Correlation of Loss of Correction with postoperative radiological factors after distal chevron osteotomy in dependence of concomitant akin osteotomy

2021 ◽  
Author(s):  
Kaufmann Gerhard ◽  
Braito Matthias ◽  
Hofer Philipp ◽  
Putzer David ◽  
Ulmer Haonn ◽  
...  
Keyword(s):  
Loss Of Correction ◽  
Chevron Osteotomy ◽  
Akin Osteotomy

Loss of Correction After Chevron Osteotomy for Hallux Valgus as a Function of Preoperative Deformity

2018 ◽  
Vol 40 (3) ◽  
pp. 287-296 ◽  
Author(s):  
Gerhard Kaufmann ◽  
Stefanie Sinz ◽  
Johannes M. Giesinger ◽  
Matthias Braito ◽  
Rainer Biedermann ◽  
...  
Keyword(s):  
Hallux Valgus ◽  
Case Series ◽  
X Rays ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Loss Of Correction ◽  
Chevron Osteotomy ◽  
Significant Correction ◽  
Preoperative Deformity

Background: Recurrence is relatively common after surgical correction of hallux valgus. Multiple factors are discussed that could have an influence in the loss of correction. The aim of this study was to determine preoperative radiological factors with an influence on loss of correction after distal chevron osteotomy for hallux valgus. Methods: Five hundred twenty-four patients who underwent the correction of a hallux valgus by means of distal chevron osteotomy at our institution between 2002 and 2012 were included. We assessed weightbearing x-rays at 4 time points: preoperatively, postoperatively, and after 6 weeks and 3 months. We investigated the intermetatarsal angle (IMA), the hallux valgus angle (HVA), the distal metatarsal articular angle (DMAA), joint congruity, and the position of the sesamoids. Results: At all points of the survey, significant correction of the IMA and HVA was detected. The IMA improved from 12.9 (± 2.8) to 4.5 (± 2.4) degrees and the HVA from 27.5 (± 6.9) to 9.1 (± 5.3) degrees. Loss of correction was found in both HVA and IMA during follow-up with a mean of 4.5 and 1.9 degrees, respectively. Loss of correction showed a linear correlation with preoperative IMA and HVA, and a correlation between preoperative DMAA and sesamoid position. Conclusion: The chevron osteotomy showed significant correction for HVA, IMA, and DMAA. Preoperative deformity, in terms of IMA, HVA, DMAA, and sesamoid position, correlated with the loss of correction and could be assessed preoperatively for HVA and IMA. Loss of correction at 3 months persisted during the follow-up period. Level of Evidence: Level IV, retrospective case series.

Effect of Akin Osteotomy on Hallux Valgus Correction After Scarf Osteotomy With Hallux Valgus Interphalangeus

2019 ◽  
Vol 40 (10) ◽  
pp. 1182-1188 ◽  
Author(s):  
Gerhard Kaufmann ◽  
Philipp Hofer ◽  
Matthias Braito ◽  
Reto Bale ◽  
David Putzer ◽  
...  
Keyword(s):  
Hallux Valgus ◽  
Weight Bearing ◽  
Level Of Evidence ◽  
Scarf Osteotomy ◽  
Loss Of Correction ◽  
Valgus Angle ◽  
Akin Osteotomy ◽  
Group A ◽  
Joint Congruity ◽  
Initial Correction

Background: Recurrence after hallux valgus correction is a relatively frequent occurrence. Little is known about the importance of initial correction on radiologic outcome. The objective of our study was to determine postoperative radiologic parameters correlating with loss of correction after scarf osteotomy and the combined scarf/akin osteotomy, respectively. Methods: Loss of correction was evaluated based on a group of 53 feet with isolated scarf osteotomy (S group) and a group of 17 feet with combined scarf and akin osteotomy (SA group) in a retrospective analysis. The intermetatarsal angle (IMA), the hallux valgus angle (HVA), the distal metatarsal articular angle (DMAA), the proximal to distal phalangeal articular angle (PDPAA), the position of the sesamoids, and joint congruity were measured in weight-bearing radiographs preoperatively and postoperatively throughout a mean follow-up of 44.8 ± 23.6 months. Results: Loss of correction was comparable between the S and the SA group ( P > .05). In contrast, we found higher loss of HVA correction in the S subgroup with a preoperative PDPAA above 8 degrees ( P = .011), whereas loss of correction in the S subgroup below 8 degrees of PDPAA was comparable to the SA group. In the S group, loss of correction showed significant correlation with postoperative IMA ( P = .015) and PDPAA ( P = .008), whereas in the SA group a correlation could be detected for IMA only ( P = .045). Conclusion: In cases with a PDPAA above 8 degrees, we recommend a combined scarf/akin osteotomy to diminish the potential for loss of correction. Level of Evidence: Level III, therapeutic, retrospective comparative series.

Does Hallux Valgus Correction Reduce the Width of the Forefoot?

2019 ◽  
Vol 13 (2) ◽  
pp. 112-115 ◽  
Author(s):  
Vinod Panchbhavi ◽  
Justin Cordova ◽  
Jie Chen ◽  
Cory Janney
Keyword(s):  
Clinical Outcomes ◽  
Hallux Valgus ◽  
Surgical Procedures ◽  
Case Series ◽  
Hallux Valgus Angle ◽  
Linear Measurements ◽  
Levels Of Evidence ◽  
Chevron Osteotomy ◽  
Valgus Angle ◽  
Akin Osteotomy

Background: Hallux valgus has been associated with a widened forefoot. Most surgical procedures for the correction of hallux valgus have the potential to reduce forefoot width. Success after hallux valgus surgery is correlated with relief of toe pain in conventional shoes and improvement in the appearance of the foot. Therefore, reduction in forefoot width, referred to as metatarsal span (MS), likely correlates with both criteria and may be a reliable radiographic indicator of success after hallux valgus surgery. Methods: Preoperative and postoperative radiographs of 52 patients who underwent correction of hallux valgus with a distal Chevron osteotomy and Akin osteotomy were evaluated by 4 observers. The observers measured the hallux valgus angle (HVA), the intermetatarsal first and second angle (IMA), and the MS. Results: Preoperative HVA ranged from 14° to 48°, IMA ranged from 6° to 25°, and MS ranged from 74.2 to 110.6 mm. The average HVA improvement was 19.4°, IMA improvement was 6.7°, and MS reduction was 8.7 mm. No correlation was identified with regard to correction of the HVA or IMA to MS. Conclusion: Digital radiographic linear measurements were easily and reliably made. Therefore, linear measurements as described in this article can be used as a tool to evaluate if clinical outcomes correlate with reduction of MS. A distal Chevron with an Akin osteotomy has the potential to reduce forefoot width. Levels of Evidence: Level IV: Case series

scholarly journals Percutaneous Chevron Osteotomy Combined with Adductor Tendon Release for Hallux Valgus Correction

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0013
Author(s):  
Sofia Carlucci ◽  
Nelly Carrasco ◽  
Maria Santini-Araujo ◽  
Ana Parise ◽  
Leonardo Conti ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Hallux Valgus ◽  
Deformity Correction ◽  
Hallux Valgus Angle ◽  
Chevron Osteotomy ◽  
Metatarsal Angle ◽  
Valgus Angle ◽  
Akin Osteotomy ◽  
American Orthopaedic

Category: Bunion, Midfoot/Forefoot Introduction/Purpose: The use of minimally invasive techniques for hallux valgus may provide complete deformity correction with minor soft tissue damage, which reduces morbidity and shortens recovery. In this way, some open osteotomies were adapted to percutaneous approaches, with good outcomes reported. The minimally invasive chevron-Akin (MICA) described by Vernois and Redfern in 2011, combines benefits of percutaneous approaches with a stable internal fixation. Since 2015 we have adapted this technique, by adding a percutaneous adductor tenotomy to dispense with the Akin osteotomy. The aim of this study was to report a single surgeon series of consecutive patients with moderate hallux valgus managed with a minimally invasive chevron osteotomy and a percutaneous adductor tendon release. Methods: This was a prospective cohort study. A total of 38 feet with moderate hallux valgus underwent the procedure and were followed up for a minimum 12 months (SD 1.10). The median age was 58 years (IQR 52 - 65), 36 women and 2 men. Radiological parameters were compared at preoperatory and at the last follow-up and included: Hallux Valgus Angle (HVA), Inter- Metatarsal Angle (IMA), Distal Metatarsal Articular Angle (DMAA) and first metatarsal shortening. Time to consolidation was also assessed. For clinical evaluation the American Orthopaedic Foot & Ankle Society score (AOFAS) was evaluated. Complications during the follow up were reported. Patients in which another procedure in the hallux was performed, with previous surgeries or not completed 1 year follow-up were excluded. Results: Radiologic postoperative parameters demonstrated to achieved correction. At the last follow up there was a statistically significant decrease in the hallux valgus angle, the intermetatarsal angle and distal metatarsal articular angle. Shortening of the first metatarsus was a mean 7.02 mm (IQR 1.24 - 10,27). The mean AOFAS score increased from 58.23 (SD 9.02) pre-operatively to 97.15 (SD 4.72) post-operatively (p< 0.001). Complications reported were 2 superficial infections, 1 broken screw, 1 screw extraction. Five patients referred metatarsalgia after surgery and 1 presented a fourth metatarsal stress fracture. Only one patient presented lost of correction in the first postoperative week and needed a second surgery. Conclusion: Our series of hallux valgus correction with a minimally invasive chevron osteotomy combined with the adductor tendon release shows good clinical and radiological outcomes, and results are comparable to series with the additional Akin osteotomy. Comparative studies are needed for major evidence.

Intraosseous Sliding Plate Fixation Used in Double Osteotomy Bunionectomy

2018 ◽  
Vol 40 (1) ◽  
pp. 85-88 ◽  
Author(s):  
Gordon L. Bennett ◽  
Derek Klaus ◽  
Scott Shemory ◽  
James A. Sabetta
Keyword(s):  
Hallux Valgus ◽  
Plate Fixation ◽  
Cannulated Screw ◽  
Ease Of Use ◽  
Metatarsal Osteotomy ◽  
Chevron Osteotomy ◽  
Number Of Patients ◽  
Double Osteotomy ◽  
Akin Osteotomy ◽  
Plate System

Background: Distal chevron metatarsal osteotomy bunionectomy is a commonly performed procedure for the treatment of mild to moderate hallux valgus. We continue to use the intraosseous sliding osteotomy plate system for fixation of the distal metatarsal osteotomy. With the addition of the Akin osteotomy, we are able to obtain reliable, reproducible correction with better cosmesis and increased patient satisfaction for more advanced deformities. Methods: We prospectively evaluated 138 (145 feet) consecutive patients who underwent double osteotomy bunionectomy using the intramedullary plate system and 3.2-mm cannulated screw system. The senior author performed all operative procedures. Patients were evaluated preoperatively, postoperatively, and at the final follow-up using the American Orthopaedic Foot & Ankle Society (AOFAS) forefoot scoring system. Results: All osteotomy sites of operatively corrected feet healed. There were no hardware failures. A small number of patients complained of stiffness and pain related to the hardware. All patients dramatically improved their AOFAS scores compared with preoperative values. The hallux valgus angle was corrected by a mean of 17.3 degrees (range, 10 to 20 degrees), and the intermetatarsal angle was corrected by a mean of 6.8 degrees (range, 5 to 9 degrees). Conclusion: Chevron osteotomy paired with an Akin osteotomy (double osteotomy bunionectomy) resulted in excellent function and pain relief. We continue to recommend the use of the intramedullary plate system and 3.2-mm cannulated screw system because of its low profile, reliability of fixation, and relative ease of use. Level of Evidence: Level III, retrospective comparative series.

Percutaneous Transosseous Suture Fixation of the Akin Osteotomy and Minimally Invasive Chevron for Correction of Hallux Valgus

2020 ◽  
Vol 41 (9) ◽  
pp. 1079-1091 ◽  
Author(s):  
Henryk Liszka ◽  
Artur Gądek
Keyword(s):  
Minimally Invasive ◽  
Hallux Valgus ◽  
Screw Fixation ◽  
Functional Improvement ◽  
Level Of Evidence ◽  
Transosseous Suture ◽  
Chevron Osteotomy ◽  
Akin Osteotomy ◽  
Group A ◽  
Group B

Background: The objective of the study was evaluation of the clinical and radiologic outcomes and complications following the minimally invasive chevron procedure employing the Akin osteotomy with percutaneous transosseous suture as compared to screw fixation. Methods: Between 2018 and 2019, the authors performed 103 minimally invasive chevron (MIC) with Akin osteotomies. In 54 patients, the Akin osteotomy was performed with screw stabilization (group A), and in 49 with percutaneous transosseous suture (group B). Preoperatively and 1 year later, the authors employed anteroposterior and lateral weightbearing radiographs of the feet to evaluate interphalangeal angle (IPA), distal phalangeal articular angle (DPAA), proximal phalangeal articular angle (PPAA), intermetatarsal angle (IMA), hallux valgus angle (HVA), and functional result using the American Orthopaedic Foot & Ankle Society (AOFAS) hallux-metatarsophalangeal-interphalangeal scale. Furthermore, all additional procedures and complications were recorded. Results: Both groups demonstrated a statistically significant decrease of the value of HVA (group A: from 34.1° to 14.0°, group B: from 33.6° to 13.0°), DPAA (group A: from 12.1° to 4.0°, group B: from 11.5° to 3.4°), PPAA (group A: from 4.6° to 1.7°, group B: from 4.3° to 1.5°), IMA (group A: from 15.1° to 8.0°, group B: from 14.7° to 7.5°) and IPA (group A: from 14.1° to 6.3°, group B: from 12.9° to 5.1°). Functional improvement as measured using the AOFAS scale was achieved in both groups (group A: from 42 to 90 points, group B: from 40 to 89 points). No cases of bone nonunion or delayed union and permanent damage to the medial dorsal cutaneous nerve were seen. Two group B patients underwent conversion of the fixation of the Akin osteotomy to screws, 3 patients had their MICA screws and 1 Akin screw removed in the outpatient setting. Conclusion: The minimally invasive chevron osteotomy with transosseous suture stabilization of the Akin osteotomy was a safe method with good functional results that were comparable to the outcomes achieved when using screw fixation. Level of Evidence: Level III, retrospective comparative study.

Sign in / Sign up

Export Citation Format

Share Document