scholarly journals Treatment of late-stage Freiberg disease using a double stemmed flexible silicone prosthesis

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0004
Author(s):  
Mingzhu Zhang ◽  
Guang-Rong Yu ◽  
Yunfeng Yang
Keyword(s):  
Plantar Flexion ◽  
Metatarsal Head ◽  
Clinical Results ◽  
Bone Union ◽  
Wedge Osteotomy ◽  
Closing Wedge Osteotomy ◽  
Silicone Prosthesis ◽  
Closing Wedge ◽  
Freiberg Disease

Category: Midfoot/Forefoot Introduction/Purpose: The purpose of this study was to evaluate the clinical outcomes using a double stemmed flexible silicone prosthesis for the treatment of Freiberg disease in its late stages. Methods: The subjects consisted of 13 feet from 13 cases suffering from Freiberg disease that underwent extra-articular dorsal closing-wedge osteotomy using a polyblend suture. The average age was 31.7 (range 13–72) years. The average follow up period was 17 (range 14–24) months. Regarding image findings, time to bone union and metatarsal shortening was reviewed. The investigation was carried out using the range of motion (ROM), visual analog scale (VAS), and Japanese Society of the Surgery of Foot lesser toe scale (JSSF score) in the MTP joint before surgery and at the latest follow-up. Results: Calluses under the metatarsal head were not observed in any cases. The mean metatarsal shortening was 2.33± 2.07 mm at follow-up. The bone union required an average of 8.4±0.8 weeks. The average ROM of dorsal flexion improved from 37.2±5.3° before surgery to 73.6±9.9° at latest follow-up (p<0.0001). The average ROM of plantar flexion improved from 16.0±10.1° before surgery to 19.5±8.6° at latest follow-up (p=0.35). The average VAS significantly improved from 75.3±8.5 before surgery to 4.9±4.2 at latest follow-up (p<0.0001). The average JSSF score significantly improved from 67.3±9.4 points before surgery to 98.8±3.0 points at the latest follow-up (p<0.0001). Conclusion: Extra-articular dorsal closing-wedge osteotomy using a polyblend suture was carried out to treat Freiberg disease. The bone union was observed in all cases with improved clinical results. Fixation using a polyblend suture was considered to be useful.

scholarly journals Treatment of late-stage Freiberg disease using a double stemmed flexible silicone prosthesis

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0053
Author(s):  
Ming-Zhu Zhang ◽  
Guang-rong Yu
Keyword(s):  
Plantar Flexion ◽  
Clinical Results ◽  
Analog Scale ◽  
Silicone Prosthesis ◽  
Prosthesis Replacement ◽  
Freiberg Disease ◽  
Metatarsophalangeal Joints ◽  
Late Stages ◽  
Dorsal Flexion

Category: Lesser Toes Introduction/Purpose: The purpose of this study was to evaluate the clinical outcomes using a double stemmed flexible silicone prosthesis for the treatment of Freiberg disease in its late stages. Methods: The subjects consisted of 13 feet from 13 cases suffering from Freiberg disease in their late stages. They underwent double stemmed flexible silicone prosthesis replacement for metatarsophalangeal joints. The average age was 63.8 (range 30~88) years. The average follow up period was 26 (range 18–42) months. The investigation was carried out using the range of motion (ROM), visual analog scale (VAS), AOFAS and Maryland metatarsophalangeal joints scale before surgery and at the latest follow-up. Results: The average ROM of dorsal flexion improved from 39.3±6.1° before surgery to 75.4±8.6° at latest follow-up (p<0.001). The average ROM of plantar flexion improved from 19.0±11.4° before surgery to 20.2±9.3° at latest follow-up (p=0.14). The average VAS significantly improved from 8.1±0.5 before surgery to 2.6±0.2 at latest follow-up (p<0.001). The average Maryland metatarsophalangeal joints score significantly improved from 65.3±9.3 points before surgery to 90.3±4.1 points at the latest follow-up (p<0.001). The average AOFAS was 89.4±8.5 after surgery compared 56.3±6.4 preoperatively (p<0.005). Conclusion: A flexible silicone prosthesis replacement was carried out to treat Freiberg disease in its late stages. The function was observed in all cases with improved clinical results. The silicone prosthesis was considered to be useful in certain cases.

scholarly journals Extra-articular dorsal closing-wedge osteotomy to treat late-stage Freiberg disease using polyblend sutures: technical tips and clinical results

2014 ◽  
Vol 38 (7) ◽  
pp. 1401-1405 ◽  
Author(s):  
Kazuya Ikoma ◽  
Masahiro Maki ◽  
Masamitsu Kido ◽  
Kan Imai ◽  
Yuji Arai ◽  
...  
Keyword(s):  
Late Stage ◽  
Clinical Results ◽  
Wedge Osteotomy ◽  
Closing Wedge Osteotomy ◽  
Closing Wedge ◽  
Freiberg Disease

scholarly journals Clinical Results and Radiographic Changes after Radial Closing Wedge Osteotomy for Advanced Stages of Kienboeck's Disease.

1999 ◽  
Vol 48 (4) ◽  
pp. 997-1000
Author(s):  
Shun Komine ◽  
Hiroyuki Iida ◽  
Osamu Soejima ◽  
Tomomi Kikuta ◽  
Kosuke Ogata
Keyword(s):  
Clinical Results ◽  
Wedge Osteotomy ◽  
Closing Wedge Osteotomy ◽  
Closing Wedge ◽  
Advanced Stages ◽  
Radiographic Changes

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

2002 ◽  
Vol 27 (2) ◽  
pp. 175-179 ◽  
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.

Effectiveness of Percutaneous Proximal Closing Wedge Osteotomy With Akin Osteotomy to Correct Severe Hallux Valgus Determined by Radiographic Parameters

2016 ◽  
Vol 10 (2) ◽  
pp. 170-179 ◽  
Author(s):  
Toshinori Kurashige ◽  
Seiichi Suzuki
Keyword(s):  
Hallux Valgus ◽  
Wedge Osteotomy ◽  
Metatarsal Osteotomy ◽  
Closing Wedge Osteotomy ◽  
First Metatarsal ◽  
Closing Wedge ◽  
Valgus Angle ◽  
Akin Osteotomy ◽  
Severe Hallux Valgus

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

scholarly journals Geometric Comparison of Second Metatarsal Shortening Osteotomy Variations Using 3D Printed Patient-Specific Models

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0002
Author(s):  
Eric Lukosius ◽  
Umur Aydogan ◽  
Gregory Lewis ◽  
Evan Roush
Keyword(s):  
Metatarsal Head ◽  
Patient Specific ◽  
Wedge Osteotomy ◽  
Metatarsal Osteotomy ◽  
Closing Wedge Osteotomy ◽  
Plantar Surface ◽  
Lateral Translation ◽  
Closing Wedge ◽  
Shortening Osteotomy ◽  
Second Metatarsal

Category: Midfoot/Forefoot Introduction/Purpose: Second metatarsal shortening osteotomy is frequently used in the treatment of metatarsalgia and aims to decrease metatarsophalangeal joint and plantar pressures. Although various proximal, midshaft, and distal metatarsal osteotomy methods have been described for surgical treatment of metatarsalgia, to our knowledge no studies quantitatively compared their resulting geometric corrections. The purpose of our study was to investigate how much each osteotomy variation changed the length of the metatarsal as well as the height and relative location of the metatarsal head (MH) itself. Methods: Following Institutional Review Board approval, three-dimensional computer models of second metatarsals of 5 deidentified clinic patients were extracted from CT scans using Mimics software. Fixed points were plotted on the printed models and a 3D coordinate digitizing arm (Microscribe) was used for precisely determining the 3D (x-y-z) coordinates of each point before and after the osteotomies. Six variations of second metatarsal osteotomies were performed using microsagittal saw and fixed using a 2.4 mm cannulated screw. The following osteotomy variations were performed with 3 and 5 mm translation or wedge resection for each patient model: (1) Classic Weil osteotomy performed at 15° and 25° to the plantar surface; (2) Classic Weil osteotomy performed at 15° and 25° using a double saw blade technique; (3) Classic Weil osteotomy performed at 25° and then a parallel block of 3 or 5 mm was removed; (4) Distal closing wedge osteotomy of the MH at 25°; (5) Proximal closing wedge osteotomy of the MH made at 45° removing a 3 and 5 mm wedge; (6) 45 degree oblique, midshaft, metatarsal osteotomy with 3 and 5 mm of translation. The change in the length of the metatarsal, and vertical and medio-lateral translation of the metatarsal head was calculated then normalized by the osteotomy translation distance. A general linear model with correlated errors and Bonferroni correction was used to assess differences between osteotomies. Results: The maximum metatarsal length shortening per millimeter translation was observed in osteotomy 3- 5 mm block (2.6 mm STD=2.1), while osteotomy 1- 15° caused the least (1.1 mm STD=0.6). Maximum dorsiflexion of the MH occurred with osteotomy 5- 5 mm wedge, 13.2 mm (STD= 4.9 mm) and minimum with osteotomy1- 25°, 0.5 mm (STD= 1.4 mm). No MH plantarflexion was noted with any of the osteotomies. The oblique midshaft osteotomies caused lateral translation of the metatarsal head significantly different from the controls (P <0.05) although not statistically different from one another (2.4 mm vs 4.3 mm). Conclusion: Discussion: Our data shows maximal change in length/millimeter translation by performing a classic Weil osteotomy at 25° to the plantar surface of the foot, 5 mm block resection and then translating 4 mm. This osteotomy also caused the most effective dorsal translation of the MH, thereby making it the most effective osteotomy in terms of affecting both length and MH vertical orientation. Should dorsiflexion of the MH be the surgeon’s only goal, then the proximal closing wedge osteotomy had the greatest impact while minimally changing overall length. With this knowledge, surgeons can tailor operations based on the direction and degree of correction needed to be achieved.

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

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.

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

1999 ◽  
Vol 20 (3) ◽  
pp. 171-177 ◽  
Author(s):  
Hans-Jörg Trnka ◽  
Michaela Mühlbauer ◽  
Alexander Zembsch ◽  
Marc Hungerford ◽  
Peter Ritschl ◽  
...  
Keyword(s):  
Hallux Valgus ◽  
Wedge Osteotomy ◽  
Closing Wedge Osteotomy ◽  
Closing Wedge
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