scholarly journals Arthroscopic Dorsal Closing-Wedge Osteotomy of Metatarsal Head for Management of Freiberg Infraction

2019 ◽  
Vol 8 (11) ◽  
pp. e1289-e1293
Author(s):  
Tun Hing Lui ◽  
Andrew Ka Hei Fan
Keyword(s):  
Metatarsal Head ◽  
Wedge Osteotomy ◽  
Closing Wedge Osteotomy ◽  
Closing Wedge

scholarly journals Geometric Comparison of Second Metatarsal Shortening Osteotomy Variations Using 3D Printed Patient-Specific Models

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0002
Author(s):  
Eric Lukosius ◽  
Umur Aydogan ◽  
Gregory Lewis ◽  
Evan Roush
Keyword(s):  
Metatarsal Head ◽  
Patient Specific ◽  
Wedge Osteotomy ◽  
Metatarsal Osteotomy ◽  
Closing Wedge Osteotomy ◽  
Plantar Surface ◽  
Lateral Translation ◽  
Closing Wedge ◽  
Shortening Osteotomy ◽  
Second Metatarsal

Category: Midfoot/Forefoot Introduction/Purpose: Second metatarsal shortening osteotomy is frequently used in the treatment of metatarsalgia and aims to decrease metatarsophalangeal joint and plantar pressures. Although various proximal, midshaft, and distal metatarsal osteotomy methods have been described for surgical treatment of metatarsalgia, to our knowledge no studies quantitatively compared their resulting geometric corrections. The purpose of our study was to investigate how much each osteotomy variation changed the length of the metatarsal as well as the height and relative location of the metatarsal head (MH) itself. Methods: Following Institutional Review Board approval, three-dimensional computer models of second metatarsals of 5 deidentified clinic patients were extracted from CT scans using Mimics software. Fixed points were plotted on the printed models and a 3D coordinate digitizing arm (Microscribe) was used for precisely determining the 3D (x-y-z) coordinates of each point before and after the osteotomies. Six variations of second metatarsal osteotomies were performed using microsagittal saw and fixed using a 2.4 mm cannulated screw. The following osteotomy variations were performed with 3 and 5 mm translation or wedge resection for each patient model: (1) Classic Weil osteotomy performed at 15° and 25° to the plantar surface; (2) Classic Weil osteotomy performed at 15° and 25° using a double saw blade technique; (3) Classic Weil osteotomy performed at 25° and then a parallel block of 3 or 5 mm was removed; (4) Distal closing wedge osteotomy of the MH at 25°; (5) Proximal closing wedge osteotomy of the MH made at 45° removing a 3 and 5 mm wedge; (6) 45 degree oblique, midshaft, metatarsal osteotomy with 3 and 5 mm of translation. The change in the length of the metatarsal, and vertical and medio-lateral translation of the metatarsal head was calculated then normalized by the osteotomy translation distance. A general linear model with correlated errors and Bonferroni correction was used to assess differences between osteotomies. Results: The maximum metatarsal length shortening per millimeter translation was observed in osteotomy 3- 5 mm block (2.6 mm STD=2.1), while osteotomy 1- 15° caused the least (1.1 mm STD=0.6). Maximum dorsiflexion of the MH occurred with osteotomy 5- 5 mm wedge, 13.2 mm (STD= 4.9 mm) and minimum with osteotomy1- 25°, 0.5 mm (STD= 1.4 mm). No MH plantarflexion was noted with any of the osteotomies. The oblique midshaft osteotomies caused lateral translation of the metatarsal head significantly different from the controls (P <0.05) although not statistically different from one another (2.4 mm vs 4.3 mm). Conclusion: Discussion: Our data shows maximal change in length/millimeter translation by performing a classic Weil osteotomy at 25° to the plantar surface of the foot, 5 mm block resection and then translating 4 mm. This osteotomy also caused the most effective dorsal translation of the MH, thereby making it the most effective osteotomy in terms of affecting both length and MH vertical orientation. Should dorsiflexion of the MH be the surgeon’s only goal, then the proximal closing wedge osteotomy had the greatest impact while minimally changing overall length. With this knowledge, surgeons can tailor operations based on the direction and degree of correction needed to be achieved.

Proximal Closing Wedge Osteotomy and Adductor Tenotomy for Treatment of Hallux Valgus

Foot & Ankle ◽  
1989 ◽  
Vol 9 (6) ◽  
pp. 272-280 ◽  
Author(s):  
Sylvia Resch ◽  
Anders Stenström ◽  
Niels Egund
Keyword(s):  
Recovery Period ◽  
Large Change ◽  
Metatarsal Head ◽  
Wedge Osteotomy ◽  
Intermetatarsal Angle ◽  
Closing Wedge Osteotomy ◽  
First Metatarsal ◽  
Closing Wedge ◽  
Radiographic Measurements ◽  
Adductor Tenotomy

After 2 to 4 years, 25 patients (27 feet) who had a proximal closing wedge osteotomy of the first metatarsal and an adductor tenotomy were reviewed. A total of 20 patients (22 of 27 feet) were completely satisfied; 5 patients not completely satisfied had metatarsalgia because of dorsal displacement of the first metatarsal head. Radiographic measurements showed a narrowing of the forefoot rather than a large change in the intermetatarsal angle. The recovery period was long, an average of 11 weeks. Pin inflammation occurred in 5 patients and incisional neuromas in 2 patients. The risk of these complications must be taken into consideration when using this operation.

scholarly journals Treatment of late-stage Freiberg disease using a double stemmed flexible silicone prosthesis

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0004
Author(s):  
Mingzhu Zhang ◽  
Guang-Rong Yu ◽  
Yunfeng Yang
Keyword(s):  
Plantar Flexion ◽  
Metatarsal Head ◽  
Clinical Results ◽  
Bone Union ◽  
Wedge Osteotomy ◽  
Closing Wedge Osteotomy ◽  
Silicone Prosthesis ◽  
Closing Wedge ◽  
Freiberg Disease

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.

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

2020 ◽  
Vol 41 (8) ◽  
pp. 964-971 ◽  
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.

scholarly journals 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

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°.

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

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

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

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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