Extra-articular dorsal closing-wedge osteotomy to treat late-stage Freiberg disease using polyblend sutures: technical tips and clinical results

Category: Midfoot/Forefoot Introduction/Purpose: The purpose of this study was to evaluate the clinical outcomes using a double stemmed flexible silicone prosthesis for the treatment of Freiberg disease in its late stages. Methods: The subjects consisted of 13 feet from 13 cases suffering from Freiberg disease that underwent extra-articular dorsal closing-wedge osteotomy using a polyblend suture. The average age was 31.7 (range 13–72) years. The average follow up period was 17 (range 14–24) months. Regarding image findings, time to bone union and metatarsal shortening was reviewed. The investigation was carried out using the range of motion (ROM), visual analog scale (VAS), and Japanese Society of the Surgery of Foot lesser toe scale (JSSF score) in the MTP joint before surgery and at the latest follow-up. Results: Calluses under the metatarsal head were not observed in any cases. The mean metatarsal shortening was 2.33± 2.07 mm at follow-up. The bone union required an average of 8.4±0.8 weeks. The average ROM of dorsal flexion improved from 37.2±5.3° before surgery to 73.6±9.9° at latest follow-up (p<0.0001). The average ROM of plantar flexion improved from 16.0±10.1° before surgery to 19.5±8.6° at latest follow-up (p=0.35). The average VAS significantly improved from 75.3±8.5 before surgery to 4.9±4.2 at latest follow-up (p<0.0001). The average JSSF score significantly improved from 67.3±9.4 points before surgery to 98.8±3.0 points at the latest follow-up (p<0.0001). Conclusion: Extra-articular dorsal closing-wedge osteotomy using a polyblend suture was carried out to treat Freiberg disease. The bone union was observed in all cases with improved clinical results. Fixation using a polyblend suture was considered to be useful.

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Clinical Results and Radiographic Changes after Radial Closing Wedge Osteotomy for Advanced Stages of Kienboeck's Disease.

Orthopedics & Traumatology ◽

10.5035/nishiseisai.48.997 ◽

1999 ◽

Vol 48 (4) ◽

pp. 997-1000

Author(s):

Shun Komine ◽

Hiroyuki Iida ◽

Osamu Soejima ◽

Tomomi Kikuta ◽

Kosuke Ogata

Keyword(s):

Clinical Results ◽

Wedge Osteotomy ◽

Closing Wedge Osteotomy ◽

Closing Wedge ◽

Advanced Stages ◽

Radiographic Changes

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Operative Treatment of Freiberg Disease Using Extra-articular Dorsal Closing-Wedge Osteotomy

Foot & Ankle International ◽

10.1177/1071100712460185 ◽

2013 ◽

Vol 34 (1) ◽

pp. 111-116 ◽

Cited By ~ 17

Author(s):

Hyun-Joo Lee ◽

Jeong-Woo Kim ◽

Woo-Kie Min

Keyword(s):

Operative Treatment ◽

Wedge Osteotomy ◽

Closing Wedge Osteotomy ◽

Closing Wedge ◽

Freiberg Disease

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Surgical Management of Freiberg Disease by Dorsal Closing Wedge Osteotomy

Malaysian Orthopaedic Journal ◽

10.5704/moj.2011.025 ◽

2020 ◽

Vol 14 (3) ◽

pp. 161-165

Author(s):

Dhar SA ◽

Mir NA ◽

Dar TA

Keyword(s):

Surgical Management ◽

Wedge Osteotomy ◽

Closing Wedge Osteotomy ◽

Closing Wedge ◽

Freiberg Disease

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Radiographic Impact of Lapidus, Proximal Lateral Closing Wedge Osteotomy, and Suture Button Procedures on First Ray Length and Dorsiflexion for Hallux Valgus

Foot & Ankle International ◽

10.1177/1071100720925438 ◽

2020 ◽

Vol 41 (8) ◽

pp. 964-971 ◽

Cited By ~ 1

Author(s):

Ian M. Foran ◽

Nasima Mehraban ◽

Stephen K. Jacobsen ◽

Daniel D. Bohl ◽

Johnny Lin ◽

...

Keyword(s):

Hallux Valgus ◽

Wedge Osteotomy ◽

Level Of Evidence ◽

Closing Wedge Osteotomy ◽

First Metatarsal ◽

Suture Button ◽

Closing Wedge ◽

Radiographic Measurements ◽

Valgus Angle ◽

First Ray

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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