Geometric analysis of indications for minimally invasive distal metatarsal osteotomy in treatment of hallux valgus

Category: Basic Sciences/Biologics; Bunion Introduction/Purpose: Hallux valgus is one of the most common surgically corrected forefoot deformities. Compared to open procedures, minimally invasive treatment of hallux valgus has resulted in decreased operative time, reduced complication rates, and greater patient satisfaction. Until recently in the United States, distal chevron osteotomies have been the standard for hallux valgus correction of moderate deformity. To the best of the authors’ knowledge, no studies have evaluated biomechanical strength of transverse and chevron distal metatarsal osteotomy constructs. The purpose of this study was to evaluate the biomechanical strength of transverse and chevron minimally invasive osteotomy techniques using 9 matched cadaveric pairs. Methods: A total of nine matched cadaveric specimens were randomized to transverse or chevron distal metatarsal osteotomies. Each minimally invasive surgical technique was performed by a fellowship trained orthopedic foot and ankle surgeon. Anterior- posterior and lateral radiographic images were obtained following surgical fixation. Biomechanical testing was performed on an Instron Mechanical System. Ultimate load to failure, yield load, and stiffness were assessed across the fixation construct with fulcrum within the metatarsal shaft proximal to screw fixation and compression load at the sesamoid bones. A pre-load of 10N was applied to the sesamoid bones by the compression post to stabilize the sample. Subsequently, a compression rate was applied to the sample at 10mm/min until failure was observed. Mean and standard deviations were assessed and compared across cohorts. Results: All nine cadaveric specimens were male. There was no difference in average percent metadiaphyseal shift among transverse (36%) and chevron (38%) osteotomies. The most common mode of failure among transverse and chevron osteotomies was fracture at screw insertion site (55.6%), followed by failure at osteotomy site (44.4%). One paired sample was noted to have poor bone quality prior to biomechanical testing. There was a trend towards increased ultimate load to failure (p=0.480) and stiffness (p=0.438) among transverse osteotomy compared to chevron osteotomy, however, no statistically significant difference was observed. Conclusion: Biomechanical testing demonstrates no statistical difference in ultimate load to failure and stiffness between minimally invasive transverse and chevron distal metatarsal osteotomy constructs. A trend towards increased ultimate load and stiffness in the transverse osteotomy cohort was observed. Chevron osteotomies violate the entire plantar cortex and may result in early failure by relative ease of cutout through cancellous bone compared to transverse osteotomies in which failure would require cortical bone cutout. Future studies are required to evaluate strength of construct in a larger sample. Analysis is limited, healing may provide additional strength that is not simulated in cadaveric studies.

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Minimally Invasive Distal Metatarsal Osteotomy for Mild-to-Moderate Hallux Valgus Deformity

The Kaohsiung Journal of Medical Sciences ◽

10.1016/s1607-551x(09)70538-8 ◽

2009 ◽

Vol 25 (8) ◽

pp. 431-437 ◽

Cited By ~ 18

Author(s):

Yu-Chuan Lin ◽

Yuh-Min Cheng ◽

Je-Ken Chang ◽

Chung-Hwan Chen ◽

Peng-Ju Huang

Keyword(s):

Minimally Invasive ◽

Hallux Valgus ◽

Valgus Deformity ◽

Metatarsal Osteotomy ◽

Hallux Valgus Deformity ◽

Distal Metatarsal Osteotomy

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Midterm Results and Complications After Minimally Invasive Distal Metatarsal Osteotomy for Treatment of Hallux Valgus

Foot & Ankle International ◽

10.1177/1071100713481453 ◽

2013 ◽

Vol 34 (7) ◽

pp. 969-977 ◽

Cited By ~ 39

Author(s):

Bruno Iannò ◽

Filippo Familiari ◽

Marco De Gori ◽

Olimpio Galasso ◽

Francesco Ranuccio ◽

...

Keyword(s):

Minimally Invasive ◽

Hallux Valgus ◽

Metatarsal Osteotomy ◽

Midterm Results ◽

Distal Metatarsal Osteotomy

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Can Generalized Ligamentous Laxity be an Obstacle to Perform Minimally Invasive Surgery for Moderate Hallux Valgus?

Foot & Ankle Orthopaedics ◽

10.1177/2473011417s000370 ◽

2017 ◽

Vol 2 (3) ◽

pp. 2473011417S0003

Author(s):

Dong-Woo Shim ◽

Yeokgu Hwang ◽

Yoo Jung Parsk ◽

Jin Woo Lee

Keyword(s):

Minimally Invasive ◽

Hallux Valgus ◽

Metatarsal Osteotomy ◽

Aofas Score ◽

First Metatarsal ◽

Ligamentous Laxity ◽

Radiographic Outcomes ◽

Distal Metatarsal Osteotomy ◽

The Mean

Category: Bunion Introduction/Purpose: Minimally invasive surgical techniques have challenged objectives in hallux valgus surgery, attempting to obtain good clinical outcomes with the least damage to anatomic structures, low complication rates, short time of surgery, cosmetic advantages and an earlier recovery. However, because patients with generalized ligamentous laxity have a major risk for recurrence, arthrodesis of the first tarsometatarsal (TMT) joint is an established method for the surgical treatment of the patients with generalized ligamentous laxity. This study aims to investigate the clinical and radiographic outcomes of joint-preserving minimally invasive distal metatarsal osteotomy in moderate hallux valgus patients with generalized ligamentous laxity. Methods: Thirty-two feet from 29 patients were involved prospectively with mean follow-up of 16.8 (range, 10 – 26) months. Generalized ligamentous laxity was assessed in all patients and the patients were divided into two groups (16: 16) with the result. Clinical outcomes were assessed using visual analogue scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS) score and Foot and Ankle Outcome Score (FAOS). Radiographic parameters were evaluated by preoperative and postoperative weight bearing radiographs. Results: Mean tourniquet time was 30.4 (range, 19 – 44) minute and additional procedures were required in 6 cases in each group. The mean VAS (p<0.001), AOFAS score (p<0.001) and three FAOS subscales (Pain, Symptoms and Quality-of-Life) (p=0.003, p=0.002 and p<0.001) improved significantly at the last follow-up. Significant corrections in the hallux valgus angle (HVA), intermetatarsal angle (IMA), distal metatarsal articular angle (DMAA) and sesamoid reduction were obtained at the last follow-up (p<0.001). Relative first metatarsal length was decreased 2.8% from preoperative length (p<0.001). No other radiographic outcomes showed significant difference between the 2 groups but the mean relative first metatarsal length was shorter in the group without generalized ligamentous laxity (p=0.014, respectively) at the last follow-up. Conclusion: Despite the patients without generalized ligamentous laxity tended to have shorter first metatarsal bone postoperatively, minimally invasive distal metatarsal osteotomy yielded substantial clinical and radiological results without any recurrence or fixation failure. This procedure can be a reasonable alternative to first TMT arthrodesis in patients with moderate hallux valgus even with generalized ligamentous laxity.

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