A Simple Method for Fixation of Proximal Opening-Wedge Osteotomy of the First Metatarsal for Correction of Hallux Valgus

Orthopedics ◽  
2016 ◽  
Vol 39 (6) ◽  
pp. e1213-e1217 ◽  
Author(s):  
A. Erdem Bagatur ◽  
Mehmet Albayrak ◽  
Yunus Emre Akman ◽  
Merter Yalcinkaya ◽  
Utku Erdem Ozer ◽  
...  
Keyword(s):  
Hallux Valgus ◽  
Wedge Osteotomy ◽  
Opening Wedge ◽  
Simple Method ◽  
First Metatarsal

scholarly journals First Tarsometatarsal Joint Loading After Sequential Correction of Hallux Valgus Using a Proximal Opening Wedge Metatarsal Osteotomy and Distal Soft Tissue Procedure

2021 ◽  
Vol 6 (3) ◽  
pp. 247301142110269
Author(s):  
Jonathan Kraus ◽  
Michael J. Ziegele ◽  
Mei Wang ◽  
Brian Law
Keyword(s):  
Soft Tissue ◽  
Hallux Valgus ◽  
Contact Force ◽  
Contact Stress ◽  
Soft Tissue Release ◽  
Wedge Osteotomy ◽  
Opening Wedge ◽  
First Metatarsal ◽  
Joint Contact ◽  
The Mean

Background: The proximal opening wedge osteotomy (POWO) of the first metatarsal (TMT-1) is commonly performed in the operative treatment of hallux valgus. Limited work has been dedicated to study POWO’s effect on the TMT-1 joint, however. The purpose of this study is to evaluate the changes in TMT-1 joint contact stress following POWO of the first metatarsal. Methods: Five fresh-frozen cadaveric below-knee specimens (mean age: 73 years) with hallux valgus deformities (mean hallux valgus angle [HVA]: 37.4 ± 8.5 degrees) were studied. The specimens were loaded to 400 N on an MTS servohydraulic load frame. Joint contact characteristics at TMT-1 joint were measured with a Tekscan pressure sensor (Model 6900, 1100 psi; Tekscan Inc, Boston, MA) with various opening wedge sizes of 3, 5, and 7 mm both without and with a distal soft tissue release (DSTR). The contact force, area, and peak contact stress were compared among groups using analysis of variance and post hoc multiple comparisons over the untreated (Dunnett test, P < .05). Results: The mean contact force was 47.7 ± 33.5 N for untreated specimens. This increased sequentially with opening wedge size and reached statistical significance for 7-mm opening wedge (129.7 ± 62.3 N, P = .01) and 7-mm wedge + DSTR (134.8 ± 60.5 N, P = .008). The mean peak contact stress was 2.8 ± 1.3 MPa for the untreated specimens and increased incrementally with wedge size to 5.7 ± 3.0 MPa for 7-mm wedge only ( P = .03) and 5.6 ± 2.5 MPa for 7-mm wedge + DSTR ( P = .05). The contact area increased with corrections, but none reached significance. Conclusion: With increasing opening wedge size, loading of the TMT-1 joint increases. Joint stresses higher than 4.7 MPa have been shown to be chondrotoxic, potentially predisposing patients to arthritic joint changes following POWO. Level of Evidence: XXXXXX

scholarly journals Proximal Opening Wedge Osteotomy With Distal Chevron Osteotomy of the First Metatarsal for the Treatment of Moderate to Severe Hallux Valgus

2018 ◽  
Vol 40 (1) ◽  
pp. 89-97 ◽  
Author(s):  
Matthias Braito ◽  
Dietmar Dammerer ◽  
Philipp Hofer-Picout ◽  
Gerhard Kaufmann
Keyword(s):  
Wound Infection ◽  
Hallux Valgus ◽  
Case Series ◽  
Wedge Osteotomy ◽  
Metatarsal Osteotomy ◽  
Level Of Evidence ◽  
Opening Wedge ◽  
First Metatarsal ◽  
Chevron Osteotomy ◽  
Severe Hallux Valgus

Background: The aim of this study was to assess radiographic and clinical outcomes after double osteotomy with proximal opening wedge first metatarsal osteotomy and first metatarsal distal chevron osteotomy in the treatment of moderate to severe hallux valgus. Methods: 33 patients (4 male, 29 female; 36 feet; average age 60.7 years) were included in the study. Radiographic and clinical outcome in terms of intermetatarsal angle (IMA), hallux valgus angle (HVA), distal metatarsal articular angle (DMAA), and the American Orthopaedic Foot & Ankle Society metatarsophalangeal-interphalangeal hallux score (AOFAS MTP-IP hallux score) were investigated at 6 weeks, 6 months, and after an average of 28 (range, 7-123) months postoperatively. Results: Preoperative IMA, HVA, and DMMA showed statistically significant improvement ( P ≤ .05) from 19.1 ± 3.8 (8.9-27.3) degrees, 45.4 ± 8.7 (25.9-60.9) degrees, and 20.8 ± 8.9 (4.5-38.0) degrees to 6.0 ± 3.3 (0.4-12.2) degrees, 9.1 ± 8.9 (–6.7 to 39.0) degrees, and 6.4 ± 5.6 (–6.8 to 21.0) degrees at last follow-up, respectively. Postoperative AOFAS MTP-IP hallux score averaged 88.1 points. Overall, 10 complications were observed: hallux varus (3 feet), hallux valgus recurrence (3 feet), nonunion (1 foot), loss of fixation (1 foot), and wound infection (2 feet). Conclusion: Proximal opening wedge first metatarsal osteotomy with distal chevron osteotomy provided powerful correction of each component of moderate to severe hallux valgus but had a substantial rate of complications in terms of over- and undercorrection, nonunion, loss of fixation, and wound infection. Level of Evidence: Level IV, case series.

Proximal First Metatarsal Opening Wedge Osteotomy with a Low Profile Plate

2009 ◽  
Vol 30 (9) ◽  
pp. 865-872 ◽  
Author(s):  
Paul S. Shurnas ◽  
Troy S. Watson ◽  
Timothy W. Crislip
Keyword(s):  
Hallux Valgus ◽  
Case Series ◽  
Wedge Osteotomy ◽  
Opening Wedge ◽  
First Metatarsal ◽  
Vas Score ◽  
Hallux Varus ◽  
Hallux Valgus Deformity ◽  
Significant Difference ◽  
The Mean

Background: Many surgical procedures have been described for the correction of metatarsus primus varus associated with hallux valgus deformity. The purpose of this study was to present the results of the proximal metatarsal opening wedge (PMOW) osteotomy using the Arthrex LPS® first metatarsal system. Materials and Methods: Eighty-four patients (90 feet) underwent PMOW osteotomy with distal bunionectomy. There were 78 patients (93%) and 84 (93%) feet available for followup. Mean followup was 2.4 (range, 2.0 to 3.2) years from the time of the index surgery. Pre- and postoperative clinical examination, level of activity, patient derived subjective satisfaction score, radiographic measurements, and visual analogue scale (VAS) score for pain were obtained and evaluated retrospectively. Results: The mean preoperative VAS score was 5.9 (± 2.2), compared with a mean postoperative score of 0.5 (± 0.8). The mean 1–2 IMA preoperatively was 14.5 (±3.3) degrees, compared with postoperative measurements of 4.6 (± 2.8) degrees. The mean hallux valgus angle (HVA) improved from a mean of 30 (range, 22 to 64) degrees preoperatively to 10 (range, −15 to +18) degrees. The mean time to radiographic union was 5.9 (range, 4 to 14) weeks. There was one nonunion, one delayed union, mild hallux varus in two patients, severe hallux varus in two patients, recurrent hallux valgus in three patients (including the nonunion) and no instances of plate failure there was no significant difference in mean preoperative (74.8 degrees ± 11) compared to postoperative (67.9 degrees ± 10) total MTP joint range of motion. Ninety percent of patients reported good to excellent subjective results after the index surgery. Conclusion: We believe PMOW osteotomy was near ideal in terms of reliable, predictable correction and healing. Length of the first metatarsal was maintained and patients ambulated safely in a CAM walking boot immediately after surgery. We believe a first web space release may result in hallux varus and increased distal metatarsal articular angle (DMAA) was associated with hallux valgus recurrence. Level of Evidence: IV, Retrospective Case Series

Radiographic Evaluation of Hallux Valgus Treated with Opening Wedge Osteotomy

2009 ◽  
Vol 30 (5) ◽  
pp. 427-431 ◽  
Author(s):  
Sunil Randhawa ◽  
Dean Pepper
Keyword(s):  
Hallux Valgus ◽  
Plate Fixation ◽  
Radiographic Evaluation ◽  
Wedge Osteotomy ◽  
Opening Wedge ◽  
First Metatarsal ◽  
Plate Group ◽  
Low Profile ◽  
Contemporary Practice

Background: There are many techniques described for treatment of hallux valgus. The role of proximal osteotomies of the 1st metatarsal is well documented. However the opening wedge osteotomy has become less popular in contemporary practice. The purpose of this paper was to report our experience with an opening wedge osteotomy for the treatment of hallux valgus using L-Plate fixation. Materials and Methods: Twenty-nine patients underwent 31 basal opening wedge osteotomies of the first metatarsal. Fixation was achieved with the Arthrex® low profile titanium plate. The IMA on the WB radiograph preoperatively, and at least 12 months postoperatively was measured. Four patients received a 3.5-mm plate, 15 received a 4.0-mm plate, and 12 received a 5.0-mm plate. Results: The 3.5-mm group had a mean preoperative IMA of 13.8 degrees (range, 6 to 18), and postoperative IMA of 5.8 (range, 3 to 8), with a mean correction of 8.0. The 4.0-mm plate group had a mean preoperative IMA of 16.9 (range, 11 to 30) and postoperative IMA of 8.9 (range, 4 to 11) with a mean correction of 9.0. The 5.0-mm plate group had a mean preoperative IMA of 24.7 (range, 15 to 35) and postoperative IMA of 9.8, (range, 3 to 22) with a mean correction of 14.9. Conclusion: We report on a successful method for correcting hallux valgus with a basilar first metatarsal opening wedge osteotomy. It was highly effective for correcting moderate to severe intermetatarsal deformities.

scholarly journals Medial Cuneiform Opening-Wedge Osteotomy for the Treatment of Hallux Valgus

2019 ◽  
Vol 4 (1) ◽  
pp. 247301141881331
Author(s):  
Jason S. Ahuero ◽  
John S. Kirchner ◽  
Paul M. Ryan
Keyword(s):  
Soft Tissue ◽  
Hallux Valgus ◽  
Wedge Osteotomy ◽  
Opening Wedge ◽  
First Metatarsal ◽  
Low Profile ◽  
Medial Cuneiform ◽  
The Mean ◽  
Wedge Plate

Background: While proximal first metatarsal osteotomy combined with distal soft tissue realignment is accepted as standard treatment of moderate to severe hallux valgus with metatarsus primus varus, none of the described proximal metatarsal osteotomies address the hyper-obliquity of the first metatarsocuneiform joint. An opening-wedge osteotomy of the medial cuneiform can potentially correct the 1-2 intermetatarsal angle (IMA) in addition to normalizing the hyper-obliquity of the first tarsometatarsal (TMT) joint. The purpose of this study was to retrospectively review the early radiographic and clinical results of the use of a medial cuneiform opening-wedge osteotomy fixed with a low-profile wedge plate combined with distal soft tissue realignment for the treatment of hallux valgus. Methods: Fourteen feet (13 patients; 2 male and 11 female, average age 56 years, range 22-75) with hallux valgus underwent an opening-wedge osteotomy of the medial cuneiform fixed with a low-profile nonlocking wedge plate combined with distal soft tissue realignment. The mean preoperative hallux valgus angle (HVA) was 32 degrees and the IMA was 16 degrees. HVA, 1-2 IMA, proximal first metatarsal inclination (PFMI), and presence of osteoarthritis of the first TMT joint were assessed on preoperative and final postoperative radiographs. Final postoperative radiographs were also evaluated for radiographic union and hardware failure at an average of 7 months (range, 3-19 months) postoperatively. Results: A mean intraoperative correction of 19 degrees and 7 degrees was achieved for the HVA and IMA, respectively. The mean HVA was 22 degrees and the mean IMA was 11 degrees at the time of final follow-up. At final follow-up, a recurrence of the deformity was observed in 12/14 feet. There were 2 nonunions—one plate failure and one screw failure. No first TMT joint instability or arthritis was observed. All patients were ambulatory without assistive device in either fashionable or comfortable shoe wear. Conclusion: Medial cuneiform opening-wedge osteotomy resulted in unreliable correction of HVA and IMA at short-term follow-up with a high rate of early recurrence of hallux valgus deformity and a complication rate similar to that of the Lapidus procedure. This procedure cannot be recommended for addressing hallux valgus in the setting of increased obliquity of the first TMT joint. Level of Evidence: Level IV, case series.

Proximal opening-wedge osteotomy of the first metatarsal for moderate and severe hallux valgus using low profile plates

2013 ◽  
Vol 19 (4) ◽  
pp. 276-282 ◽  
Author(s):  
Caio Nery ◽  
Cibele Réssio ◽  
Gerson de Azevedo Santa Cruz ◽  
Rafael Silva Remor de Oliveira ◽  
Carla Chertman
Keyword(s):  
Hallux Valgus ◽  
Wedge Osteotomy ◽  
Opening Wedge ◽  
First Metatarsal ◽  
Low Profile ◽  
Severe Hallux Valgus

Radiographic Impact of Lapidus, Proximal Lateral Closing Wedge Osteotomy, and Suture Button Procedures on First Ray Length and Dorsiflexion for Hallux Valgus

2020 ◽  
Vol 41 (8) ◽  
pp. 964-971 ◽  
Author(s):  
Ian M. Foran ◽  
Nasima Mehraban ◽  
Stephen K. Jacobsen ◽  
Daniel D. Bohl ◽  
Johnny Lin ◽  
...  
Keyword(s):  
Hallux Valgus ◽  
Wedge Osteotomy ◽  
Level Of Evidence ◽  
Closing Wedge Osteotomy ◽  
First Metatarsal ◽  
Suture Button ◽  
Closing Wedge ◽  
Radiographic Measurements ◽  
Valgus Angle ◽  
First Ray

Background: Shortening and dorsiflexion of the first metatarsal are known potential side effects of metatarsal osteotomies for hallux valgus (HV) with the potential to cause transfer metatarsalgia. We compared the effect of the first tarsometatarsal joint arthrodesis (Lapidus procedure), proximal lateral closing wedge osteotomy (PLCWO), and intermetatarsal suture button fixation procedures on the length and dorsiflexion of the first ray. Methods: We retrospectively evaluated 105 feet in 99 patients with 30 weeks of follow-up. The average age was 54 years. Seventy-four feet had a Lapidus procedure, 12 had a PLCWO, and 19 had intermetatarsal suture button fixation. Digital radiographic measurements were made for the pre- and postoperative hallux valgus angle (HVA) and intermetatarsal angle (IMA), absolute and relative shortening of the first ray, and dorsiflexion. Results: Preoperative HVA and IMA did not differ between treatment groups ( P > .05 for each). Similar corrections of HVA (30.5-13.5 degrees) were achieved between all groups ( P > .05). The IMA was improved more in the Lapidus group (14.3-6.5 degrees) compared with the suture button fixation group (14.2-8.1 degrees) ( P = .045). There were significant differences in the change in absolute first cuneiform–metatarsal length (FCML) between the Lapidus (–1.6 mm), PLCWO (–2.3 mm), and intermetatarsal suture button fixation (+1.9 mm) procedure ( P = .004). There were also significant differences in relative first metatarsal shortening between the Lapidus (0.1 mm relative shortening), PLCWO (1.1 mm relative shortening), and intermetatarsal suture button fixation (1.3 mm lengthening) procedure ( P < .001). The average dorsiflexion differed between the Lapidus (1.8 degrees) and suture button fixation (0.4 degrees) groups ( P = .004). Conclusion: Intermetatarsal suture button fixation relatively lengthened the first ray, the Lapidus procedure maintained length, and the PLCWO relatively and absolutely shortened it. Dorsiflexion may be higher with the Lapidus and osteotomy procedures. Level of Evidence: Level III, retrospective comparative series.

Sign in / Sign up

Export Citation Format

Share Document