. 40 feet underwent this procedure (36 patients), with a total report of 86 osteotomies. Clinical results were evaluated with American Orthopaedic Foot and Ankle Society Lesser Metatarsophalangeal-Interphalangeal Scale Score (maximum score: 100 points). RESULTS A 10-15-grade correction was achieved with a mean resection of 2mm. Assessment with AOFAS' scale disclosed previous average 35.75+/-4.2 with a final score reported of 88.4+/-6.9 (range 65-100). An overall mean increase of 52.65 points was achieved. No case had major complications that required further surgery. Pain improved in 39 patients (97.5%), and persisted in one patient. CONCLUSIONS Proximal metatarsal resection is a simple technique that provides adequate correction of the abnormal pressure distribution across the MTP joint without internal fixation.
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22
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Bauer T, Biau D, Lortat-Jacob A, Hardy P. Percutaneous hallux valgus correction using the Reverdin-Isham osteotomy. Orthop Traumatol Surg Res 2010; 96:407-16. [PMID: 20488776 DOI: 10.1016/j.otsr.2010.01.007] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2009] [Revised: 11/08/2009] [Accepted: 01/25/2010] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The present study assessed 2-year clinical and radiological results of percutaneous correction of hallux valgus by Reverdin-Isham osteotomy and sought to clarify indications for the technique. PATIENT AND METHODS A continuous prospective single-center series of 104 cases of medium-to-moderate hallux valgus was managed by the same percutaneous technique, with a median 2 years' clinical and radiological follow-up (with no loss to follow-up). Uni- and multivariate analysis determined predictive factors for the mobility and degree of correction obtained. RESULTS American Orthopedic Foot and Ankle Society (AOFAS) functional score rose from a preoperative median of 49/100 to 87.5/100 postoperatively (p<0.05); 89% of patients were satisfied or very satisfied with their result at end of follow-up. Hallux valgus and distal metatarsal articular angle (DMAA) were significantly reduced (30 and 15 degrees to 15 and 7 degrees, respectively; p<0.05). Associated lateral ray surgery significantly increased the postoperative risk of MTP1 joint incongruence (p=0.009). DISCUSSION Percutaneous correction by Reverdin-Isham osteotomy seemed effective in isolated medium-to-moderate hallux valgus, but involves a learning curve and lacks precision in case of associated lateral metatarsal osteotomy, with a risk of DMAA hypercorrection and increased risk of MTP1 joint incongruence. Indications for percutaneous Reverdin-Isham osteotomy seem to be limited to isolated medium-to-moderate hallux valgus (M1M2 angle <15 degrees, M1P1 angle around 30 degrees) with elevated DMAA and congruent MTP1 joint. LEVEL OF EVIDENCE Level IV. Therapeutic study.
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Affiliation(s)
- T Bauer
- Orthopedic and Traumatologic Surgery Department, Ambroise-Paré Hospital, Paris Area West University, Boulogne, France.
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23
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Bauer T, de Lavigne C, Biau D, De Prado M, Isham S, Laffenétre O. Percutaneous hallux valgus surgery: a prospective multicenter study of 189 cases. Orthop Clin North Am 2009; 40:505-14, ix. [PMID: 19773056 DOI: 10.1016/j.ocl.2009.05.002] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Distal first metatarsal osteotomies have been indicated for the correction of mild-to-moderate hallux valgus deformity. The aim of this study was to assess the clinical and radiographic results of the distal Reverdin-Isham first metatarsal osteotomy with use of a percutaneous procedure after a minimum 1-year followup. One hundred eighty-nine feet in 168 consecutive subjects were included in the present prospective multicenter study. A radiographic and clinical assessment using the American Orthopaedic Foot and Ankle Society's (AOFAS) hallux-metatarsophalangeal-interphalangeal scale was performed for all the subjects with a minimum 1-year follow-up. One hundred fifty six subjects (87%) were satisfied or very satisfied with the outcome of the procedure. The median postoperative AOFAS score was 93 points. Subjects averaged a loss 17% of first metatarsophalangeal joint motion. The median hallux valgus angle and intermetatarsal angle improved from 28 degrees and 13 degrees preoperatively, to 14 degrees and 10 degrees postoperatively, respectively. Percutaneous correction of mild-to-moderate hallux valgus deformity with the Reverdin-Isham osteotomy of the first metatarsal enables us to achieve clinical and radiographic results comparable to other percutaneous or open distal metatarsal osteotomies after 1-year follow-up.
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Affiliation(s)
- Thomas Bauer
- GRECMIP: Groupe de Recherche en Chirurgie Mini-Invasive du Pied, Sport Medical Center, Department of Orthopedic Surgery, 9 rue Jean Moulin, 33700 Merignac, France.
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24
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Abstract
Selecting the appropriate surgical procedure for the treatment of hallux valgus not always is clear. Every procedure has its merits depending on the individual and circumstances. Correcting pain and deformity, avoiding recurrence, and preserving or re-establishing normal foot function should be the goals of bunion surgery. Although radiographic measurements can be helpful, their weight is not as important as understanding the function of the first ray in each patient. This article attempts to guide procedure selection based on re-establishing normal foot function as much as possible while meeting patients' goals and expectations.
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25
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Neese DJ, Zelent ME. The modified Mau-Reverdin double osteotomy for correction of hallux valgus: a retrospective study. J Foot Ankle Surg 2008; 48:22-9. [PMID: 19110156 DOI: 10.1053/j.jfas.2008.09.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2007] [Indexed: 02/03/2023]
Abstract
UNLABELLED The deformity of hallux valgus is multifactorial, albeit primarily in the transverse plane. In order to achieve an anatomic correction, a surgical technique must be able to address the deformity with consistent outcomes. The purpose of the present study was to evaluate a technique designed to reposition the first metatarsal bone, metatarsophalangeal joint, and sesamoid apparatus in an anatomic and biomechanical corrected position for correction of hallux valgus deformity. This article is a retrospective analysis of 36 operations performed in 28 individuals between January 1995 and December 2005. Each case involved the use of a modified-Mau osteotomy combined with a Reverdin osteotomy to correct the first intermetatarsal and proximal articular set angles. Comparisons were made between the preoperative and postoperative first IM angle, proximal articular set angle, tibial sesamoid position, and hallux valgus angle. The median follow-up period was 48 (range 12-121) months from the date of surgery. The median reduction of the 1-2 intermetatarsal angle was 12 degrees (range 5-19 degrees). The median decrease for the hallux valgus angle was 20.5 degrees (range 0-63 degrees). The median reduction in the PASA was 16 degrees (range 4-69 degrees). The median decrease in the tibial sesamoid position was 5 (range 2-6). These differences were all highly statistically significant (P < .001), and all of the patients experienced a high rate of satisfaction (median AOFAS score 95 [range 70-95]) following the intervention. The Mau-Reverdin double osteotomy appears to be an effective intervention for the radiographic and clinical correction of hallux valgus. LEVEL OF CLINICAL EVIDENCE 4.
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Affiliation(s)
- David J Neese
- Mercy Hospital Podiatric Medical and Surgical Residency, Coon Rapids, MN, USA
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Murawski DE, Beskin JL. Increased displacement maximizes the utility of the distal chevron osteotomy for hallux valgus deformity correction. Foot Ankle Int 2008; 29:155-63. [PMID: 18315970 DOI: 10.3113/fai.2008.0155] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Correction of hallux valgus deformity with distal chevron osteotomy is limited by the amount of lateral translation achieved. Since 1999, the senior author has performed a modified technique referred to as increased displacement distal chevron osteotomy in which the distal fragment is translated laterally as far as necessary to obtain correction. This technique can be applied to a deformity with an intermetatarsal angle of up to 18 degrees. The surgical technique and results of this modified procedure are reported. MATERIALS AND METHODS The senior author's (JLB) database was searched for correction of hallux valgus deformity by distal chevron osteotomy performed over a 2-year period. Patients having undergone lateral displacement greater than 50% of the width of the head were studied. At a minimum of two years after surgery, patients were invited to participate in a telephone interview and a final followup office visit. RESULTS Sixty-two patients underwent 72 procedures during the investigation period. Thirty-three patients having undergone 39 procedures completed comprehensive followup at an average of 34 (range, 24 to 47) months. No patients were dissatisfied and all patients would have surgery again under similar circumstances. AOFAS score averaged 93 with a standard deviation of 8.7 (range, 65 to 100). Radiographic union occurred in all 39 feet. Lateral translation averaged 8.2 mm (60%). No cases of radiographic avascular necrosis or advancement of degenerative joint disease were noted. Correction of the hallux valgus angle (HVA) averaged 22.2 degrees, intermetatarsal angle (IMA) 7.9 degrees, and sesamoid position 1.6 stages. Nine complications were identified in nine feet, two of which required additional surgery. CONCLUSION Increasing the displacement achieved with distal chevron osteotomy resulted in reliable correction including moderate to severe deformity. At 2 years, patients displayed a high rate of satisfaction, good clinical outcomes scores, and a complication rate similar to other techniques.
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Affiliation(s)
- Daniel E Murawski
- Baylor University Medical Center, Orthopaedic Surgery, Dallas, TX 75246, USA.
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Modified Diaphyseal Osteotomy With a Proximal Center of Rotation for Moderate to Severe Hallux Valgus. TECHNIQUES IN FOOT AND ANKLE SURGERY 2007. [DOI: 10.1097/01.btf.0000235420.30791.98] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Martínez Giménez J, Bustamante Suárez de Puga D, Verdú Román C, Lizaur Utrilla A. Resultados radiológicos de la osteotomía en chevron modificada por Johnson para la corrección del hallux valgus. Rev Esp Cir Ortop Traumatol (Engl Ed) 2006. [DOI: 10.1016/s1888-4415(06)76359-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Caminear DS, Pavlovich R, Pietrzak WS. Fixation of the chevron osteotomy with an absorbable copolymer pin for treatment of hallux valgus deformity. J Foot Ankle Surg 2005; 44:203-10. [PMID: 15940599 DOI: 10.1053/j.jfas.2005.02.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
This study investigated the use of a bioabsorbable pin made of an oriented poly-L-lactic acid/polyglycolic acid (82:18 ratio) copolymer to fix distal chevron osteotomies in 15 patients (18 feet), with an average follow-up of 18 months. This material absorbs faster than poly-L-lactic acid and slower than poly-p-dioxanone, 2 bioabsorbable polymers that have a clinical history in fixation of distal chevron osteotomies. The average intermetatarsal angle significantly decreased from 11.9+/-1.7 degrees to 0.9+/-3.8 degrees (P < .001) while the average hallux valgus angle significantly decreased from 19.4+/-4.7 degrees to 6.2+/-6.4 degrees (P < .001). The preoperative American Orthopaedic Foot and Ankle Society's hallux-metatarsophalangeal-interphalangeal score averaged 44.6+/-15.1, which increased significantly to 87.4+/-14.9 (P < .001) postoperatively. In 1 procedure, a giant cell granuloma developed that was treated with debridement. Overall, these results were comparable to those derived from the use of other methods of fixation used for bunionectomies.
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Freslon M, Gayet LE, Bouche G, Hamcha H, Nebout J, Pries P. Ostéotomie Scarf dans le traitement de l’hallux valgus. ACTA ACUST UNITED AC 2005; 91:257-66. [PMID: 15976670 DOI: 10.1016/s0035-1040(05)84312-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE OF THE STUDY Many different osteotomies can be used for the treatment of hallux valgus. The purpose of this study was to evaluate the Scarf osteotomy associated or not with phalangeal osteotomy and to search for deformation cutoff points beyond which corrections appear to be difficult to achieve. MATERIAL AND METHODS This retrospective analysis included 87 patients (123 feet) among 130 who underwent hallux valgus surgery between October 1993 and November 2000. Mean follow-up was four years eight months. The serie included 83 women and 4 men. Mean age at surgery was 53.5 years. A Scarf diaphyseal osteotomy was performed in all patients associated or not with phalangeal osteotomy. Each patient was reviewed clinically and radiographically with anteroposterior and lateral views of the foot in the standing position. RESULTS 84.6% of the patients were satisfied or very satisfied. There was a correlation between the index of satisfaction and clinical symptoms (metatarsalgia, stiff hallux, pain over exostosis). There was a statistically significant decrease in hallux valgus (31.2 degrees to 17.5 degrees ), of metatarsus varus (12.1 degrees to 7.5 degrees ), and articular angle of the distal metatarsus (13.3 degrees to 11.1 degrees ). Patients who had phalangeal osteotomy achieved the best hallux valgus correction (15 degrees versus 21.4 degrees ). Mean shortening of the first metatarsus was 2.2 mm with a decrease in the metatarsus-ground angle (19 degrees versus 20.1 degrees ). Cutoff limits for deformations which are difficult to correct satisfactorily were M1M2 angle > or = 15 degrees and distal metatarsal articular angle > or = 13 degrees . The overall Groulier score showed 70.7% very good and good results, 27.6% fair results and 1.7% poor results. DISCUSSION The Scarf technique is a reliable method to achieve significant correction of hallux valgus deformation. It requires a rigorous technique with specific attention to the elevation of the first metatarsus and excessive shortening, two factors favoring metatarsalgia. Adding a phalangeal osteotomy can improve the radiological result, but it is very difficult to obtain satisfactory correction if the initial deformations are severe and associated. Rotation of the plantar fragment helps for better orientation of the articular surface of the first metatarsus but limits the correction of the metatarsus varus. Function is the basic objective of hallux valgus surgery and patient satisfaction is related solely to clinical symptoms.
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Affiliation(s)
- M Freslon
- Service d'Orthopédie-Traumatologie, CHU de la Milétrie, Hôpital Jean-Bernard, BP 577, 86021 Poitiers.
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Hetman J, Myer KD. The distal metatarsal osteotomy for the treatment of hallux valgus. Clin Podiatr Med Surg 2005; 22:143-67, v. [PMID: 15833415 DOI: 10.1016/j.cpm.2004.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This article discusses various forms of distal metatarsal osteotomy for the treatment of hallux valgus. The techniques for the various osteotomies have evolved over the years to allow the surgeon to match a procedure and its modifications to the individual patient's deformity, thus optimizing outcomes. Fixation techniques continue to evolve, and meticulous surgical technique to prevent complications remains a must. Regardless of the osteotomy used, the authors believe that adherence to the techniques laid out in current literature will provide gratifying results for the surgeon and the patient.
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Affiliation(s)
- Jeff Hetman
- West Houston Medical Center, Harris County Podiatric Surgical Residency Program, 11301 Richmond Avenue, Suite K-105, Houston, TX 77082, USA.
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Williams GF, Blustein SM, Blustein H. HV evaluation relative base line: the HERB line. J Foot Ankle Surg 2005; 44:166-71. [PMID: 15768369 DOI: 10.1053/j.jfas.2005.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Die distale Chevron-Osteotomie zur Hallux valgus-Korrektur: Analyse einer mittelfristigen klinischen, radiologischen und pedographischen Studie. ACTA ACUST UNITED AC 2005. [DOI: 10.1007/s10302-005-0105-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Comentario. Rev Esp Cir Ortop Traumatol (Engl Ed) 2004. [DOI: 10.1016/s1888-4415(04)76177-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Dalton SK, Bauer GR, Lamm BM, Hillstrom HJ, Spadone SJ. Stability of the offset V osteotomy: effects of fixation, orientation, and surgical translocation in polyurethane foam models and preserved cadaveric specimens. J Foot Ankle Surg 2003; 42:53-62. [PMID: 12701072 DOI: 10.1016/s1067-2516(03)70002-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Polyurethane foam models and cadaver specimens were used to examine the stability of the offset V first metatarsal osteotomy. Uniform osteotomies were performed in all specimens by using a specially designed jig. Specimens in the polyurethane foam model series (n = 10) varied with respect to fixation type, fixation orientation, and degree of lateral translocation of the osteotomy. All specimens were loaded to failure in an Instron testing machine (Instron, Canton, MA). The plantar wing-pin (Kirschner wire) osteotomy group showed statistically significantly greater stiffness (P =.0119) and load at failure (P =.0027) than the dorsal wing-pin group. Cadaveric offset V specimens received the same amount of capital fragment lateral translocation but had different fixation types and orientations. Using the identical protocol as the models, the cadaveric dorsal wing-screw group showed statistically significantly less displacement at failure than the plantar wing-screw, plantar wing-pin, and dorsal wing-pin groups (P =.0262). The dorsal wing-pin group with a synthetic tension band showed a statistically significant greater stiffness (P =.0054) and peak load at failure (P =.0004) compared with the dorsal wing-pin group without the tension band. The most stable offset V construct in the polyurethane foam model was the plantar wing-pin group. The preserved cadaveric specimens yielded different results. The cadaveric dorsal wing-pin group with the synthetic tension band showed superior stability compared with all other non-tension-band groups. These results indicate the importance of tension band effects provided by capsular and ligamentous structures, which are typically ignored in surgical optimization research.
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Affiliation(s)
- Sandra K Dalton
- Temple University School of Podiatric Medicine, 8th at Race Street, Philadelphia, PA 19107, USA
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