Surgical Treatment of Moderate Hallux Valgus: A Comparison of Distal Chevron Metatarsal Osteotomy With and Without Lateral Soft-Tissue Release

2017 ◽  
Vol 10 (6) ◽  
pp. 524-530 ◽  
Author(s):  
Maki Grle ◽  
Goran Vrgoc ◽  
Ivan Bohacek ◽  
Vladimir Hohnjec ◽  
Marko Martinac ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Surgical Treatment ◽  
Soft Tissue ◽  
Hallux Valgus ◽  
Soft Tissue Release ◽  
Metatarsal Osteotomy ◽  
Group I ◽  
Group Ii ◽  
Surgical Treatments

Purpose: The purpose of the study was to determine whether lateral soft-tissue release (LSTR) has a beneficial or detrimental effect on the outcome of distal Chevron first metatarsal osteotomy (DCMO) in the treatment of moderate hallux valgus (HV). Methods: We compared the effect of different surgical treatments in 2 groups of patients: group I (23 patients, 25 feet, average age of 55 [from 43 to 77] years) was subjected to DCMO only, whereas group II (18 patients, 23 feet, average age of 59 [from 52 to 70] years]) was subjected to DCMO with LSTR. The American Orthopaedic Foot and Ankle Society’s Hallux Metatarsophalangeal-Interphalangeal scale survey was conducted postoperatively, followed by the brief survey on postoperative patient satisfaction. The patient follow-up period was from 18 to 24 months after surgical treatment, on average. Results: After surgical intervention, both groups of patients presented with an improved HV angle, but there was no significant difference between the groups. However, group II showed significant improvements in medial sesamoid bone position and patient satisfaction scores as compared with group I. Conclusion: Our midterm follow-up of surgical treatments for moderate HV deformity suggests that both procedures provide good postoperative results. However, according to our results, DCMO with LSTR provides better results than procedures without LSTR. Levels of Evidence: Therapeutic, Level III: Retrospective comparative study

Evolving Solutions in the Surgical Treatment of Isolated Pulmonary Valve Stenosis

2021 ◽  
Author(s):  
Sonia B. Albanese Albanese
Keyword(s):  
Surgical Treatment ◽  
Pressure Gradient ◽  
Pulmonary Valve ◽  
Balloon Valvuloplasty ◽  
Pulmonary Valve Stenosis ◽  
Group I ◽  
Mean Pressure ◽  
Valve Function ◽  
Group Ii

Background: Surgical treatment of isolated pulmonary valve stenosis in infants and children has evolved over the years, shifting from the original exclusive aim at lowering right ventricle pressure to the current concomitant focus on preserving pulmonary valve function. In our study, we sought to analyze the effect of such evolving philosophy on long-term results. Methods: All consecutive patients treated in our center between July 1983 and March 2019 were included. Patients were categorized into 2 groups based on the introduction into treatment practice of sparing valve techniques (1995). Actuarial survival, freedom from reintervention on the right outflow tract, transvalvular mean pressure gradient decrease, and pulmonary valve function at follow-up were analyzed. Results: One hundred twenty-three patients operated before (Group I, n=81) or since (Group II, n=42) 1995 were enrolled in the study. Mean age and weight were 3.0 ± 0.36 years and 16.6 ± 1.7kg, respectively. Early mortality occurred exclusively in 3 patients of Group 1. Transvalvular mean pressure gradient decreased in the entire patient population (from 63.28 ± 12.9mmHg to 16.46 ± 7.9mmHg). At a mean follow-up interval of 4.9 ± 33 years, freedom from death was comparable, but freedom from right ventricular outflow tract reintervention was significantly greater in Group II. Although the transvalvular gradient remained stable over time in non-reoperated survivors (mean value of 16.46 ± 7.9mmHg), pulmonary valve function on 2D-Echo showed severe incompetence in 2 patients of Group I and just mild to moderate incompetence in 20 patients of Group II, with a significantly negative effect of unsuccessful preoperative pulmonary balloon valvuloplasty (14/20 vs 6/20, p=0.025) in the latter. Conclusion: Current pulmonary valve sparing techniques are associated with better results, particularly in terms of freedom from re-interventions and pulmonary valve function at follow-up. Balloon valvuloplasty prior to surgery may worsen operative results, promoting pulmonary insufficiency and therefore should probably be avoided in all patients in whom anatomical characteristics predict failure of percutaneous therapy.

scholarly journals Peak Contact Stress of TMT-1 Joint after Sequential Correction of Hallux Valgus Using a Proximal Opening Wedge Metatarsal Osteotomy (PMO) and Distal Soft Tissue Procedure

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0030
Author(s):  
Jonathan C. Kraus ◽  
Michael Ziegele ◽  
Mei Wang; Brian C. Law ◽  
Glenn G. Shi
Keyword(s):  
Soft Tissue ◽  
Hallux Valgus ◽  
Contact Force ◽  
Contact Stress ◽  
Soft Tissue Release ◽  
Wedge Osteotomy ◽  
Metatarsal Osteotomy ◽  
Opening Wedge ◽  
Joint Contact ◽  
The Mean

Category: Bunion; Midfoot/Forefoot Introduction/Purpose: The proximal opening wedge metatarsal osteotomy (PMO) of the first metatarsal is a common procedure for the surgical treatment of moderate to severe hallux valgus. Although with a long track record of success, limited work has been dedicated to this procedures effect on the first tarsometatarsal (TMT-1) joint. The purpose of this study is to evaluate the changes in TMT-1 joint contact stress in the diseased and corrected state following an opening wedge osteotomy of the proximal metatarsal. In addition, the effect of a distal soft tissue release (DSTR) was evaluated as it related to both radiographic correction and TMT-1 joint contact stress. Methods: Seven fresh-frozen cadaveric below knee specimens (mean age: 69yrs) with hallux valgus deformities (mean HVA: 31.7+-12.0degs) were obtained for the study. The specimen was loaded up to 400N on an MTS servo hydraulic load frame with the tibia at 90-degree to the neutrally position foot. Joint contact characteristics at TMT-1 joint were measured with a Tekscan pressure sensor (Model6900, 1100psi). A standard proximal metatarsal osteotomy was performed. Various sized metal wedges (3, 5, 7 mm) with locking plates and screws were inserted in the osteotomy for correction. Following initial tests, a complete distal soft tissue release (DSTR) was performed and the specimens were retested. Additionally, dorsoplantar weight bearing (400N) radiograph was obtained for each condition to measure intermetatarsal (IMA) and hallux valgus (HVA) angles. The contact force, area, and peak contact stress were compared among groups using ANOVA and post-hoc multiple comparisons over the untreated (Dunnett test, p<0.05). Results: The mean HVA decreased with wedge size and DSTR, reached to significant level with 7mm+DSTR (24.1 degs). The mean contact force was 39.7+-32.6 N for untreated specimens. This increased sequentially with opening wedge size and reached statistical significance 7mm opening-wedge (119.6+-53.8 N, p=0.03) and 7mm-wedge+DSTR (116.7+-58.3 N, p=0.04). The peak contact stress followed a similar trend (Figure 1). The mean peak contact stress was 2.3+-1.5 MPa for the untreated specimens and increased incrementally with wedge size to 5.3+-2.6 MPa for 7mm-wedge only (p=0.03) and 5.2+-2.1 MPa for 7mm- wedge+DSTR (p=0.04). Contact area increased with corrections, but none reached significance. Conclusion: The results from this study demonstrate that with sequentially increasing opening wedge size, loading properties through the TMT-1 joint increase. Prior work has demonstrated that joint stresses of over 4.7 MPa can be chondrotoxic, a value which was surpassed with our peak contact stress with the 7mm wedge. This has significant implications for the long-term health of the TMT-1 joint following PMO, potentially predisposing patients to arthritic joint changes. The optimal degree of correction with PMO to limit chondrotoxicity is not known at this time, and is a direction for future work.

Surgical Treatment of Mild to Severe Hallux Valgus Deformities With a Percutaneous Subcapital Osteotomy Combined With a Lateral Soft Tissue Procedure

2018 ◽  
Vol 12 (2) ◽  
pp. 138-145 ◽  
Author(s):  
Mauro Maniglio ◽  
Paolo Fornaciari ◽  
Henrik Bäcker ◽  
Emanuel Gautier ◽  
Marc Lottenbach
Keyword(s):  
Soft Tissue ◽  
Hallux Valgus ◽  
Complication Rate ◽  
Lateral Release ◽  
Soft Tissue Release ◽  
Aofas Score ◽  
Radiological Parameters ◽  
Soft Tissue Procedure ◽  
Significant Correction

Distal metatarsal (MT) osteotomies have been used in mild or moderate cases of hallux valgus (HV) and proximal MT osteotomy has been considered the treatment of choice for severe deformities. A distal osteotomy could achieve a greater degree of correction by the addition of a distal soft-tissue procedure and be used to treat also severe deformity. Limited evidence about the use of the percutaneous subcapital osteotomy (SCOT); a type of MT osteotomy, in combination of a soft tissue procedure, is available. We evaluated this procedure routinely used in our clinic. A total of 30 consecutive patients treated in our hospital from September 2012 to April 2015 with SCOT combined with lateral soft tissue release were included in this retrospective review. Outcomes assessed included radiological parameters: HV angle (HVA) and intermetatarsal angle (IMA), clinical evaluation using the American Orthopaedic Foot and Ankle Society (AOFAS) score, and complication rate. In 12 of the 30 patients included, the pathology was bilateral, comprising a total of 42 cases. The overall correction of the angles was statistically significant (P < .001), changing from a HVA of 28.2° and IMA of 13.5° preoperatively to 8.0° and 6.0° postoperatively, respectively. The cases were divided into mild-moderate (34/42) and severe (8/42). Both groups showed a statistically significant correction in the angles, 3 months after surgery (P < .001). The AOFAS score showed a median of 49 points (n = 24) preoperatively and of 95 points (n = 40) at the end of follow-up. The complication rate at end of follow-up was 19% (8/42). After a minimum follow-up of 1 year, our technique for HV correction results in a clinically relevant improvement of the radiological parameters and AOFAS score in mild to severe deformities. Combination with lateral release could be a meaningful surgical alternative for the treatment of severe cases to help decrease the risk of recurrence. Levels of Evidence: Level IV

scholarly journals Rigid Internal Fixation of Proximal Crescentic Metatarsal Osteotomy in Hallux Valgus Correction

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0046
Author(s):  
Andrew Stith ◽  
Matthew Griffin ◽  
Wesley Flint ◽  
Michael Coughlin
Keyword(s):  
Soft Tissue ◽  
Range Of Motion ◽  
Hallux Valgus ◽  
Hardware Removal ◽  
Metatarsal Osteotomy ◽  
Titanium Plate ◽  
Aofas Score ◽  
Low Profile ◽  
First Ray

Category: Bunion Introduction/Purpose: Proximal first metatarsal crescentic osteotomies are an effective means for correction of moderate to severe hallux valgus deformities. The originally described fixation construct included an intramedullary screw and a Kirschner wire which crossed the joint and required removal at 6 weeks. Elevation malunion of the first ray was also frequently noted postoperatively. The purpose of this study was to evaluate the outcomes of utilizing a low-profile titanium plate and screw construct for rigid fixation of proximal crescentic osteotomies. Methods: There were 53 patients (60 feet, 7 bilateral) with hallux valgus deformities enrolled in the study. They were all treated operatively with a proximal crescentic osteotomy and distal soft tissue correction with or without an Akin osteotomy. The crescentic osteotomy was fixed with a low-profile titanium plate and screws. Postoperatively patients were assessed at 3 months, 6 months and 1 year. Outcomes assessed included the need for hardware removal, change in elevatus of the first ray, as well as pre- and post-op VAS pain scores, radiographic evaluation, AOFAS score, MTP joint range of motion, and complications. Results: Of the 60 hallux valgus cases enrolled, 56 have completed their final follow-up (93%). At 1 year 55/56 patients had achieved radiographic union of their osteotomy. Nine patients had their hardware removed (16%). Range of motion at the 1st MTP joint decreased from 76.5 to 59.6 degrees. Hallux valgus angle improved from a mean of 28.8 to 9.6 degrees. The mean 1-2 intermetatarsal angle decreased from 14.1 to 6.4 degrees. Elevatus of the first ray increased from a mean of 2.5 mm pre-op to 3.2 mm (<1 mm) post-op. Mean VAS score improved from 4.43 to 0.68 (3.75 points). AOFAS score improved from 54.7 to 88.5 points. Complications included 4 superficial infections, 2 delayed wound healing cases and one DVT. Conclusion: Proximal crescentic metatarsal osteotomy with distal soft tissue repair is a safe and reliable method for operative treatment of hallux valgus. Utilization of a low-profile titanium plate and screw construct to rigidly fix the osteotomy yields a high rate of union and deformity correction with a low incidence of hardware removal and minimal increase in elevation of the first ray at final follow up.

scholarly journals RESULTS OF SURGICAL TREATMENT OF INFANTILE AND JUVENILE SCOLIOSIS USING VARIOUS INSTRUMENTATION

2015 ◽  
Vol 14 (1) ◽  
pp. 51-59
Author(s):  
M. V. Mikhailovsky ◽  
V. A. Suzdalov ◽  
D. N. Dolotin ◽  
I. G. Udalova
Keyword(s):  
Surgical Treatment ◽  
Lumbar Lordosis ◽  
Thoracic Kyphosis ◽  
Scoliotic Curve ◽  
Average Value ◽  
Group I ◽  
Juvenile Scoliosis ◽  
Congenital Kyphosis ◽  
Group Ii

Introduction. The analysis Results of surgical treatment of growing children with infantile and juvenile scoliosis (IS) can the optimal method of treatment select. In young children with significant growth potential spinal fusion may not be the best option as it limits further longitudinal growth of the spine and may to the thoracic insufficiency syndrome result. To address this problem recently several techniques focused, their have advantages and drawbacks.Material and methods. Since 2008 year 127 patients (64 girls, 63 boys) aged (4.5 ± 2.1) years were operated on. In group I 65 patients were operated on using VEPTR (Vertical Expandable Prosthetic Titanium Rib) instrumentation, in group II 42 patients using various spinal instrumentation. 20 patients with congenital kyphosis were excluded. The average follow-up time was (5.6 ± 1.1) years.Results. In group I average value of the primary scoliotic curve before surgery was (74.7 ± 22.9), secondary curve (42.8 ± 16.0), thoracic kyphosis (46.3 ± 27.4), lumbar lordosis (54.6 ± 14). Average value of the primary scoliotic curve after surgery was reduced to (51 ± 20) (correction 31.7%), at followup to (56.5 ± 18.5), secondary curve (31.8 ± 12.8) (25.7%), at follow-up to (32.4 ± 18.4), thoracic kyphosis (36.8 ± 20.8) (20,5%), at follow-up to (41.8 ± 21.0), lumbar lordosis (45.4 ± 12.7) (16,9%), at follow-up to (48.2 ± 11.7) (p < 0.05). Space available for lung before surgery was (84.5 ± 8.7) %, after surgery was (94.8 ± 6.7)%, at follow-up increased to (98.6 ± 5.4) % (p < 0.05). Complications included 11 implant dislocations and 1 infection. In group II average value of the primary scoliotic curve before surgery was (87.6 ± 6.6), secondary curve (47.8 ± 4.6), thoracic kyphosis (61.4 ± 10.4), lumbar lordosis (61.8 ± 4.9). Average value of the primary scoliotic curve after surgery was reduced to 50.6 ± 5.3 (correction 42.3%), at follow-up to (66.1 ± 6.3), secondary curve (24.1 ± 2.9) (49.6%), at follow-up to (37 ± 5.4), thoracic kyphosis (38.8 ± 7.7) (36.8%), at follow-up to (59.4 ± 11.2), lumbar lordosis (47.5 ± 4.1) (23.2%), at follow-up to (64.5 ± 4.5) (p < 0.05). Complications included 23 implant dislocations and 1 infection. No neurological complications.Conclusion. Stage correction fusions using various instrumentation is a method of choice for controlled correction of growing children with IS.

Clinico-radiological Results of Distal Chevron Osteotomy without Lateral Soft Tissue Release in Mild to Moderate Hallux Valgus Deformity

2021 ◽  
Vol 23 (4) ◽  
pp. 287-293
Author(s):  
Mohd Rafeeq Wani ◽  
Mohd Iqbal Wani ◽  
Arshid Bashir ◽  
Manzoor Ahmad Halwai ◽  
Stanzin Sonum ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Hallux Valgus ◽  
Valgus Deformity ◽  
Soft Tissue Release ◽  
Average Value ◽  
Radiological Results ◽  
Chevron Osteotomy ◽  
Hallux Valgus Deformity ◽  
A Prospective Study

Background. The study was done to evaluate short term clinico-radiological results of distal chevron oste­otomy without lateral soft tissue release in mild to moderate hallux valgus. Materials and methods. This was a prospective study consisting of a total of 35 cases with mild to moderate hallux valgus deformity. All these patients were treated by distal chevron osteotomy without lateral soft tissue release. Results. In our study, the average value of hallux angle preoperatively was 32° (range, 24°-40°) and at final follow-up it was 14° (range, 8°-31°). The average reduction was 18°. The average intermetatarsal angle showed mean reduction of 5.3° at the final follow-up. Average range of motion of the first metatarsophalyngeal joint preoperatively and at final follow-up showed a small reduction of 5 degrees. The average preoperative AOFAS score was 49, which improved by 35 points to 84 at the final follow-up. 11.42% of the patients in the study group had a recurrence. Conclusions. 1. Based on our experience with distal chevron osteotomy without lateral soft tissue release, we found the procedure easy to perform with good procedural outcomes. 2. The possible complications of lateral soft tissue release are avoided.

Avascular Necrosis of the First Metatarsal Head: Incidence in Distal Osteotomy Combined with Lateral Soft Tissue Release

1994 ◽  
Vol 15 (2) ◽  
pp. 59-63 ◽  
Author(s):  
Drew A. Peterson ◽  
Jeffrey L. Zilberfarb ◽  
Marie A. Greene ◽  
Robert C. Colgrove
Keyword(s):  
Soft Tissue ◽  
Avascular Necrosis ◽  
Metatarsal Head ◽  
Soft Tissue Release ◽  
Radiographic Examination ◽  
Metatarsal Osteotomy ◽  
First Metatarsal ◽  
Valgus Angle ◽  
Adductor Tenotomy

The incidence of avascular necrosis of the metatarsal head following distal first metatarsal osteotomy combined with adductor tendon release has not been documented in a large series of patients. Of 82 consecutive procedures in 64 patients performed between 1986 and 1988, 42 patients (58 procedures) were available for clinical and radiographic examination. Average follow-up was 2.5 years (range 1.0–4.2 years). There were 35 L-shaped and 23 chevron osteotomies which were combined with a lateral soft tissue release that included adductor tenotomy. preoperative hallux valgus angle averaged 25° (range 15–40°), and intermetatarsal angle averaged 12° (range 5–24°). Follow-up amount of correction averaged 13° and 5°, respectively. Eighty-four percent of patients were satisfied with their result. There was one case of avascular necrosis. The patient was asymptomatic at 4.2 years' follow-up, and the remaining patients included two with infections, one hallux varus, and no nonunions.

Effect of Metatarsus Adductus on Hallux Valgus Treated With Proximal Reverse Chevron Metatarsal Osteotomy

2021 ◽  
pp. 107110072199036
Author(s):  
Seung-Myung Choi ◽  
Jong-Soo Lee ◽  
Jung-Won Lim ◽  
Je-Min Im ◽  
Duk-Hwan Kho ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Hallux Valgus ◽  
Recurrence Rate ◽  
Metatarsal Osteotomy ◽  
Aofas Score ◽  
Level Of Evidence ◽  
Significant Difference ◽  
Metatarsus Adductus ◽  
The Mean

Background: This study aimed to compare clinical and radiographic outcomes and recurrence rates after reverse proximal chevron metatarsal osteotomy (PCMO) for patients with hallux valgus (HV) with or without metatarsus adductus (MA). We hypothesized that patients with MA would have poorer outcomes and a higher radiographic recurrence rate than those without MA. Methods: This retrospective single-surgeon series comprised 144 patients (173 feet) with moderate to severe HV, treated with PCMO and Akin osteotomy without lesser metatarsal procedures, who were grouped according to the presence (MA group) or absence of MA (non-MA group). Clinical assessment included the American Orthopaedic Foot & Ankle Society (AOFAS) score, pain visual analog scale (VAS), and patient satisfaction rating. Radiographic assessments included metatarsus adductus angle (MAA), HV angle (HVA), and intermetatarsal angle (IMA). Results: The prevalence of the MA was 24.2%. The mean MAA was 23.1 ± 3.3 degrees in the MA group. There were no differences in the mean AOFAS score and pain VAS score at the final follow-up between the 2 groups (all P > .05). The patient satisfaction rate was 73.8% in the MA group vs 90.1% in the non-MA group ( P = .017). The mean postoperative HVA and IMA significantly improved at the final follow-up in both groups, respectively (all P < .001). Preoperative and postoperative HVA were larger in the MA group vs non-MA group. However, no significant difference was found in the improvement of HVA and IMA after surgery between the 2 groups (all P > .05). The recurrence rate was 28.6% in the MA group and 6.1% in the non-MA group ( P < .001). Conclusion: HV patients associated with the MA had a higher degree of preoperative HV, lower correction of the HVA, higher radiographic recurrence rate, and poorer patient satisfaction than those without MA post-PCMO without lesser metatarsal procedures. Therefore, a more extensive HV correction procedure or the addition of a lesser metatarsal realignment procedure may need to be considered. Level of Evidence: Level III, retrospective comparative series.

scholarly journals Analysis of Independent Predictors of Poor Outcomes of Chevron Osteotomy for Hallux Valgus: Focus on Generalized Ligamentous Laxity and Foot Width Changes

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0022
Author(s):  
Yeok Gu Hwang ◽  
Jungtae Ahn ◽  
Tae Yong Kim ◽  
Bi O Jeong
Keyword(s):  
Surgical Treatment ◽  
Hallux Valgus ◽  
Metatarsophalangeal Joint ◽  
Metatarsal Osteotomy ◽  
Regression Analyses ◽  
Aofas Score ◽  
Ligamentous Laxity ◽  
Chevron Osteotomy ◽  
Poor Outcomes

Category: Bunion, Midfoot/Forefoot Introduction/Purpose: The identification of factors associated with poor outcomes in patients who have undergone chevron metatarsal osteotomy is helpful for predicting postoperative outcomes. The purpose of this study was to evaluate the impact of generalized ligamentous laxity and various clinical risk factors on the radiological and clinical outcomes of chevron osteotomy for hallux valgus. Methods: A total of 135 patients (137 feet) who underwent chevron metatarsal osteotomy for hallux valgus deformity were included in this study. The mean follow-up duration was 5.6 years (range, 2–10.4 years). Generalized ligamentous laxity was assessed in all patients. After assessing the clinical outcome after chevron osteotomy for hallux valgus using the American Orthopedic Foot and Ankle Society scores - Hallux Metatarsophalangeal-Interphalangeal scale (AOFAS score), the clinical and radiological risk factors that affect postoperative outcomes were analyzed with bivariate and logistic regression analyses. Results: The average AOFAS score improved on surgical treatment from 51.4 ± 13.5 preoperatively to 86.0 ± 12.1 at the last follow-up (P < 0.001). Patients with generalized ligamentous laxity showed no significant difference in radiological and clinical parameters compared to non-laxity patients. According to bivariate and multivariate logistic regression analyses, second plantar callosity on the metatarsophalangeal joint before surgery and the ratio of foot width difference after surgery were significantly associated with clinical outcome after surgery. Conclusion: In the surgical treatment of hallux valgus, more careful surgical technique is required for patients with second plantar callus on the metatarsophalangeal joint before surgery, and efforts are needed to reduce foot width through surgical treatment.

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