Basal Closing Wedge Osteotomy for Correction of Hallux Valgus and Metatarsus Primus Varus: 10- to 22-Year Follow-up

Some authors reported the results from percutaneous distal metatarsal osteotomy for hallux valgus recently. On the other hand, there are few reports of percutaneous proximal metatarsal osteotomy. The purpose of the present study was to evaluate the radiographic results of percutaneous proximal closing wedge osteotomy with Akin osteotomy for correction of severe hallux valgus and increasing longitudinal arch height. Consecutive 17 feet (mean age = 70.8 years) were investigated. The mean follow-up was 22 months. Excision of medial eminence, distal soft tissue release, and Akin osteotomy were all performed percutaneously and concurrently. Weight-bearing anteroposterior and lateral radiographs of the feet were acquired preoperatively and at final follow-up. On the anteroposterior radiographs, hallux valgus angle, intermetatarsal angle, and first metatarsal shortening were measured. On the lateral radiographs, talometatarsal angle, calcaneal pitch angle, and first metatarsal dorsiflexion were measured. The average improvements in hallux valgus angle and intermetatarsal angle were 27.6° and 9.9°, respectively. The average first metatarsal shortening was 2.7 mm. The first metatarsal dorsiflexion improved by 2.2°; however, other parameters did not improve significantly. In conclusion, percutaneous proximal closing wedge osteotomy with Akin osteotomy corrects severe hallux valgus; however, the procedure does not increase the medial longitudinal arch. Levels of Evidence: Therapeutic, Level IV: Case series

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

Foot & Ankle Orthopaedics ◽

10.1177/2473011417748895 ◽

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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Radial Closing Wedge Osteotomy for Kienböck’s Disease: an Over 10 Year Clinical and Radiographic Follow-Up.

Journal of Hand Surgery (European Volume) ◽

10.1054/jhsb.2001.0621 ◽

2002 ◽

Vol 27 (2) ◽

pp. 175-179 ◽

Cited By ~ 48

Author(s):

A. WADA ◽

H. MIURA ◽

H. KUBOTA ◽

Y. IWAMOTO ◽

Y. UCHIDA ◽

...

Keyword(s):

Long Term Results ◽

Wedge Osteotomy ◽

Kienböck’S Disease ◽

Kienböck's Disease ◽

Closing Wedge Osteotomy ◽

Radial Inclination ◽

Closing Wedge ◽

Joint Contact ◽

Kienbock’S Disease

Thirteen patients with Kienböck’s disease who had undergone a radial closing wedge osteotomy were reviewed clinically and radiologically at a follow-up mean of 14 years. Good long-term results were obtained in all patients. Their levels of pain were improved, and significant increases were seen in the range of motion and grip strength. Radiographic stage, as assessed by Lichtman’s classification, improved in one, did not change in four, and advanced in eight patients. The radial inclination angle significantly decreased and the carpal-ulnar distance and lunate covering ratios both increased, demonstrating that radial shift in the alignment of the carpal bones occurs and that the joint contact area of the lunate increases in proportion to the decrease in radial inclination. The preoperative radiolunate and radioscaphoid angles, which were significantly larger than those of the unaffected wrist, did not change postoperatively which shows that this technique was not able to correct the flexion deformity of the lunate and the scaphoid.

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Proximal Oblique Sliding Closing Wedge Osteotomy for Hallux Valgus

Foot & Ankle International ◽

10.1177/1071100713497933 ◽

2013 ◽

Vol 34 (11) ◽

pp. 1493-1500 ◽

Cited By ~ 12

Author(s):

Emilio Wagner ◽

Cristián Ortiz ◽

John S. Gould ◽

Sameer Naranje ◽

Pablo Wagner ◽

...

Keyword(s):

Hallux Valgus ◽

Wedge Osteotomy ◽

Closing Wedge Osteotomy ◽

Closing Wedge

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Scarf versus proximal closing wedge osteotomy in hallux valgus treatment

Archives of Orthopaedic and Trauma Surgery ◽

10.1007/s00402-008-0741-4 ◽

2008 ◽

Vol 129 (10) ◽

pp. 1347-1352 ◽

Cited By ~ 8

Author(s):

Łukasz Paczesny ◽

Jacek Kruczyński ◽

Ryszard Adamski

Keyword(s):

Hallux Valgus ◽

Wedge Osteotomy ◽

Closing Wedge Osteotomy ◽

Closing Wedge

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First Metatarsal Length Change after Basilar Closing Wedge Osteotomy for Hallux Valgus

Foot & Ankle International ◽

10.3113/fai.2011.0513 ◽

2011 ◽

Vol 32 (5) ◽

pp. 513-518 ◽

Cited By ~ 17

Author(s):

Thomas Day ◽

Timothy P. Charlton ◽

David B. Thordarson

Keyword(s):

Hallux Valgus ◽

Length Change ◽

Wedge Osteotomy ◽

Closing Wedge Osteotomy ◽

First Metatarsal ◽

Closing Wedge

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Successful Treatment Of Advanced Freiberg’s Disease With A Dorsal Closing Wedge Osteotomy

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00237 ◽

2018 ◽

Vol 3 (3) ◽

pp. 2473011418S0023

Author(s):

Mansur Halai ◽

Kenneth David-West

Keyword(s):

Clinical Outcomes ◽

Severe Disease ◽

Caucasian Population ◽

Wedge Osteotomy ◽

Closing Wedge Osteotomy ◽

Closing Wedge ◽

American Orthopaedic ◽

Freiberg’S Disease ◽

Radiological Union

Category: Lesser Toes Introduction/Purpose: Treatment for Freiberg’s disease is largely conservative. For severe disease and refractory cases, there are various surgical options. Most studies are from the Far-Eastern population and have short follow-up. The purpose of this study was to report the 5 year clinical outcomes of a dorsal closing wedge osteotomy in the treatment of advanced Freiberg’s disease in a Caucasian population. Methods: Twelve patients (12 feet), with a mean age of 30.7 years (range 17-55), were treated with a synovectomy and a dorsal closing wedge osteotomy of the affected distal metatarsal. There were 10 females and 2 males. All patients were born in the United Kingdom. Clinical outcomes were independently evaluated pre and postoperatively using the American Orthopaedic Foot and Ankle Society (AOFAS) scoring system and a subjective satisfaction score. Nine (75%) feet involved the 2nd metatarsal and 3 feet (25%) involved the 3 rd metatarsal. According to the Smillie classification, 6 feet were Grade IV and 6 feet were grade V. Radiological union was evaluated postoperatively. Results: No patients were lost to follow up and the mean follow-up time was 5.2 years (4-7). AOFAS scores improved from 48.1 +/- 7.4 to 88.9 +/- 10.1 postoperatively (p<0.001) giving a mean improvement of 40.8. 92% of patients were satisfied with their operation at latest follow-up, reporting excellent or good results. All patients had postoperative radiological union. One patient had a superficial postoperative infection that was successfully treated with oral antibiotics. Conclusion: A dorsal closing wedge osteotomy is an effective treatment of advanced Freiberg’s disease in a Caucasian population, with good outcomes and few complications.

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Clinical and radiological outcomes of modified posterior closing wedge osteotomy for the treatment of posttraumatic thoracolumbar kyphosis

Journal of Neurosurgery Spine ◽

10.3171/2015.1.spine131011 ◽

2015 ◽

Vol 23 (4) ◽

pp. 510-517 ◽

Cited By ~ 7

Author(s):

Dae-Jean Jo ◽

Yong-Sang Kim ◽

Sung-Min Kim ◽

Ki-Tack Kim ◽

Eun-Min Seo

Keyword(s):

Back Pain ◽

Sagittal Alignment ◽

Wedge Osteotomy ◽

Thoracolumbar Fractures ◽

Thoracolumbar Kyphosis ◽

Analog Scale ◽

Closing Wedge Osteotomy ◽

Closing Wedge ◽

The Mean

OBJECT Most thoracolumbar fractures have a good healing outcome with adequate treatment. However, posttraumatic thoracolumbar kyphosis can occur in a proportion of thoracolumbar fractures after inappropriate treatment, osteoporosis, or osteonecrosis of the vertebral body. There are several surgical options to correct posttraumatic thoracolumbar kyphosis, including anterior, posterior, and combined approaches, which are associated with varying degrees of success. The aim of this study was to assess the use of a modified closing wedge osteotomy for the treatment of posttraumatic thoracolumbar kyphosis and to evaluate the radiographic findings and clinical outcomes of patients treated using this technique. METHODS Thirteen consecutive patients with symptomatic posttraumatic thoracolumbar kyphosis were treated using a modified closing wedge osteotomy. The mean patient age was 62 years. The kyphosis apex ranged from T-10 to L-2. The sagittal alignment, kyphotic angle, neurological function, visual analog scale for back pain, and Oswestry Disability Index were evaluated before surgery and at follow-up. RESULTS The mean preoperative regional angle was 27. 4°, and the mean correction angle was 29. 6°. Sagittal alignment improved with a mean correction rate of 58. 3%. The mean surgical time was 275 minutes, and the mean intraoperative blood loss was 1585 ml. The intraoperative complications included 2 dural tears, 1 nerve root injury, and 1 superficial wound infection. The mean visual analog scale score for back pain improved from 6. 6 to 2, and the Oswestry Disability Index score decreased from 55. 4 to 22. 6 at the last follow-up. All patients achieved bony anterior fusion based on the presence of trabecular bone bridging at the osteotomy site. CONCLUTIONS The modified posterior closing wedge osteotomy technique achieves satisfactory kyphosis correction with direct visualization of the circumferentially decompressed spinal cord, as well as good fusion with less blood loss and fewer complications. It is an alternative method for treating patients with posttraumatic thoracolumbar kyphosis.

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Very Distal Radius Wedge Osteotomy for Kienböck’s Disease: Case Series

The Journal of Hand Surgery (Asian-Pacific Volume) ◽

10.1142/s0218810417500551 ◽

2017 ◽

Vol 22 (04) ◽

pp. 490-496 ◽

Cited By ~ 1

Author(s):

Hirotaka Okubo ◽

Chojo Futenma ◽

Hideyuki Sunagawa ◽

Masaki Kinjo ◽

Fuminori Kanaya

Keyword(s):

Distal Radius ◽

Stage Iii ◽

Wedge Osteotomy ◽

Kienböck’S Disease ◽

Kienböck's Disease ◽

Closing Wedge Osteotomy ◽

Closing Wedge ◽

Disease Case ◽

Kienbock’S Disease

Background: Radius osteotomy is one of the standard surgical procedures for the treatment of Kienböck’s disease. Unfortunately, radius osteotomy can result in an incongruous distal radio-ulnar joint (DRUj) postoperatively, because the procedure is performed proximal to the DRUj. Methods: A very distal radius wedge osteotomy was performed as a 15-degree lateral closing wedge osteotomy with the apex of the wedge distal to that of conventional lateral closing wedge osteotomy; this procedure was developed to avoid postoperative incongruous DRUj. We performed this procedure on 6 patients (stage III-A: 1, stage III-B: 5) with a mean age of 49 years. Clinical and radiographic evaluations were performed at a mean follow-up of 32 months. Results: Wrist pain disappeared in all patients. Mean grip strength improved from 35% to 87% of the contralateral side (p = 0.0255). Mean range of motion, measured as flexion-extension arc, improved from 93 to 128 degrees. Nakamura’s score was good in all patient. Mean lunate covering ratio increased from 61% to 90% (p = 0.0151) and mean sigmoid notch inclination angle, a radiographic parameter of DRUj congruency, was not significantly different between pre-operative and final follow-up evaluation. No clinical or radiographic DRUj osteoarthritis findings were observed. Conclusions: Our procedure of very distal radius wedge osteotomy provided satisfactory clinical results without an incongruous DRUj. This technique might prevent the occurrence of postoperative DRUj osteoarthritis.

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