scholarly journals A modified minimally invasive osteotomy for hallux valgus enables reduction of malpositioned sesamoid bones

2020 ◽  
Author(s):  
Ezequiel Palmanovich ◽  
Nissim Ohana ◽  
Viktor Feldman ◽  
Yaron Brin ◽  
Meir Nyska ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Hallux Valgus ◽  
Metatarsal Head ◽  
Metatarsal Osteotomy ◽  
Sesamoid Bone ◽  
Optimal Method ◽  
Chevron Osteotomy ◽  
Sesamoid Bones ◽  
Distal Metatarsal Osteotomy ◽  
The Mean

Abstract Background: Current minimally invasive distal metatarsal osteotomy for hallux valgus (HV) is V-shaped, which prevents correcting the rotational metatarsal head deformity and reduction of sesamoid bones. We aimed to determine the optimal method for sesamoid bone reduction in HV surgery.Methods: We reviewed the records of 53 patients who underwent HV surgery by a single surgeon from 2017 to 2019 according to one of three techniques: open chevron osteotomy (n=19), minimally invasive V-shaped osteotomy (n=18) and a modified, straight minimally invasive osteotomy (n=16). Sesamoid position was graded using the Hardy and Clapham method based on standing radiographs. Results: Postoperative sesamoid position scores were significantly lower (better) following the modified osteotomy than following open chevron osteotomy and V-shaped osteotomy (1.44±0.81, 3.74±1.48 and 4.61±1.09, respectively, P<0.001); and the mean change in score was greater (P<0.001). Conclusion: Modified minimally invasive osteotomy was superior to the two other techniques, in the correction of HV deformity in all planes, including sesamoid reduction.

scholarly journals A Modified Minimally Invasive Osteotomy for Hallux Valgus Allows Reduction of Malpositioned Sesamoid Bones

2020 ◽  
Author(s):  
Ezequiel Palmanovich ◽  
Nissim Ohana ◽  
Omer Slevin ◽  
Viktor Feldman ◽  
Yaron Brin ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Hallux Valgus ◽  
Metatarsal Head ◽  
Metatarsal Osteotomy ◽  
Modified Technique ◽  
Chevron Osteotomy ◽  
Sesamoid Bones ◽  
Distal Metatarsal Osteotomy

Abstract Background: Current minimally invasive distal metatarsal osteotomy for hallux valgus (HV) is V-shaped, which prevents correcting the rotational metatarsal head deformity and reduction of sesamoid bones. Methods: We retrospectively reviewed the records of 53 patients that underwent HV surgery by a single surgeon from 2017 to 2019 to compare outcomes of three techniques: open chevron osteotomy (n=19), minimally invasive V-shaped osteotomy (n=18), and a modified, straight minimally invasive osteotomy (n=16). Sesamoid position was graded using the Hardy and Clapham method based on standing radiographs. Results: Postoperative sesamoid position scores were significantly lower (better) following the modified osteotomy, compared with the two other techniques (1.44±0.81 vs 3.74±1.48 and 4.61±1.09, P<0.001), and mean change in score was greater (P<0.001). The modified technique yielded the largest improvements in inter-metatarsal and HV angles (P<0.05).Conclusion: The modified minimally invasive osteotomy was superior in the correction of HV deformity in all planes, including sesamoid reduction.Level of Evidence: IV

scholarly journals Hallux Valgus Correction: Comparison of Minimally Invasive Transverse and Chevron Distal Metatarsal Osteotomy Constructs

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0006
Author(s):  
Dustin H. Massel ◽  
Amiethab A. Aiyer ◽  
Jorge I. Acevedo
Keyword(s):  
Minimally Invasive ◽  
Hallux Valgus ◽  
Ultimate Load ◽  
Biomechanical Testing ◽  
Metatarsal Osteotomy ◽  
Sesamoid Bones ◽  
Load To Failure ◽  
Distal Metatarsal Osteotomy ◽  
Transverse Osteotomy ◽  
Biomechanical Strength

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.

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

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.

The Hallux Metatarsophalangeal Capsule: An Anatomic Study With Respect to Percutaneous Hallux Valgus Correction

2021 ◽  
pp. 107110072110272
Author(s):  
Kenneth M. Chin ◽  
Nicholas S. Richardson ◽  
John T. Campbell ◽  
Clifford L. Jeng ◽  
Matthew W. Christian ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Hallux Valgus ◽  
Metatarsal Head ◽  
Cadaveric Study ◽  
Anatomic Study ◽  
Orthopedic Surgeons ◽  
Popular Knowledge ◽  
Fresh Frozen ◽  
The Mean ◽  
Anatomic Relationship

Background: Minimally invasive surgery for the treatment of hallux valgus deformities has become increasingly popular. Knowledge of the location of the hallux metatarsophalangeal (MTP) proximal capsular origin on the metatarsal neck is essential for surgeons in planning and executing extracapsular corrective osteotomies. A cadaveric study was undertaken to further study this anatomic relationship. Methods: Ten nonpaired fresh-frozen frozen cadaveric specimens were used for this study. Careful dissection was performed, and the capsular origin of the hallux MTP joint was measured from the central portion of the metatarsal head in the medial, lateral, dorsal, plantarmedial, and plantarlateral dimensions. Results: The ten specimens had a mean age of 77 years, with 5 female and 5 male. The mean distances from the central hallux metatarsal head to the MTP capsular origin were 15.2 mm dorsally, 8.4 mm medially, 9.6 mm laterally, 19.3 mm plantarmedially, and 21.0 mm plantarlaterally. Conclusion: The MTP capsular origin at the hallux metatarsal varies at different anatomic positions. Knowledge of this capsular anatomy is critical for orthopedic surgeons when planning and performing minimally invasive distal metatarsal osteotomies for the correction of hallux valgus. Type of Study: Cadaveric Study.

scholarly journals Radiographic Outcomes after Fixation of Distal Metatarsal Osteotomy for Hallux Valgus Using a Tension Band Construct

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0042
Author(s):  
Alexander Volpi ◽  
Robert Zbeda ◽  
Christopher Katchis ◽  
Lon Weiner ◽  
Stuart Katchis
Keyword(s):  
Hallux Valgus ◽  
Postoperative Period ◽  
Weight Bearing ◽  
Line Tension ◽  
Tension Band ◽  
Metatarsal Osteotomy ◽  
First Metatarsal ◽  
Distal Metatarsal Osteotomy ◽  
The Mean

Category: Bunion Introduction/Purpose: Hallux valgus is a common deformity of the forefoot. There are over 130 procedures described to correct hallux valgus. Classically, the treatment of mild to moderate hallux valgus is with a distal metatarsal osteotomy. A variety of fixation techniques have been described for use with this osteotomy most of which require partial or non-weight bearing until the osteotomy is healed. Tension Band fixation is a well-known principle in orthopedic surgery. The goal of the present study is to radiographically assess the maintenance of distal first metatarsal osteotomy fixation using a novel tension band device (Re+Line tension band bunion plate system, Nextremity Solutions) with immediate post-operative weight-bearing. Methods: The patient database for one surgeon was retrospectively reviewed for patients that underwent hallux valgus correction with the Re+Line tension band device between 2014 and 2017. Postoperative protocol included a soft dressing, firm surgical shoe, and weight-bearing as tolerated with a cane. Patients were excluded if fixation was achieved with something other than a tension band construct. Radiographs were obtained and reviewed retrospectively by 3 authors. Pre and postoperative hallux valgus (HVA) and intermetatarsal angles (IMA) were measured as described previously in the literature, and the changes in correction compared. Maintenance of correction and hardware integrity were assessed at final follow-up after weight bearing as tolerated in a surgical shoe in the postoperative period. Statistical analysis was performed using a Wilcoxon signed-rank test for the changes in HVA and IMA. Results: There was a total of 72 patients and 76 toes that underwent hallux valgus correction with a tension band construct, at a mean follow-up of 4.36 months. 68 of 72 patients were female. The average age was 60.8 years old. The mean preoperative HVA was 27.1 degrees. The mean postoperative HVA was 6.14 degrees, with a mean correction of 20.22 degrees (p<0.001). The mean preoperative IMA was 14.14 degrees. The mean postoperative IMA was 6.10 degrees, with a mean correction of 7.98 degrees (p<0.001). There was loss of reduction found in 6 of 76 toes (7.89%).There were zero cases of hardware failure. All osteotomies healed at final follow-up. Conclusion: This study shows successful radiographic outcome after hallux valgus correction using a tension band construct and allowing immediate full weight-bearing in a surgical shoe in the postoperative period. Significant deformity correction was achieved and maintained and all osteotomies healed. The Re+Line tension band bunion correction system can be safely used as a successful option to fix distal first metatarsal osteotomies, while allowing patients to fully weight bear in a surgical shoe postoperatively and potentially return to activities faster than when using traditional fixation methods. Future studies are needed to assess functional outcomes and patient satisfaction with this novel technique.

Radiographic Evaluation of Minimally Invasive Distal Metatarsal Osteotomy for Hallux Valgus

2011 ◽  
Vol 32 (5) ◽  
pp. 503-507 ◽  
Author(s):  
Peng-Ju Huang ◽  
Yuh-Chuan Lin ◽  
Yin-Chih Fu ◽  
Yi-Hsin Yang ◽  
Yuh-Min Cheng ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Hallux Valgus ◽  
Radiographic Evaluation ◽  
Metatarsal Osteotomy ◽  
Distal Metatarsal Osteotomy

scholarly journals Correlative Study Between the Sesamoid Bones under the Head of the First Metatarsal and the Development of Hallux Valgus Determined with Radiographs

2021 ◽  
Author(s):  
Xiaozhong Li ◽  
Dongxue Liu ◽  
Xufang Wang
Keyword(s):  
Hallux Valgus ◽  
Metatarsal Head ◽  
Sesamoid Bone ◽  
Hallux Valgus Angle ◽  
Intermetatarsal Angle ◽  
First Metatarsal ◽  
Valgus Angle ◽  
Second Metatarsal ◽  
Sesamoid Bones ◽  
The Absolute

Abstract Objective. To study the correlative between the sesamoid bones under the head of the first metatarsal and the development of hallux valgus determined with radiographs.Methods.The measurements were performed on the X-ray of 300 normal feet and 300 cases of hallux valgus. The following parameters were measured: hallux valgus angle(HVA); the first-second intermetatarsal angle(IMA) between the axes of the first and second metatarsal;the length of the second metatarsal（CD）;the position of tibial sesamoid(TSP ) measured the percent formed between the tibial sesamoid and the centreline of the first metatarsal;the position of fibular sesamoid(FSP) measured tangent value between fibular sesamoid bone and lateral cortex of first metatarsal bone ; the absolute distances (AB) from the centre of the tibial sesamoid to the long axis of the second metatarsal, the absolute distances (EF) from the centre of the fibular sesamoid to the long axis of the second metatarsal and the absolute distance (GH) from the centre of the tibial sesamoid to the centre of the fibular sesamoid. Then calculate the ratio of AB to CD (K1), EF to CD (K2) and GH to CD (K3). Results.HVA moderately positively correlates with TSP and moderately negatively correlates with FSP in subjects with HVA ≥ 20°. HVA and FSP are strongly negatively correlated in the hallux valgus group. Conclusion.The dislocation of sesamoid bone under the first metatarsal head is an important pathological factor leading to valgus. HVA is positively correlated with TSP and negatively correlated with FSP.

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