Magnesium-based bioabsorbable screw fixation for hallux valgus surgery – A suitable alternative to metallic implants

Category: Bunion Introduction/Purpose: Kirschner-wires fixation, sometimes we have encountered pin irritation or pull-out. This is the reason why we consider additional fixation. Moreover, there are few reports according to comparison of fixation method, and Most of them focused on comparison K-wires or screw fixation only. Purpose of study is to compare clinical and radiographic outcome between Kirschner-wires only and combined screw fixation. Methods: The study included two different groups according to fixation methods. One with Kirschner-wires fixation (KW group) included 117 feet(of 98 patients), the other with combined screw fixation (KWS group) 56 feet (of 40 patients) with moderate to severe hallux valgus. Clinically, the preoperative and final follow-up visual analog scale (VAS) pain scores, the preoperative and final follow-up American Orthopaedic Foot & Ankle Society (AOFAS) hallux metatarsophalangeal (MTP)-interphalangeal (IP) scores, and patient satisfaction after the surgery were evaluated. Radiographically, the hallux valgus angle (HVA), intermetatarsal angle (IMA), medial sesamoid position (MSP), and first to fifth metatarsal width (1-5MTW) were analyzed before and after surgery. Results: The mean AOFAS score improved preoperative 65.5 to 95.3 at final follow up in group A, while preoperative 56.5 to 88.6 at final follow up. Pain VAS decreased from 5.7 to 0.5 in group A, whereas from 6.2 to 1.6 in group B. The mean HVA all improved from preoperative 38.5 to 9.3 at final follow up in group A and 34.7 to 9.1 in group B. The mean IMA and MSP also improved significantly at final follow up. In comparative analysis, the IMA did not show significant difference between postoperative and final state in group A, while showed significant increase in group B. Conclusion: We achieved favorable clinical and radiographic outcomes with minimal complications in patient with moderate to severe hallux valgus in both groups. However, this study shows no statistically significant difference in IMA during follow-up period and lower recurrence rate. Therefore we need to consider combined fixation method to provide better stability and can expect lower recurrence rate.

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Assessment of First Metatarsal Head Bone Density for Optimal Screw Placement in Minimally-Invasive Hallux Valgus Surgery

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00038 ◽

2020 ◽

Vol 5 (4) ◽

pp. 2473011420S0003

Author(s):

Katherine M. Dederer ◽

Patrick J. Maloney ◽

John T. Campbell ◽

Clifford L. Jeng ◽

Rebecca A. Cerrato

Keyword(s):

Bone Density ◽

Minimally Invasive ◽

Hallux Valgus ◽

Screw Fixation ◽

Weight Bearing ◽

Metatarsal Head ◽

Screw Placement ◽

Cannulated Screws ◽

First Metatarsal ◽

History Of

Category: Bunion; Basic Sciences/Biologics Introduction/Purpose: Minimally-invasive surgery (MIS) for hallux valgus correction has become increasingly common. This technique involves an osteotomy of the first metatarsal, followed by fixation with two cannulated screws. Since screws are typically not bicortical, they rely upon bone quality within the metatarsal head for fixation strength. However, bone mineral density (BMD) within different regions of the metatarsal head is unknown. Measuring the BMD in the target region may predict the strength of the bone-screw fixation. Similar to previous work which determined the optimal position for lag screw placement in the femoral head during hip fracture fixation, this study aimed to determine average BMD within four quadrants of the metatarsal head using CT and thus predict the optimal trajectories for cannulated screws during the MIS bunion procedure. Methods: All patients between 18-75 years of age scheduled to undergo MIS hallux valgus correction by one of two surgeons experienced in the MIS technique were eligible to participate. Patients were excluded if they had a prior first metatarsal surgery, pre-existing hardware, previous first metatarsal fracture, or a history of osteoporosis treatment. Patients were enrolled prospectively, and a weight-bearing CT scan of the affected foot was obtained pre-operatively. Demographic factors including age, sex, laterality, body mass index (BMI), comorbidities, and smoking status as well as standard three-view weight-bearing radiographs were collected for all patients.Using the coronal CT slice at maximal metatarsal head diameter, each head was divided into equal quadrants. Hounsfield units (HU) within each quadrant were measured independently by three study investigators using our hospital’s radiology viewing software (Merge PACS; IBM Corporation, Armonk, NY), and these density measurements were averaged. Statistical analysis was conducted using ANOVA and Student’s t-test. Results: Fifteen patients were included for preliminary analysis. All patients were female. The average age was 45.7 years. 9 of the 15 included feet were right feet. Average BMI was 28.0. One patient reported active smoking prior to surgery. Comorbidities included obesity in three patients; none were diabetic. One had a history of diplegic cerebral palsy. The average HVA on a weight- bearing AP foot x-ray was 28.2°, and the average IMA was 12.6°. The BMD within the metatarsal head varied by quadrant, with the two combined dorsal quadrants having higher average BMD than the two combined plantar quadrants (122 vs 85 HU; p<0.001). The dorsal lateral quadrant had the highest average BMD of any quadrant (132 HU, p<0.001; Table 1). Conclusion: The density of the metatarsal head did vary by region within the head. The highest BMD was found in the dorsal lateral quadrant, and the lowest in the plantar lateral and plantar medial quadrants, which did not differ significantly from each other. Because strength of screw fixation is predicated upon screw design as well as bone density, these results suggest that surgeons may wish to direct screws toward the dorsolateral region of the metatarsal head in order to achieve optimal fixation. Further work is needed to determine whether this varies with patient age, gender, or hallux valgus angle. [Table: see text]

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Comparison of Bioabsorbable Magnesium versus Titanium Screw Fixation for Modified Distal Chevron Osteotomy in Hallux Valgus

BioMed Research International ◽

10.1155/2018/5242806 ◽

2018 ◽

Vol 2018 ◽

pp. 1-9 ◽

Cited By ~ 8

Author(s):

Baver Acar ◽

Ozkan Kose ◽

Adil Turan ◽

Melih Unal ◽

Yusuf Alper Kati ◽

...

Keyword(s):

Hallux Valgus ◽

Screw Fixation ◽

Clinical Results ◽

Significant Loss ◽

Compression Screw ◽

Titanium Screw ◽

Chevron Osteotomy ◽

Valgus Angle ◽

Significant Difference ◽

Screw Group

Objective. The purpose of this retrospective study was to compare the clinical and radiological results of magnesium versus titanium screw fixation for modified distal chevron osteotomy in hallux valgus (HV). Materials and Methods. A total of 31 patients who underwent modified distal chevron osteotomy for HV deformity between 2014 and 2017 were reviewed retrospectively. Headless magnesium (Mg) compression screw fixation was applied in 16 patients (17 feet) and headless titanium (Ti) compression screw in 15 patients (17 feet). Patients were followed up for at least 12 months with a mean of 19.0 ± 6.8 months in the Mg screw group and 16.2 ± 6.19 in the Ti screw group, respectively (p: 0.234). Clinical results were evaluated using the American Orthopedic Foot and Ankle Society Hallux metatarsophalangeal-interphalangeal (AOFAS-MTP-IP) scale and a visual analogue scale (VAS). The hallux valgus angle (HVA) and intermetatarsal angle (IMA) were measured before and after surgery. Time to osteotomy union and any complications were recorded and compared between the groups. Results. An improvement in the AOFAS-MTP-IP scale and VAS points were recorded in both groups with no statistically significant difference between the groups (p: 0.764 and 0.535, resp.). At the final follow-up examination, HVA and IMA were similar (p: 0.226 and 0.712, resp.). There was no significant loss of correction between the early and final radiographs in respect of HVA and IMA in both groups (p: 0.321 and p: 0.067). Full union of the osteotomy was obtained in all patients. Prolonged (1.5 months) swelling and mild hyperemia around the surgical incision were observed in 1 patient in the Mg group but there was a good response to physical and medical therapy, and the complaints were completely resolved. There were no other significant complications in either group. Conclusion. The results of this study showed that bioabsorbable Mg compression screw fixation has similar therapeutic efficacy to Ti screw fixation in respect of functional and radiological outcomes. Bioabsorbable Mg screw is an alternative fixation material that can be safely used for modified distal chevron osteotomy in HV surgery.

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Modified Chevron Osteotomy for Hallux Valgus

Foot & Ankle International ◽

10.1177/107110079401501202 ◽

1994 ◽

Vol 15 (12) ◽

pp. 642-645 ◽

Cited By ~ 64

Author(s):

Richard E. Donnelly ◽

Charles L. Saltzman ◽

Todd A. Kile ◽

Kenneth A. Johnson

Keyword(s):

Hallux Valgus ◽

Screw Fixation ◽

Valgus Deformity ◽

Chevron Osteotomy ◽

Hallux Valgus Deformity ◽

Long Term Follow Up ◽

Reliable Procedure ◽

Shoe Wear

The chevron osteotomy for hallux valgus was modified by addition of screw fixation and change of the osteotomy angle. Thirty-six patients underwent this modified osteotomy. All had mild to moderate symptomatic hallux valgus deformities. No other forefoot procedures were performed. Standing radiographs were taken before surgery, at 1 month after surgery, and, for the 15 patients who returned for long-term follow-up, at 1 year or more after surgery. Overall, 35/42 procedures were rated as satisfactory without reservations and 7 were rated as satisfactory with mild reservations. All patients stated that they had some improvement in their preoperative symptoms, which included pain, cosmetic concerns, and shoe wear difficulties. Radiographically, none of the capital fragments displaced and there were no malunions, nonunions, nor evidence of avascular necrosis. The average metatarsophalangeal-1 angle improved 8° and the average intermetatarsal 1–2 angle improved 4°. This modification is relatively simple, increases stability, and allows early weightbearing. In our experience, the modified chevron osteotomy has been a very reliable procedure for mild to moderate symptomatic hallux valgus deformity.

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Femoral fracture following knee ligament reconstruction surgery due to an unpredictable complication of bioabsorbable screw fixation: a case report and review of literature

Journal of Orthopaedics and Traumatology ◽

10.1007/s10195-009-0079-x ◽

2009 ◽

Vol 11 (1) ◽

pp. 51-55 ◽

Cited By ~ 14

Author(s):

Sujith Konan ◽

Fares Sami Haddad

Keyword(s):

Case Report ◽

Femoral Fracture ◽

Ligament Reconstruction ◽

Screw Fixation ◽

Review Of Literature ◽

Knee Ligament ◽

Reconstruction Surgery ◽

Bioabsorbable Screw ◽

Knee Ligament Reconstruction

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Compare the Initial Result of One Screw or Two Screws Fixation for Proximal Crescentic Metatarsal Osteotomy with Distal Soft Tissue Reconstruction in Severe Hallux Valgus Treatment

10.21203/rs.3.rs-132132/v1 ◽

2021 ◽

Author(s):

Haijiao Mao ◽

Linger Wang ◽

Jiahui Li

Keyword(s):

Soft Tissue ◽

Hallux Valgus ◽

Screw Fixation ◽

Metatarsal Osteotomy ◽

Soft Tissue Reconstruction ◽

Single Screw ◽

Tissue Reconstruction ◽

Group 2 ◽

Severe Hallux Valgus ◽

Group 1

Abstract Proximal crescentic metatarsal osteotomy and distal soft tissue reconstruction have been introduced to correct severe hallux valgus (HV). The intrinsically unstable proximal first crescentic osteotomy depends on enough force fixation for stability. It is necessary to judge the number of fixation’s screw for osteotomy. Fifty two feet from 50 adult patients with severe HV were included in this study. The treatment was proximal crescentic metatarsal osteotomy with a single screw and distal soft tissue reconstruction in Group 1. The fixation with two screws with distal soft tissue reconstruction in Group 2. Clinical and radiological follow-ups were assessed after 4 and 12 months of operation. In Group 1, hallux valgus angle (HVA) was decreased from 46.4 ±3.28 to 19.9 ±4.70 after 12 months of operation. HVA was decreased from 45.1 ±3.45 to19.1 ±4.70 for group 2. For intermetatarsal angle (IMA) in Group 1, it was changed from 18.5 ±1.98 to 9.25 ±1.11 after 12 months of operation. For group 2, it was decreased from 18.3 ±1.81 to 9.53 ±1.70. Meanwhile, the American Orthopedic Foot and Ankle Society (AOFAS) score was improved from 63.1 to 83.9 after 12 months of operation for group1, and was improved from 64.3 to 82.8 for group2. Furthermore, the visual analogue scale (VAS) score was reduced from 4.5±1.01 to 1.7± 0.43 for group 1, and it was reduced from 4.7±0.92 to 1.7±0.55 for group 2 after 12 months of operation. The first metatarsal dorsal elevation was occurred in 4 feet in Group1, and no metatarsal dorsal elevation was occurred in Group 2. There were no significant differences identified among Group1 and Group 2 in terms of VAS and AOFAS scores, and HVA and IMA measurements. However, there is less complication in two-screw fixation for crescentic osteotomy compared to a single screw fixation.

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