scholarly journals Immediate weight-bearing after locking plate fixation of the Ludloff osteotomy

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0003
Author(s):  
Steven Neufeld ◽  
John Marcel
Keyword(s):  
Clinical Outcomes ◽  
Hallux Valgus ◽  
Locking Plate ◽  
Weight Bearing ◽  
Loss Of Correction ◽  
Function Index ◽  
Foot Function ◽  
Anatomic Locking Plate ◽  
Joint Arthritis ◽  
With Screws

Category: Bunion Introduction/Purpose: One of the more common and versatile osteotomies to correct moderate hallux valgus deformities is the Ludloff osteotomy. This oblique osteotomy is typically stabilized with screws and patients kept non-weight bearing until healed. Complications include malunion, nonunion and loss of correction, which can occur due to poor compliance with non- weight bearing protocols. Elderly, obese and physically weak patients can have difficulty remaining non-weight bearing. A novel anatomic-locking plate and fixation method was developed that allows immediate weight bearing after a Ludloff osteotomy. We analyzed the results of a consecutive cohort of patients who underwent a Ludloff osteotomy stabilized with this method. The cohort included all patients presenting with a moderate to severe hallux valgus deformities. Complications, radiographic & clinical outcomes were studied. Methods: In this IRB approved retrospective cohort study, we analyzed clinical & radiographic data of all Ludloff osteotomies performed between 2010 and 2015. Preoperative and postoperative data included Foot Function Index, intermetatarsal & hallux valgus angles, complications, callus formation & clinical outcomes. 395 feet in 350 patients were examined. 6 patients (2.1%) were male. 43 feet were excluded due to incomplete films and 21 were excluded due to screw fixation only; requiring restricted post- operative weightbearing protocols. Three surgeons performed the surgeries and review/analyses conducted by a senior orthopedic resident, uninvolved with the care of any of the patients. Indications included symptomatic hallux valgus deformities (intramedullary angle greater than 10°), failure of conservative treatment and normal preoperative range of motion. Exclusion criteria included 1st tarsometatarsal joint arthritis/instability, peripheral neuropathy, vascular disease and 1st metatarsophalangeal joint arthritis. Preoperative and postoperative radiographs were weightbearing. Patients discharged when comfortable in normal shoes. Results: At an average of 8 months postop (2 - 43 months), there was an average hallux valgus (HVA) correction angle correction of 7.6° (p<.0001) and intermetatarsal angle (IMA) correction of 21° from initial to final radiographs. Patients were discharged when comfortable in normal shoes. In the 15 feet (4.6%) who formed hypertrophic callus, there was loss of IMA of 2.3° (p<.0001) and HVA of 4.6° (p<.0001). Superficial wound infection or mild cellulitis was noted in 16 feet (4.9°); no deep infections. 15 (4.6%) feet had hardware removal due to prominent and/or broken screws. These were in older women with thin feet. There was only 1 nonunion & 8 mal-unions. An average foot function index (in 70 patients) of 9.5/100 indicated low pain and disability. Conclusion: The data from this large series of patients (395 osteotomies) supports the use of an immediate weight-bearing protocol for Ludloff osteotomies fixed with anatomic locking plates, including patients with osteopenic bone. All patients were allowed activities and weight bearing as tolerated during the post-operative period. There were relatively few complications including loss of correction or nonunion. Patients and surgeons can expect healing and complication rates similar to osteotomies fixed with screws and a non-weight-bearing post-operative protocol. Furthermore, because of the increased stability imparted by the anatomic locking plate, it would be a good option for revision bunion surgery.

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.

scholarly journals Hallux MTP Arthrodesis for Treatment of Severe Hallux Valgus Using a Dorsal Locking Plate

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0031
Author(s):  
Wonyong Lee ◽  
Cooper M. Truitt ◽  
Venkat Perumal ◽  
Joseph Park
Keyword(s):  
Hallux Valgus ◽  
Failure Rate ◽  
Locking Plate ◽  
Weight Bearing ◽  
Valgus Deformity ◽  
X Rays ◽  
Lag Screw ◽  
Screw Augmentation ◽  
Hallux Valgus Deformity ◽  
Severe Hallux Valgus

Category: Bunion Introduction/Purpose: First metatarsophalangeal (MTP) joint arthrodesis is widely accepted as a treatment option for severe hallux valgus deformities. Although successful results of first MTP joint arthrodesis for hallux valgus have been reported in previous studies, the reported rates of fusion have been lower than for the general hallux rigidus population. The purpose of this study was to demonstrate the failure rate of first MTP joint arthrodesis for severe hallux valgus deformities and to evaluate radiographic correction of hallux valgus parameters after the surgery. Methods: From January 2014 to June 2017, 34 patients underwent first MTP joint arthrodesis surgery for severe hallux valgus deformity and were included in this retrospective study. Severe hallux valgus was defined as having a hallux valgus angle (HVA) of greater than 40 degrees and an intermetatarsal angle (IMA) greater than 15 degrees. For radiographic evaluation, the patients were evaluated by measuring the IMA and HVA in preoperative and postoperative weight-bearing AP foot x-rays. We defined failure after first MTP joint arthrodesis as non-union, incomplete union, or implant breakage or migration leading to a symptomatic recurrence of hallux valgus deformity. Results: The mean preoperative IMA and HVA were 16.7 ± 4.2 degrees (range 8.4 to 26.5) and 45.2 ± 8.6 degrees (range 28.7 to 71.1) respectively, and the postoperative IMA and HVA were 11.3 ± 3.8 degrees (range 4.1 to 20.4) and 20.9 ± 11.8 degrees (range 0.4 to 51.1) respectively. The postoperative IMA and HVA were significantly improved after surgery (< 0.001). Among the 34 patients in this study, a 14.7% failure rate was reported (n=5). For fusion procedures performed without lag screw fixation, there was a 12.6-fold increase in failure risk when we used the small dorsal locking plate compared with the medium dorsal locking plate (Odds ratio = 12.571). Conclusion: First MTP joint arthrodesis is an effective and reliable option for severe hallux valgus correction. However, for this challenging cohort, the 14.7% failure rate in this study is consistent with other studies in the literature. For severe hallux valgus deformities, selection of implant may play a more significant role. The use of longer plates to gain additional purchase in the diaphyseal bone, lag screw augmentation, and utilizing flat cuts instead of cup and cone reaming to realign the joint may help mitigate the increased stresses placed on the fixation constructs for MTP arthrodesis.

scholarly journals Investigation on the Site of Coronal Deformities in Hallux Valgus

2021 ◽  
Author(s):  
Rachel Xiaoyu WEI ◽  
Violet Man-Chi KO ◽  
Elvis Chun-Sing Chui ◽  
Bruma Sai-Chuen FU ◽  
Vivian Wing-Yin HUNG ◽  
...  
Keyword(s):  
Hallux Valgus ◽  
Weight Bearing ◽  
Transverse Plane ◽  
Rotational Deformity ◽  
Rotational Malalignment ◽  
Joint Rotation ◽  
Valgus Angle ◽  
Foot Function ◽  
Coronal Rotation ◽  
The Relationship

Abstract BackgroundHallux valgus (HV) is a common foot deformity that is more prevalent in females, characterised by abnormal adduction of the first metatarsal (MT) and valgus deviation of phalanx on the transverse plane. Increasing evidence indicates that HV is more than a 2D deformity but a 3D one with rotational malalignment. Pronation deformity is seen during clinical examination for HV patients, but the exact origin of this rotational deformity is still unknown. Some attribute it first tarsometatarsal (TMT) joint rotation, while others attribute it to intra-metatarsal bony torsion. In addition, the correlation between the rotational and transverse plane deformity is inconclusive. Identifying the origin of the rotational deformity will help surgeons choose the optimal surgical procedure while also enhancing our understanding of the pathophysiology of Hallux valgus.ObjectiveThis study aims to (1) develop an objective method for measuring the first MT torsion and first TMT joint rotation; (2) investigate the exact location of the coronal deformity in HV; (3) investigate the relationship between the severity of deformity on the transverse and coronal planes as well as the correlation between deformity severity and foot function/symptoms in HV.MethodsAge-matched females with and without HV were recruited at Foot and Ankle Clinic of the Department of Orthopaedics and Traumatology. Computed tomography was conducted for all subjects with additional weight-bearing dorsal-plantar X-ray examination for HV subjects. Demographic information of all subjects was recorded, and foot function was evaluated. Intra-class correlation was used to explore the relationship between deformities on different planes and the deformity severity and functional outcomes, respectively. Independent t-test was used to compare joint rotation degrees and bone torsion degrees.ResultsHallux Valgus patients had more TMT joint rotation but not MT torsion compared to normal controls. TMT joint rotation is significantly correlated with foot functions. No relationship was found between the coronal rotation and the 1,2-intermetatarsal angle (IMA) or Hallux valgus angle (HVA) on the transverse plane.ConclusionOur results indicate that coronal deformities in HV may originate from TMT joint rotation. In addition, the severity of the TMT joint coronal rotation correlates with worse foot function; thus, multi-plane assessment and examination will be important for more precise surgical correction in the future.

scholarly journals Early Clinical Outcomes of Triplanar Modified Lapidus Arthrodesis with Immediate Weight Bearing

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0039
Author(s):  
Justin Ray ◽  
Jennifer Koay ◽  
Robert Santrock
Keyword(s):  
Clinical Outcomes ◽  
Hallux Valgus ◽  
Weight Bearing ◽  
Valgus Deformity ◽  
Recurrence Rates ◽  
Full Activity ◽  
Radiographic Outcomes ◽  
Hallux Valgus Deformity ◽  
Athletic Shoes

Category: Bunion Introduction/Purpose: There are numerous corrective procedures for hallux valgus deformity. The majority of procedures prioritize correction in the transverse plane based on anteroposterior (AP) radiographs. Long-term results demonstrate high recurrence rates ranging from 8-78% with various metatarsal osteotomy techniques. Recent evidence suggests that hallux valgus is a multi-planar deformity with significant contributions from the sagittal and frontal planes. Correction of hallux valgus at the first tarsometatarsal joint (modified Lapidus) offers a powerful method to restore anatomic alignment in all three planes and correct hallux valgus at the apex of the deformity. The purpose of this study is to investigate early clinical and radiographic outcomes and complications of triplanar tarsometatarsal (TMT) arthrodesis with immediate weight-bearing. Methods: After receiving IRB approval, charts and radiographs were retrospectively reviewed for 37 patients (30 female, age 54.8 years) undergoing triplanar tarsometatarsal (TMT) arthrodesis for hallux valgus deformity correction at our institution between June 2016 and June 2017. All patients were allowed immediate weight-bearing as tolerated in a boot walker. Radiographic imaging at 4 months and 12 months was compared to pre-operative imaging. Clinical outcomes were evaluated using the American Academy of Orthopaedic Surgeons Foot and Ankle questionnaire (AAOS FAQ), Quality of Life 12 (QOL-12), and the patient-reported outcomes measurement information system 10 (PROMIS 10). Demographics included age, gender, body mass index, and medical comorbidities. The time in days to weight-bearing, wearing athletic shoes, and return to full activity were noted. Any complications were recorded. For statistical analysis, t-tests were performed for continuous variables and chi-square tests were performed for categorical variables using JMP 11.0.0 (SAS Institute Inc., Cary, NC). Results: Although improvements were noted in the AAOS FAQ and PROMIS 10 at 3 and 6 months post-operative, these results were not significantly different compared to baseline scores (Table 1). From the time of procedure, average time to weight-bearing was 2.75 ± 7.2 days. Patients returned to wearing athletic shoes an average of 48.3 ± 12.1 days after the procedure. Return to full activity without restrictions was 130.9 ± 37.0 days from surgery. Radiographic results demonstrated significant improvement in IMA and HVA at final follow-up (p < 0.001). 35 patients (94.6%) demonstrated evidence of radiographic union by final follow-up. Regarding complications, one patient (2.7%) required hardware removal for soft-tissue irritation, and there were three cases (8.1%) of hardware failure that did not require re-operation. Conclusion: In this study, early clinical and radiographic outcomes of triplanar tarsometatarsal corrective arthrodesis (modified Lapidus) with immediate weight-bearing were promising with low complication rates. Patients were able to return to normal shoe wear approximately 7 weeks after the procedure and return to full activity a little more than 4 months after surgery. Radiographic results demonstrated high union rates, low recurrence rates, and significant improvements in HVA and IMA at final follow-up. Longer follow-up is necessary to determine the long-term radiographic and clinical outcomes of triplanar tarsometatarsal arthrodesis to correct hallux valgus deformity.

scholarly journals Long-term clinical outcomes of scarf osteotomy in regional hospital Hong Kong

2019 ◽  
Vol 27 (1) ◽  
pp. 28-32
Author(s):  
Ng Weng-Io ◽  
Chan Kwok-Bill ◽  
Yeung Yuk-Nam
Keyword(s):  
Hong Kong ◽  
Clinical Outcomes ◽  
Hallux Valgus ◽  
Recurrence Rate ◽  
Weight Bearing ◽  
Symptom Control ◽  
Scarf Osteotomy ◽  
Hallux Valgus Deformity

Background: Lack of local data concerning the long-term clinical outcomes of scarf osteotomy in Hong Kong. Methods: This is a retrospective review of 75 patients (88 feet) who underwent scarf osteotomy with a mean follow-up of 94.20 months (60–144 months). Clinical ratings were based on visual analog scale (VAS) and American Orthopaedic Foot & Ankle Society (AOFAS) scale. Weight-bearing radiographs were used to perform angular measurements: (i) hallux valgus angle (HVA), (ii) intermetatarsal angle, (iii) distal metatarsal articular angle, and (iv) tibial sesamoid position before operation and at the time of latest follow-up. Results: The mean overall AOFAS scales improved from 29.66 (5–49) points preoperatively to 86.83 (39–100) points at the time of final follow-up. The VAS improved from 6.61 (5 to 9) to 0.66 (0 to 4). The average HVA correction was 25.42 (8–46). The 8- to10-year recurrence rate (HVA > 20) was 31.80%. A higher degree of preoperative HVA predicts higher recurrence rate. Conclusion: Scarf osteotomy is an effective procedure for symptom control and improvement in radiological parameters for hallux valgus deformity. However, recurrence rate is relatively high.

scholarly journals Comparative study of functional outcome between plantar fascia stretching and achilles tendon stretching exercises in choronic plantar fasciitis

2015 ◽  
Vol 3 (2) ◽  
pp. 84-88
Author(s):  
S Shrestha ◽  
S Rai ◽  
H Limbu ◽  
S Bajracharya
Keyword(s):  
Achilles Tendon ◽  
Functional Outcome ◽  
Plantar Fasciitis ◽  
Weight Bearing ◽  
Plantar Fascia ◽  
Foot Function Index ◽  
Function Index ◽  
Pain Subscale ◽  
Foot Function ◽  
Stretching Exercises

Background: Plantar fasciitis is a self limiting disease, with only 10% of patient developing chronic condition even after ten months. We hypothesized that patient with chronic plantar fasciitis who are treated with standard plantar fascia stretching program can have a better functional outcome than those treated with Achilles tendon-stretching exercise.Method: Forty patients who had chronic plantar fasciitis for duration of at least ten months were randomized into one of two groups. Group A received plantar stretching exercise and Group B had Achilles tendon stretching program. All patients completed the pain subscale of Foot Function Index and a subject relevant outcome survey that incorporated generic and condition-specific outcome measures related to pain, function and satisfaction with treatment outcome.Result: The pain subscale scores of the Foot Function Index showed significantly better results at eight weeks for the patients managed with plantar fascia stretching program respect to item 1 (worst pain; p = 0.004) and item 2 (first steps in the morning; p =0.001). Similarly at ten months follow up, pain subscale score comparison was statistically significant for item 1 (p = 0.018) and item 2 (p =0.003).Conclusions: A treatment method of non-weight-bearing stretching exercises specific to plantar fascia is superior to the conventional method of weight-bearing Achilles tendon-stretching exercises for treating patients with chronic plantar fasciitis.Nepal Journal of Medical Sciences Vol.3(2) 2014: 84-88

Immediate Weight Bearing After Hallux Valgus Correction Using Locking Plate Fixation of the Ludloff Osteotomy: A Retrospective Review

2018 ◽  
Vol 11 (2) ◽  
pp. 148-155 ◽  
Author(s):  
Steven K. Neufeld ◽  
John J. Marcel ◽  
Michael Campbell
Keyword(s):  
Hallux Valgus ◽  
Locking Plate ◽  
Callus Formation ◽  
Plate Fixation ◽  
Weight Bearing ◽  
Complication Rates ◽  
Recurrence Rates ◽  
Superficial Infection ◽  
Common Procedure ◽  
Hardware Failures

Background. A Ludloff osteotomy is a common procedure used to correct hallux valgus deformities. Traditionally, the osteotomy is stabilized with screws only, thus requiring the patient to be non–weight bearing until healed. There have been no outcome studies analyzing immediate weight bearing after Ludloff osteotomy for hallux valgus. Methods. Of the 350 patients (390 feet) who underwent a Ludloff osteotomy fixed with a locking plate and prescribed an immediate weight-bearing postoperative protocol, 288 patients (326 feet) were included in the analysis. Average radiographic follow-up was 8 months, and hallux-valgus angle (HVA), intermetatarsal angle (IMA), and any hardware failures or hypertrophic callus formation were recorded. The Foot Function Index (FFI) was assessed in 103 patients at an average of 44 months postoperatively. Results. Average IMA and HVA correction were 7.6° and 21.6°, respectively (P < .0001). Loss of HVA and IMA correction of 4.6° and 2.3°, respectively, were noted between the initial postoperative films and final weight-bearing films. The average FFI score calculated for the 103 respondents was 10.4 out of a possible 100, indicating relatively low pain and disability. Complication rates were consistent with most other published postoperative protocols, with the most commonly seen being superficial infection (4.9%) and symptomatic hardware (4.6%). Conclusion. An immediate weight-bearing protocol for Ludloff osteotomies fixed with locking plates results in recurrence rates that are similar to those found with other protocols. Patient function is quite high and pain low following this protocol. The most commonly observed complications were superficial infection and symptomatic hardware requiring removal. Levels of Evidence: Level IV

Capitolunate Instability and Clinical Outcomes after Resection of the STT Joint in CMC Joint Arthritis

2015 ◽  
Vol 04 (S 02) ◽  
Author(s):  
Mark Ross ◽  
David Gilpin ◽  
Susan Peters ◽  
Bradley Gilpin ◽  
Gregory Couzens
Keyword(s):  
Clinical Outcomes ◽  
Joint Arthritis ◽  
Cmc Joint

scholarly journals Application of 3D printing and framework internal fixation technology for high complex rib fractures

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Xuetao Zhou ◽  
Dongsheng Zhang ◽  
Zexin Xie ◽  
Yang Yang ◽  
Menghui Chen ◽  
...  
Keyword(s):  
3D Printing ◽  
Internal Fixation ◽  
Locking Plate ◽  
Rating Scale ◽  
Preoperative Planning ◽  
Numerical Rating Scale ◽  
Chest Ct ◽  
Rib Fractures ◽  
X Rays ◽  
With Screws

Abstract Objective To explore the clinical effect of 3D printing combined with framework internal fixation technology on the minimally invasive internal fixation of high complex rib fractures. Methods Total 16 patients with high complex rib fractures were included in the study. Before the procedure, the 3D rib model was reconstructed based on the thin-layer chest CT scan. According to the 3D model, the rib locking plate was pre-shaped, and the preoperative planning were made including the direction of the locking plate, the location of each nail hole and the length of the screw. During the operation, the locking plate was inserted from the sternum to the outermost fracture lines of ribs with screws at both ends. In addition, the locking plate was used as the frame to sequentially reduce the middle fracture segment and fix with screws or steel wires. Chest x-rays or chest CT scans after surgery were used to assess the ribs recovery. All patients were routinely given non-steroidal anti-inflammatory drugs (NSAIDS) for analgesia, and the pain level was evaluated using numerical rating scale (NRS). Results The preoperative planning according to the 3D printed rib model was accurate. The reduction and fixation of each fracture segment were successfully completed through the framework internal fixation technology. No cases of surgical death, and postoperative chest pain was significantly alleviated. Five to 10 months follow up demonstrated neither loosening of screws, nor displacement of fixtures among patients. The lungs of each patients were clear and in good shape. Conclusion The application of 3D printing combined with framework internal fixation technology to the high complex rib fractures is beneficial for restoring the inherent shape of the thoracic cage, which can realize the accurate and individualized treatment as well as reduces the operation difficulty.

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