Percutaneous, Intra-articular, Chevron Osteotomy (PeICO) for the Treatment of Hallux Valgus: A Cadaveric Study

2019 ◽  
Vol 40 (5) ◽  
pp. 586-595 ◽  
Author(s):  
Jorge Javier Del Vecchio ◽  
Mauricio Esteban Ghioldi ◽  
Anuar Emanuel Uzair ◽  
Lucas Nicolás Chemes ◽  
María Cristina Manzanares-Céspedes ◽  
...  
Keyword(s):  
Sagittal Plane ◽  
Metatarsophalangeal Joint ◽  
Cadaveric Study ◽  
Percutaneous Surgery ◽  
Lateral Border ◽  
Iatrogenic Injuries ◽  
Orthopedic Surgeons ◽  
Chevron Osteotomy ◽  
Extensor Hallucis Longus ◽  
Fresh Frozen

Background: Percutaneous surgery is experiencing sustained growth based on third-generation techniques. This cadaveric study was designed with the main goal of exploring the risk of iatrogenic tendon and neurovascular lesions and defining the safe zones in a percutaneous, intra-articular, chevron osteotomy (PeICO) procedure, as well as assessing the accuracy of the osteotomy itself. Methods: Eight feet from below-knee fresh-frozen specimens were selected. After the procedure, the specimens were dissected, and structures were inspected for damage. Results: The results of the safety measurements were as follows: (1) distance between portal 1 (P1) and the lateral border of the extensor hallucis longus (EHL) tendon: average 17.6 mm (range 12.7-21.3); (2) distance between P1 and the dorsomedial digital nerve (DMDN): average 7.2 mm (range 1.6-10.4); (3) distance between P1 and the metatarsophalangeal joint: average 15.7 mm (range 9.4-20.5); distance between portal 2 (P2), or the osteosynthesis portal, and the metatarsophalangeal joint: average 25.5 mm (range 22-30.4); distance between P2 and the lateral border of the EHL tendon: average 12.7 mm (range 8-16.7); and distance between P2 and the DMDN: average 4.1 mm (range 1.7-8.2). There were no iatrogenic injuries. The osteotomy angulation in the sagittal plane (reproducibility) average was 85.6 degrees. Conclusion: There were no iatrogenic injuries on this cadaveric study of PeICO. Clinical Relevance: This study will help orthopedic surgeons understand the risks of performing percutaneous surgery by mimicking an accepted open technique (chevron).

scholarly journals Percutaneous, intra-articular Chevron osteotomy (PICO) for the treatment of hallux valgus. A Cadaveric Study

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0050
Author(s):  
Jorge Del Vecchio ◽  
Miki Dalmau-Pastor ◽  
Anuar Uzair ◽  
Mauricio Ghioldi ◽  
Lucas Chemes
Keyword(s):  
Hallux Valgus ◽  
Sagittal Plane ◽  
Cadaveric Study ◽  
Lateral Release ◽  
Minimal Risk ◽  
Third Generation ◽  
Lateral Border ◽  
Forefoot Surgery ◽  
Chevron Osteotomy ◽  
The Mean

Category: Bunion Introduction/Purpose: Percutaneous or minimally invasive surgery (MIS) forefoot surgery has experienced a vertiginous and sustained growth especially in the last decade. This is supported by numerous studies among which can be mentioned: clinical series, comparative studies, technique reports, radiological validations. Two cadaveric studies considered percutaneous forefoot surgery safe and has reported minimal risk which is consistent with clinical studies. We can consider that MIS forefoot surgery is transiting a sustained and responsible experience based on Third generation (TG) techniques (Open Chevron like). The purpose of this cadaveric study was to investigate the risk of iatrogenic neurovascular and tendon injury in a TG technique. Particularly, this study evaluated the Percutaneous, Intraarticular, Chevron Osteotomy (PICO) for the correction of hallux valgus. Methods: Eight unpaired feet, from Caucasian fresh frozen voluntary donor specimens were carefully dissected. One surgeon (JJDV) performed all of the procedures. In each foot, the surgeon performed a PICO and a lateral release of the first metatarsophalangeal joint (MTPJ). To evaluate the safety of the procedure the following data was obtained: 1. Distance between (DB) PICO portal (PP) and lateral border of the extensor hallucis longus (EHLT); 2. DB PP and dorsomedial digital nerve (DMDN); 3. DB PP and MTPJ; 4. DB Osteosynthesis portal (OP) and MTPJ; 5. DB OP and lateral border of EHLT; 6. DB OP and DMDN. This anatomical study also assessed if any arterial plexus damage was present via an indirect method by examination of the capsule and soft tissue around the first metatarsal. In addition, the following measurements were taken: angulation of osteotomy in the sagittal plane (Reproducibility) and IMA and HV angles (Correction power). Results: Two independent observers made all the assessments. The results of the safety measurements were as follow: 1. Average: 17,64 (range: 12,72-21,31); 2. Average: 7,29 (range:1,62-10,41); 3. Average: 15,72 (range: 9,48-20,52); 4. Average: 25,55 (range: 22,06-30,44); 5. Average: 12,77 (range: 8,04-16,71); 6. Average: 4,14 (range:1,72-8,20). There were no iatrogenic injuries. Nevertheless, the DB OP and DMDN showed the lowest average distance. With respect of the osteotomy angulation in the sagittal plane (Reproducibility), the average was: 85,62º (range: 78-100). Mean preoperative intermetatarsal angle (IMA) was 9,75° (range: 8-18°), and postoperatively the mean IMA was 8° (range: 4-13°). Before surgery the mean hallux valgus angle (HVA) was 22° (range: 13-40°) and the average postoperative HVA was 13,5° (range: 6-34°). Conclusion: The “Third generation” (TG) techniques reliably mimics the open Chevron procedure with all its known virtues whilst does not reproduce its disadvantages and complications. Also, according to several studies, these surgeries are useful, effective and (maybe) easier than open procedures. The proposed surgery (PICO) has shown to be safe, reproducible and have effective correction power when performed by a single surgeon (Trained in MIS surgery). We emphasize that percutaneous surgery has an extensive learning curve and therefore it may be difficult to reproduce the results initially.

The Hallux Metatarsophalangeal Capsule: An Anatomic Study With Respect to Percutaneous Hallux Valgus Correction

2021 ◽  
pp. 107110072110272
Author(s):  
Kenneth M. Chin ◽  
Nicholas S. Richardson ◽  
John T. Campbell ◽  
Clifford L. Jeng ◽  
Matthew W. Christian ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Hallux Valgus ◽  
Metatarsal Head ◽  
Cadaveric Study ◽  
Anatomic Study ◽  
Orthopedic Surgeons ◽  
Popular Knowledge ◽  
Fresh Frozen ◽  
The Mean ◽  
Anatomic Relationship

Background: Minimally invasive surgery for the treatment of hallux valgus deformities has become increasingly popular. Knowledge of the location of the hallux metatarsophalangeal (MTP) proximal capsular origin on the metatarsal neck is essential for surgeons in planning and executing extracapsular corrective osteotomies. A cadaveric study was undertaken to further study this anatomic relationship. Methods: Ten nonpaired fresh-frozen frozen cadaveric specimens were used for this study. Careful dissection was performed, and the capsular origin of the hallux MTP joint was measured from the central portion of the metatarsal head in the medial, lateral, dorsal, plantarmedial, and plantarlateral dimensions. Results: The ten specimens had a mean age of 77 years, with 5 female and 5 male. The mean distances from the central hallux metatarsal head to the MTP capsular origin were 15.2 mm dorsally, 8.4 mm medially, 9.6 mm laterally, 19.3 mm plantarmedially, and 21.0 mm plantarlaterally. Conclusion: The MTP capsular origin at the hallux metatarsal varies at different anatomic positions. Knowledge of this capsular anatomy is critical for orthopedic surgeons when planning and performing minimally invasive distal metatarsal osteotomies for the correction of hallux valgus. Type of Study: Cadaveric Study.

Structures at Risk During Percutaneous Extra-Articular Chevron Osteotomy of the Distal First Metatarsal

2019 ◽  
pp. 193864001989591
Author(s):  
Maria McGann ◽  
Travis M. Langan ◽  
Roberto A. Brandão ◽  
Gregory Berlet ◽  
Mark Prissel
Keyword(s):  
At Risk ◽  
Minimally Invasive ◽  
Hallux Valgus ◽  
Metatarsophalangeal Joint ◽  
Joint Capsule ◽  
Flexor Hallucis Longus ◽  
First Metatarsophalangeal Joint ◽  
Chevron Osteotomy ◽  
Extensor Hallucis Longus ◽  
Medial Eminence

Background. Minimally invasive surgery of the forefoot has regained popularity as an alternative to traditional open procedures. Minimally invasive hallux valgus surgery has been shown to be effective and reproducible for the treatment of mild to moderate hallux valgus. The aim of this study is to identify vital structures that are at risk for iatrogenic damage while performing a minimally invasive distal chevron osteotomy due to limited direct visualization. Methods. Ten fresh-frozen below knee cadavers were used for this study. A minimally invasive distal chevron osteotomy and medial eminence resection with a 2.2 mm × 22 mm Shannon burr was performed on each cadaver. Each specimen was dissected to expose the potential structures at risk for injury during the procedure. Structures evaluated included the medial neurovascular bundle, first metatarsophalangeal joint capsule, extensor hallucis longus tendon, flexor hallucis longus tendon, abductor hallucis tendon, and the sesamoid apparatus. Results. Ten specimens were evaluated. The dorsal medial cutaneous nerve was directly injured in 5 of the 10 cadaver specimens and intact/uninjured in the remaining 5 specimens. The flexor hallucis longus, extensor hallucis longus, adductor tendon, sesamoid apparatus, and first metatarsophalangeal joint capsule were uninjured in all specimens. Conclusion. Minimally invasive chevron distal osteotomy and medial eminence resection has a high learning curve. The resection of the medial eminence may iatrogenically injure the dorsal medial cutaneous nerve. The incidence is higher in this study than prior reported cadaveric studies and may warrant extra care to protect vital structures. Level of Evidence: Level IV: Cadaver study

Correlation analysis of the x-ray and functional parameters from the results of chevron (Austin) osteotomy for hallux valgus

2020 ◽  
pp. 54-63
Author(s):  
Ruslan Khairutdinov ◽  
Timur Minasov ◽  
Ekaterina Yakupova ◽  
Elvina Mukhametzyanova
Keyword(s):  
Hallux Valgus ◽  
Rating Scale ◽  
Metatarsophalangeal Joint ◽  
Valgus Deformity ◽  
First Metatarsophalangeal Joint ◽  
Chevron Osteotomy ◽  
Hallux Valgus Deformity ◽  
Valgus Angle ◽  
The Right ◽  
Bone Structures

Hallux valgus is characterized by the appearance and growth of a painful “lump” in the region of the first metatarsophalangeal joint, the development of forefoot corns, and inability to choose the right shoes, which leads to a significant decrease in the quality of life of these patients. Corrective osteotomies that preserve the metatarsophalangeal joint, for example Austin (Chevron) osteotomy, are usually used for hallux valgus deformity of the I, II degrees. Radiography with the study of the hallux valgus angle (HVA), the intermetatarsal angle (IMA), the distal metatarsal articular angle (DMAA) is a research method that shows the true correlation between bone structures. The correlation between the radiological and functional indicators of osteotomy allows us to determine possible recommendations for indications for surgical treatment of Hallux valgus. Correlation shows that the largest correction of hallux valgus in older patients occurs due to a small adjustment of the angle of DMMA and HVA. IMA had the best correction after Austin osteotomy among patients of a younger age, then the HVA, and the DMMA had minimum correction according to the AOFAS rating scale (Kitaoka). The revealed correlations allow us to determine the correct tactics for the treatment of hallux valgus by identifying the benefits of Austin osteotomy.

Multiplanar Correction of the Lesser Digital Deviation and Indirect Plantar Plate Rupture Repair Using a Braided Polyethylene Nylon Suture: A Technique Guide

2017 ◽  
Vol 10 (6) ◽  
pp. 551-554 ◽  
Author(s):  
Cody D. Blazek ◽  
Roberto A. Brandão ◽  
Jeffrey M. Manway ◽  
Patrick R. Burns
Keyword(s):  
Sagittal Plane ◽  
Digital Pathology ◽  
Metatarsophalangeal Joint ◽  
Metatarsal Head ◽  
Foot And Ankle ◽  
Dorsal Approach ◽  
Plantar Plate ◽  
Direct Repair ◽  
Nylon Suture ◽  
A New Technique

Forefoot and lesser digital pathology continues to be a challenging area of surgical correction for foot and ankle surgeons. Many techniques for the correction of digital deformities secondary to plantar plate rupture, regardless of planal dominance, have been described including direct repair and metatarsal shortening osteotomies for repair. The authors present a new technique for multiplanar correction of deformed lesser digits without direct repair of the plantar plate rupture utilizing a specialty suture. The technique utilizes a braided synthetic polyethylene Nylon suture, which has been traditionally used for open or arthroscopic shoulder labrum repair, for the stabilization of the lesser metatarsophalangeal joint. This novel technique guide for the correction of transverse and sagittal plane deformities of the digit at the metatarsophalangeal joint negates the need for a plantar incisional approach for plantar plate repair or metatarsal head osteotomy from a dorsal approach with augmented stabilization. Levels of Evidence: Level V: Expert opinion

Examination of the Origin and Branching Direction of the Anterior Medial Malleolar Artery From the Anterior Tibial Artery: A Cadaveric Study

2018 ◽  
Vol 12 (2) ◽  
pp. 167-171 ◽  
Author(s):  
Ichiro Tonogai ◽  
Fumio Hayashi ◽  
Yoshihiro Tsuruo ◽  
Koichi Sairyo
Keyword(s):  
Ankle Joint ◽  
Sagittal Plane ◽  
External Iliac Artery ◽  
Longitudinal Axis ◽  
Cadaveric Study ◽  
Ankle Arthroscopy ◽  
Anterior Tibial Artery ◽  
Tibial Artery ◽  
Anterior Tibial ◽  
Branching Point

Background. This study characterized the anterior medial malleolar artery (AMMA) branching from the anterior tibial artery (ATA) to identify problems in anterior ankle arthroscopy possibly contributing to injury to the AMMA. Methods. Barium was injected into 12 adult cadaveric feet via the external iliac artery and the origin and branching direction of the AMMA were identified on computed tomography. Results. The AMMA originated from the level of the ankle joint and below and above the ankle joint line (AJL) in 4 (33.3%), 6 (50.0%), and 1 (8.3%) specimen, respectively. Mean distance from the AJL to the branching point of the AMMA on the sagittal plane was 2.5 mm distal to the AJL. Mean angle between the distal longitudinal axis of the ATA and AMMA was 83.2°. Conclusions. This study established the origin and branching of the AMMA from the ATA. The AMMA should be examined carefully during ankle arthroscopy. Levels of Evidence: Level IV: Cadaveric study

Plantar Pressure and Load in Cadaver Feet After a Weil or Chevron Osteotomy

2005 ◽  
Vol 26 (2) ◽  
pp. 158-165 ◽  
Author(s):  
John Snyder ◽  
John Owen ◽  
Jennifer Wayne ◽  
Robert Adelaar
Keyword(s):  
Contact Area ◽  
Plantar Pressure ◽  
Metatarsal Osteotomy ◽  
Plantar Surface ◽  
First Metatarsal ◽  
The Third ◽  
Load Transmission ◽  
Chevron Osteotomy ◽  
First Ray ◽  
Fresh Frozen

Background: Since metatarsal osteotomy was first used to treat metatarsalgia in the early twentieth century, many techniques have been described to accomplish the basic aim of reduction of load transmission through the operated metatarsal and reduction of localized high pressure on the plantar surface of the metatarsal. Our study examined two popular distal metatarsal neck osteotomies used for the relief of central metatarsalgia and the biomechanical changes that result from their use in a cadaver forefoot model. Methods: After applying 445N (100 lbs) of axially directed force, we measured plantar pressure using the TekScan HR Mat™ (TekScan, Inc., South Boston, MA) in twelve paired, thawed, fresh-frozen intact cadaver legs, then after either a Weil or chevron osteotomy of the second metatarsal and finally after the addition of the same osteotomy of the third metatarsal. Results: Load in the forefoot was not significantly affected by the Weil osteotomy. A significant increase in load was produced in the first metatarsal region, and significant decreases in load were produced beneath the operated metatarsal heads after the chevron osteotomy. Average pressure in the contact area of the forefoot showed similar trends; however, load and pressure changes occurred independently, owing to the changes in contact area produced by the osteotomies. No significant changes were observed in the nonoperated metatarsal regions. Conclusions: In this model, the chevron osteotomy more effectively reduced load and plantar pressure in the operated metatarsal regions; however, increases in load and pressure were observed in the first metatarsal region. The increase in pressure without a change in load in region 3 (third metatarsal) after a Weil osteotomy of the third metatarsal was attributed to the creation of a plantar prominence. This study did not show a reduction in load transmission as a result of the Weil osteotomy, which contradicts the proposed mechanism of clinical benefit. An intact first ray likely prevents transfer of load or pressure to adjacent lesser metatarsals with chevron osteotomy.

scholarly journals Safe Zone for Percutaneous Screw Fixation - Talonavicular Fusion

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0043
Author(s):  
Ashish Shah ◽  
Sung Lee ◽  
Sameer Naranje ◽  
Zachariah Pinter ◽  
Robert Stibolt ◽  
...  
Keyword(s):  
Medial Branch ◽  
Screw Insertion ◽  
Anterior Branch ◽  
Bony Landmarks ◽  
Medial Plane ◽  
Extensor Hallucis Longus ◽  
Hindfoot Deformities ◽  
Fresh Frozen ◽  
Optimal Fusion ◽  
Neurovascular Structures

Category: Hindfoot Introduction/Purpose: Talonavicular fusion has been established as a reliable intervention for degenerative, inflammatory, and traumatic joint lesions as well as hindfoot deformities. In order to achieve optimal fusion, various versions of the procedure have been introduced in literature and have remained a topic of contention, with the most common variation involving the insertion of 1 to 3 screws dorsomedially and dorsolaterally. Dorsolateral screw placements commonly cause neurovasculature injury. The purpose of our cadaveric study was first to establish the safety of the dorsolateral percutaneous screw insertion in relation to these dorsal neurovascular structures, and then subsequently to standardize the ideal placement of the dorsolateral screw by comparing two insertion sites based on consistent bony landmarks. Methods: Ten fresh-frozen cadaver legs amputated at the knee were used for this study. Percutaneous cannulated screws were inserted to perform isolated talonavicular arthrodesis. The screws were inserted at 3 consistent sites: “medial screw” at dorsomedial navicular where it intersected at the medial plane of the first cuneiform, “central screw” at the edge of dorsal navicular between medial and intermediate cuneiforms, and “lateral screw” at the edge of dorsal navicular between intermediate and lateral cuneiforms. Superficial and deep dissections were carried out to identify any injured nerves, arteries, and tendons. Results: The mean age at death in our sample of cadavers was 80.1 ± 7.5 years (range 68 to 92) and had the BMI of 21.8 ± 2.4 (range 18.1 to 25.1). There were 5 males (50.0%) and 5 females (50.0%). The medial screw injured the anterior tibialis tendon in 2 cases (20.0%), the central screw injured the extensor hallucis longus tendon in 3 cases (30.0%), and the lateral screw injured the anterior branch of SPN, lateral branch of SPN, and medial branch of DPN once each in a total of 3 cases (30.0%). Conclusion: TN fusion with central screw placement at the interspace between the medial and intermediate cuneiforms protects the neurovasculatures of the foot to a superior extent than lateral screws between the intermediate and lateral cuneiforms.

The effect of in-situ decompression on ulnar nerve stability: a cadaveric study

2017 ◽  
Vol 42 (7) ◽  
pp. 715-719 ◽  
Author(s):  
B. Butler ◽  
J. Peelman ◽  
L.-Q. Zhang ◽  
M. Kwasny ◽  
D. Nagle
Keyword(s):  
Ulnar Nerve ◽  
Medial Epicondyle ◽  
Cadaveric Study ◽  
Flexion Angle ◽  
Anterior Translation ◽  
Nerve Decompression ◽  
Flexor Carpi Ulnaris ◽  
Before And After ◽  
Fresh Frozen

Ten fresh frozen right cadaver arms were placed in a motorized jig and an in-situ ulnar nerve decompression was performed in 5 mm increments distally to the flexor carpi ulnaris (FCU) aponeurosis then proximally to the intermuscular septum. The elbows were ranged 0–135° after each incremental decompression and the ulnar nerve to medial epicodyle distance was measured to assess for nerve translation/subluxation compared with baseline (prerelease) values. None of the specimens had ulnar nerve subluxation (defined as anterior translation past the medial epicondyle) even after full decompression. Furthermore, there were no statistically significant ulnar nerve translations (defined as any difference in distance from ulnar nerve to medial epicondyle before and after each decompression) for any flexion angle or extent of decompression. This study provides biomechanical evidence that in situ ulnar nerve decompression from the FCU aponeurosis to the intermuscular septum does not result in significant ulnar nerve translation or subluxation.

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