Complications Associated with Cranial Closing Wedge Osteotomy

Background: Shortening and dorsiflexion of the first metatarsal are known potential side effects of metatarsal osteotomies for hallux valgus (HV) with the potential to cause transfer metatarsalgia. We compared the effect of the first tarsometatarsal joint arthrodesis (Lapidus procedure), proximal lateral closing wedge osteotomy (PLCWO), and intermetatarsal suture button fixation procedures on the length and dorsiflexion of the first ray. Methods: We retrospectively evaluated 105 feet in 99 patients with 30 weeks of follow-up. The average age was 54 years. Seventy-four feet had a Lapidus procedure, 12 had a PLCWO, and 19 had intermetatarsal suture button fixation. Digital radiographic measurements were made for the pre- and postoperative hallux valgus angle (HVA) and intermetatarsal angle (IMA), absolute and relative shortening of the first ray, and dorsiflexion. Results: Preoperative HVA and IMA did not differ between treatment groups ( P > .05 for each). Similar corrections of HVA (30.5-13.5 degrees) were achieved between all groups ( P > .05). The IMA was improved more in the Lapidus group (14.3-6.5 degrees) compared with the suture button fixation group (14.2-8.1 degrees) ( P = .045). There were significant differences in the change in absolute first cuneiform–metatarsal length (FCML) between the Lapidus (–1.6 mm), PLCWO (–2.3 mm), and intermetatarsal suture button fixation (+1.9 mm) procedure ( P = .004). There were also significant differences in relative first metatarsal shortening between the Lapidus (0.1 mm relative shortening), PLCWO (1.1 mm relative shortening), and intermetatarsal suture button fixation (1.3 mm lengthening) procedure ( P < .001). The average dorsiflexion differed between the Lapidus (1.8 degrees) and suture button fixation (0.4 degrees) groups ( P = .004). Conclusion: Intermetatarsal suture button fixation relatively lengthened the first ray, the Lapidus procedure maintained length, and the PLCWO relatively and absolutely shortened it. Dorsiflexion may be higher with the Lapidus and osteotomy procedures. Level of Evidence: Level III, retrospective comparative series.

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Comparison of Tibial Anatomical-mechanical Axis Angles and Patellar Positions Between Tibial Plateau Levelling Osteotomy (TPLO) and Modified Cranial Closing Wedge Osteotomy (AMA-Based CCWO) for the Treatment of Cranial Cruciate Ligament Disease in Large Dogs With Tibial Plateau Slopes Greater Than 30° and Clinically Normal Labradors Retrievers

10.21203/rs.3.rs-937337/v1 ◽

2021 ◽

Author(s):

Laurent Guénégo ◽

Aldo Vezzoni ◽

Luca Vezzoni

Keyword(s):

Tibial Plateau ◽

Mechanical Axis ◽

Cruciate Ligament ◽

Patellar Height ◽

Patellar Ligament ◽

Wedge Osteotomy ◽

Control Group ◽

Closing Wedge Osteotomy ◽

Clinically Normal ◽

Closing Wedge

Abstract Background: The objective of this study was to evaluate tibial anatomical-mechanical axis angles (AMA-angles) and proximodistal and craniocaudal patellar positions following tibial plateau levelling osteotomy (TPLO) and AMA-based modified cranial closing wedge osteotomy (CCWO) in large dogs with tibial plateau angle (TPA) >30°, to compare these postoperative positions with those of a control group of healthy normal dogs, and to assess which procedure yields postoperative morphology of the tibiae and stifles that is most consistent with that of the unaffected group. This study also investigated whether the occurrence of patellar ligament thickening (PLT), which is commonly observed two months postoperatively after TPLO, is associated with misplacement of the osteotomy. A total of 120 dogs weighing more than 20 kg, 40 of which were control animals, were enrolled in this retrospective study. Stifles were radiographically evaluated preoperatively and postoperatively on the side with CCLR and on the healthy contralateral side and compared with clinically normal stifles. PLT was reassessed after two months.Results: Significant decreases in median patellar height ratio were found after both procedures (TPLO 0.24 (0.05–0.8); CCWO 0.22 (0.05–0.4)). The postoperative craniocaudal patellar position and the median AMA angle differed significantly among the groups (P=0.000) (TPLO 87.5% caudal to the AA and 3.12° (0.76–6.98°); CCWO 100% cranial to the AA and 0° (-1.34–0.65°); control group 5% caudal to the AA and 0.99° (0–3.39°)).At 8 weeks, PLT grade differed significantly in the two operated groups (P=0.000) (TPLO 40% 0–2, 20% 2–4, 40% >4; CCWO 98.8% 0).Conclusions: TPLO and AMA-based CCWO are associated with significant decreases in patellar height; however, the PLT results two months postoperatively differed between the two groups; the decrease in patellar height and PLT were independent of osteotomy position in the TPLO group. Compared to TPLO, CCWO results in reduced postoperative AMA angles and craniocaudal patellar positions that more closely resemble those of unaffected dogs, suggesting that the CCWO procedure allows us to better correct the caudal bowing of the proximal tibia that is often associated with deficient stifles in large dogs with TPA >30°.

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Treatment of a combined deformity following tibial tubercle ventromedialization with single proximal tibial closing wedge osteotomy

Joint Diseases and Related Surgery ◽

10.5606/ehc.2019.19002 ◽

2019 ◽

Vol 30 (3) ◽

pp. 316-321

Author(s):

Erdem Aras Sezgin

Keyword(s):

Tibial Tubercle ◽

Wedge Osteotomy ◽

Closing Wedge Osteotomy ◽

Closing Wedge

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Results of closing wedge osteotomy in the treatment of sagittal imbalance due to ankylosing spondylitis

Acta Orthopaedica et Traumatologica Turcica ◽

10.3944/aott.2016.14.0059 ◽

2016 ◽

Cited By ~ 1

Author(s):

Fatih Yıldız

Keyword(s):

Ankylosing Spondylitis ◽

Wedge Osteotomy ◽

Sagittal Imbalance ◽

Closing Wedge Osteotomy ◽

Closing Wedge

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MANAGEMENT OF CUBITUS VARUS DEFORMITY BY LATERAL CLOSING WEDGE OSTEOTOMY- A CASE SERIES

Journal of Evolution of Medical and Dental Sciences ◽

10.14260/jemds/2017/489 ◽

2017 ◽

Vol 6 (27) ◽

pp. 2275-2277

Author(s):

Murugasarathy Sambandam ◽

Kalaiyarasan Thamizharasan ◽

Duraisamy Ezhilmaran ◽

Maharajothi Paramasivam

Keyword(s):

Case Series ◽

Varus Deformity ◽

Wedge Osteotomy ◽

Cubitus Varus ◽

Closing Wedge Osteotomy ◽

Closing Wedge

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Anterior Closing-Wedge Osteotomy for Posterior Slope Correction

Arthroscopy Techniques ◽

10.1016/j.eats.2018.07.003 ◽

2018 ◽

Vol 7 (11) ◽

pp. e1079-e1087 ◽

Cited By ~ 14

Author(s):

Tilman Hees ◽

Wolf Petersen

Keyword(s):

Wedge Osteotomy ◽

Posterior Slope ◽

Closing Wedge Osteotomy ◽

Closing Wedge ◽

Slope Correction

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Percutaneous Basal Closing Wedge Osteotomy of the First Metatarsal in the Treatment of Moderate to Severe Hallux Valgus and Its Short-Term Clinical Outcomes

Foot & Ankle Orthopaedics ◽

10.1177/2473011417748895 ◽

2018 ◽

Vol 3 (1) ◽

pp. 247301141774889

Author(s):

K. B. Chan ◽

Raymond Yeung

Keyword(s):

Clinical Outcomes ◽

Hallux Valgus ◽

Delayed Union ◽

Wedge Osteotomy ◽

Short Term ◽

Closing Wedge Osteotomy ◽

First Metatarsal ◽

Closing Wedge ◽

Severe Hallux Valgus ◽

Mini Open

Background: Although percutaneous surgery for the treatment of hallux valgus is popular in Europe, there is sparse English written literature documenting its efficacy. This study described the operative techniques using percutaneous basal closing wedge osteotomy of the first metatarsal in correction of moderate to severe hallux valgus (HV) and its short-term clinical outcomes. We postulated that satisfactory correction of hallux valgus (HV) angle, intermetatarsal (IM) angle, and patients’ clinical outcomes could be achieved with this technique. Methods: We conducted a retrospective review of 25 feet in 23 patients who underwent a percutaneous basal closing wedge osteotomy of the first metatarsal (MT1) combined with a mini-open modified McBride procedure and mini-open resection of medial eminence. Follow-up averaged 21.5 months. Radiographic outcomes included pre- and postoperative HV angle, IM angle, absolute and relative shortening of MT1, and time to union. American Orthopaedic Foot & Ankle Society (AOFAS) scores were compared between pre- and postoperatively. Results: The average HV angle improved from 39.4 (range, 29-58.3) degrees preoperatively to 14.7 (range, 0.1-23.2) degrees postoperatively ( P < .05). IM angle improved from 14.9 (range, 6.7-22.4) degrees to 6.6 (range, 0.9-14.8) degrees ( P < .05). The average absolute shortening was 3.8 (range, 0.27-12.91) mm and the relative shortening was 0.8 (range, 0.05-1.91) mm. There was no delayed union or malunion at the osteotomy site. The average AOFAS score improved from 39 (range, 12-50) to 81 (range, 70-93) ( P < .05). Conclusions: Satisfactory hallux valgus deformity correction and patients’ outcomes were achieved with this technique. Our results are similar to results reported in other studies using open techniques. There was no malunion or delayed union of the osteotomy. Level of Evidence: Level IV, case series study.

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