scholarly journals Proximal opening wedge metatarsal osteotomy for correction of moderate to severe hallux valgus deformity using a locking plate

2013 ◽  
Vol 37 (9) ◽  
pp. 1765-1770 ◽  
Author(s):  
Athanasios Badekas ◽  
Dimitrios Georgiannos ◽  
Vasilios Lampridis ◽  
Ilias Bisbinas
Keyword(s):  
Hallux Valgus ◽  
Locking Plate ◽  
Valgus Deformity ◽  
Metatarsal Osteotomy ◽  
Opening Wedge ◽  
Hallux Valgus Deformity ◽  
Severe Hallux Valgus

scholarly journals Rotated Insertion Metatarsal Osteotomy with Distal Soft Tissue Procedure for Severe Hallux Valgus Deformity ―Novel Procedure of the 1st metatarsal osteotomy―

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0003
Author(s):  
Norihiro Samoto ◽  
Yasuhito Tanaka ◽  
Ryuhei Katsui ◽  
Kazuya Sugimoto
Keyword(s):  
Soft Tissue ◽  
Hallux Valgus ◽  
Locking Plate ◽  
Valgus Deformity ◽  
Metatarsal Osteotomy ◽  
Rigid Fixation ◽  
Soft Tissue Procedure ◽  
Hallux Valgus Deformity ◽  
The Mean ◽  
Severe Hallux Valgus

Category: Bunion Introduction/Purpose: Hallux valgus deformity is recently a common disease involved in the foot and ankle and many procedures are recommended globally. However it is controversial about the operative treatment for severe hallux valgus. Many authors have reported the technical difficulties and various complications. We performed rotated insertion metatarsal osteotomy with the distal soft tissue procedure for severe hallux valgus deformity since January 2008. The purpose of this study is to evaluate the medium-term outcome of this procedure. Methods: Two hundred thirty-two feet in 173 patients were enrolled in this study and followed them up for a mean of 44.5 months. The mean age at the operation was 64.5 years. Hallux valgus angle(HVA) and intermetatarsal angle(IMA) were measured. This procedure consists of the rotated insertion metatarsal osteotomy and the distal soft tissue procedure. This diaphysial longitudinal metatarsal oblique osteotomy was performed from proximally- medial site of the first metatarsal directed to distally- lateral site through the dorsal exposure. The tip of osteotomized proximal metatarsal was formed at the dorso-distal site to insert in the central intramedullary aspect of osteotomized distal metatarsal. The second triangular cut of one third of dorso-plantar thick was made about 10 to 15 mm length from the lateral tip of osteomized proximal metatarsal. The internal fixation was performed with locking plate with screws. As a result, osteotomized sites were locked each other such as a puzzle. Results: The mean preoperative HVA and IMA were 43.8 degrees and 20.1 degrees. The mean postoperative HVA and IMA were decreased to 9.0 degrees and 6.1 degrees. AOFAS scores improved from 49.3 to 89.7. All cases were obtained complete union. Postoperative displacement was in 12 feet (5.2%) and followed under-correction (or recurrence). Overcorrection (hallux varus) occurred in 10 feet (4.7%). Wound healing was delayed in 21 feet (9.1%). In general, we found no severe complication and unsatisfactory result. Conclusion: This procedure provided satisfactory result for severe hallux valgus deformity. Especially the rigid fixation at the site of metatarsal osteotomy was much stronger because of the insertion and locking plate. However the further more outcomes in detail are essential for longer term follow-up.

scholarly journals Hallux MTP Arthrodesis for Treatment of Severe Hallux Valgus Using a Dorsal Locking Plate

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0031
Author(s):  
Wonyong Lee ◽  
Cooper M. Truitt ◽  
Venkat Perumal ◽  
Joseph Park
Keyword(s):  
Hallux Valgus ◽  
Failure Rate ◽  
Locking Plate ◽  
Weight Bearing ◽  
Valgus Deformity ◽  
X Rays ◽  
Lag Screw ◽  
Screw Augmentation ◽  
Hallux Valgus Deformity ◽  
Severe Hallux Valgus

Category: Bunion Introduction/Purpose: First metatarsophalangeal (MTP) joint arthrodesis is widely accepted as a treatment option for severe hallux valgus deformities. Although successful results of first MTP joint arthrodesis for hallux valgus have been reported in previous studies, the reported rates of fusion have been lower than for the general hallux rigidus population. The purpose of this study was to demonstrate the failure rate of first MTP joint arthrodesis for severe hallux valgus deformities and to evaluate radiographic correction of hallux valgus parameters after the surgery. Methods: From January 2014 to June 2017, 34 patients underwent first MTP joint arthrodesis surgery for severe hallux valgus deformity and were included in this retrospective study. Severe hallux valgus was defined as having a hallux valgus angle (HVA) of greater than 40 degrees and an intermetatarsal angle (IMA) greater than 15 degrees. For radiographic evaluation, the patients were evaluated by measuring the IMA and HVA in preoperative and postoperative weight-bearing AP foot x-rays. We defined failure after first MTP joint arthrodesis as non-union, incomplete union, or implant breakage or migration leading to a symptomatic recurrence of hallux valgus deformity. Results: The mean preoperative IMA and HVA were 16.7 ± 4.2 degrees (range 8.4 to 26.5) and 45.2 ± 8.6 degrees (range 28.7 to 71.1) respectively, and the postoperative IMA and HVA were 11.3 ± 3.8 degrees (range 4.1 to 20.4) and 20.9 ± 11.8 degrees (range 0.4 to 51.1) respectively. The postoperative IMA and HVA were significantly improved after surgery (< 0.001). Among the 34 patients in this study, a 14.7% failure rate was reported (n=5). For fusion procedures performed without lag screw fixation, there was a 12.6-fold increase in failure risk when we used the small dorsal locking plate compared with the medium dorsal locking plate (Odds ratio = 12.571). Conclusion: First MTP joint arthrodesis is an effective and reliable option for severe hallux valgus correction. However, for this challenging cohort, the 14.7% failure rate in this study is consistent with other studies in the literature. For severe hallux valgus deformities, selection of implant may play a more significant role. The use of longer plates to gain additional purchase in the diaphyseal bone, lag screw augmentation, and utilizing flat cuts instead of cup and cone reaming to realign the joint may help mitigate the increased stresses placed on the fixation constructs for MTP arthrodesis.

Clinical Outcomes after Chevron Procedure are Better than Pedobarographic Results

2014 ◽  
Vol 601 ◽  
pp. 177-180
Author(s):  
Radu Prejbeanu ◽  
Dinu Vermesan ◽  
Horia Hărăgus ◽  
Simona Vermesan ◽  
Dan Ioan Stoia
Keyword(s):  
Clinical Outcomes ◽  
Hallux Valgus ◽  
Pressure Sensors ◽  
Valgus Deformity ◽  
Physical Contact ◽  
Chevron Osteotomy ◽  
Hallux Valgus Deformity ◽  
Reaction Forces ◽  
Severe Hallux Valgus ◽  
Better Than

The distal Chevron or Austin procedure, is arguably the most prominent of the distal metatarsal osteotomies. Recent studies in the literature have shown a trend in recommending this osteotomy or one if it’s modifications for even severe hallux valgus deformities. Therefore we aimed to compare the clinical and pedobarographic results after chevron osteotomy in patients with moderate hallux valgus deformity. We investigated a homogeneous lot of 10 patients undergoing hallux valgus correction using distal chevron technique. In order to quantify the improvement of the gait in these patients, several biomechanical parameters have been measured using a matrix of pressure sensors that provide us the vertical reaction forces when the foot is in physical contact with it. Results show an improvement in patient’s velocity and cadence after the surgery, and also a smaller variability in gait. Nevertheless, optimal clinical outcomes are still found to have altered ground reaction forces on pedobarographic assessment.

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