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Xiong Y, Shen B, Hao C, Xiao K, Wang J, Fang Z. Transfer of abductor hallucis tendon combined with scarf osteotomy versus single scarf osteotomy in moderate to severe hallux valgus deformity: a comparative retrospective cohort study. BMC Musculoskelet Disord 2019; 20:455. [PMID: 31630676 PMCID: PMC6802301 DOI: 10.1186/s12891-019-2860-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 10/01/2019] [Indexed: 11/21/2022] Open
Abstract
Background Scarf osteotomy (SO) was broadly applied in moderate to severe hallux valgus (MSHV), and the results were satisfactory. However, due to the complicated pathologic changes in hallux valgus, the ideal surgical treatment is still controversial. Transfer of the abductor hallucis tendon combined with Scarf osteotomy (TAHTCSO) was an innovative alternative technique. This retrospective cohort study aimed to define if TAHTCSO mode resulted in improved outcomes as compared with the single SO in MSHV. Methods Of 73 patients (92 ft) with MSHV, 36 (45 ft) were treated through TAHTCSO and 37 ones (47 ft) through SO. The patients were assessed clinically and radiographically with a 24-month follow-up. They were assessed pre-operatively and post-operatively with intermetatarsal angle (IMA), hallux valgus angle (HVA), distal metatarsal articular angle (DMAA), first metatarsophalangeal joint range of motion (1#MTP ROM), as well as American Orthopaedic Foot and Ankle Society (AOFAS) forefoot scores and postoperative complications of surgery. Results Both cohorts had the same baseline feathures. All patients were followed up from 24 to 40 months, with a mean of 28.3 months. Patients in the TAHTCSO cohort had significantly decreased HVA at 6 months (p < 0.0001), 12 months (p < 0.0001), and 24 months (p < 0.0001) after surgery. 1#MTP had been increased slightly with non-statistic sense (p>0.05). IMA, DMAA and AOFAS also had not significantly difference at all followed time after surgery as compared with the SO cohort. The healing of osteotomies was observed within 8 weeks in the two cohorts. Two cases of hallus varus had been found in SO cohort and there were no cases of delayed healing and bone non-union in both cohorts. Conclusion In this retrospective cohort study, TAHTCSO had sufficient maintenance of the correction and improved functional performance thereby was a good alternative for MSHV, though it did not display a better result for MSHV compared to SO.
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Affiliation(s)
- Yuan Xiong
- Department of Orthopaedics, Wuhan Fourth Hospital, Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 43033, China
| | - Bo Shen
- Department of Orthopaedics, Wuhan Fourth Hospital, Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 43033, China
| | - Cheng Hao
- Department of Orthopaedics, Wuhan Fourth Hospital, Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 43033, China
| | - Kai Xiao
- Department of Orthopaedics, Wuhan Fourth Hospital, Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 43033, China
| | - Junwen Wang
- Department of Orthopaedics, Wuhan Fourth Hospital, Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 43033, China
| | - Zhenhua Fang
- Department of Orthopaedics, Wuhan Fourth Hospital, Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 43033, China.
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Stukenborg-Colsman C, Claaßen L, Ettinger S, Yao D, Lerch M, Plaaß C. [Distal osteotomy for the treatment of hallux valgus (Chevron osteotomy)]. DER ORTHOPADE 2017; 46:402-407. [PMID: 28405710 DOI: 10.1007/s00132-017-3422-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Distal osteotomies, like the Chevron osteotomy, is indicated for mild to moderate hallux valgus deformities. Splayfoot, painful pseudoexostosis, and transfer metatasalgia are observed in the clinical examination. Radiographic examination should be done with weight bearing in two planes. Preoperatively the intermetatarsal (IM), hallux valgus, and distal metatarsal articular (DMAA) angles should be measured. The operative technique is based on soft tissue and bony correction. Modifications of the osteotomy allow a shortening, lengthening, or neutral correction of the first metatarsal. With a modified Chevron osteotomy, an increased DMAA can be also corrected.
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Affiliation(s)
- C Stukenborg-Colsman
- Department Fuß- und Sprunggelenkchirurgie, DIAKOVERE Annastift, Orthopädische Klinik der Medizinischen Hochschule Hannover (MHH), Anna-von-Borries-Str. 1-7, 30625, Hannover, Deutschland.
| | - L Claaßen
- Department Fuß- und Sprunggelenkchirurgie, DIAKOVERE Annastift, Orthopädische Klinik der Medizinischen Hochschule Hannover (MHH), Anna-von-Borries-Str. 1-7, 30625, Hannover, Deutschland
| | - S Ettinger
- Department Fuß- und Sprunggelenkchirurgie, DIAKOVERE Annastift, Orthopädische Klinik der Medizinischen Hochschule Hannover (MHH), Anna-von-Borries-Str. 1-7, 30625, Hannover, Deutschland
| | - D Yao
- Department Fuß- und Sprunggelenkchirurgie, DIAKOVERE Annastift, Orthopädische Klinik der Medizinischen Hochschule Hannover (MHH), Anna-von-Borries-Str. 1-7, 30625, Hannover, Deutschland
| | - M Lerch
- Department Fuß- und Sprunggelenkchirurgie, DIAKOVERE Annastift, Orthopädische Klinik der Medizinischen Hochschule Hannover (MHH), Anna-von-Borries-Str. 1-7, 30625, Hannover, Deutschland
| | - C Plaaß
- Department Fuß- und Sprunggelenkchirurgie, DIAKOVERE Annastift, Orthopädische Klinik der Medizinischen Hochschule Hannover (MHH), Anna-von-Borries-Str. 1-7, 30625, Hannover, Deutschland
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[Lapidus arthrodesis]. DER ORTHOPADE 2017; 46:424-433. [PMID: 28361194 DOI: 10.1007/s00132-017-3411-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The tarso-metatarsal 1 joint (TMT-I) arthrodesis is a treatment option or moderate to severe hallux valgus (HV) deformities. Instability of the TMT1 joint is still a debatable indication. Using stable osteosynthesis techniques allows early postoperative weight bearing. Plantar plating combined with a lag screw is the biomechanical most stable construct. An additional intermetatarsal screw can improve the horizontal stability. Clinical results are good and radiological parameters stay constant, even in the long term.
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Waizy H, Bouillon B, Stukenborg-Colsman C, Claaßen L, Danniilidis K, Plaaß C, Arbab D. [Soft tissue techniques in hallux valgus surgery]. DER ORTHOPADE 2017; 46:434-439. [PMID: 28349173 DOI: 10.1007/s00132-017-3412-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The hallux valgus represents combined bony and soft tissue pathology. In addition to known bony surgical procedures, addressing the soft tissue with regard to the anatomical structures, the surgical technique and the extent of correction are discussed.The goal of the operation is the restoration of the physiological balance between the active and passive stabilizing factors of the MTP-I-joint. The joint capsule, the ligaments and the tendons of the first ray act directly as stabilizing structures, whereas the hind foot and the position of the upper ankle have an indirect influence on the MTP-I-joint.The present work gives an overview of the pathoanatomy of the MTP-I-joint in the hallux valgus pathology. The individual anatomical structures are presented with regard to their physiological and pathological influence and the possible therapeutic options.
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Affiliation(s)
- H Waizy
- Klinik für Fuß- und Sprunggelenkchirurgie, Hessing Stiftung, Hessingstraße 17, 86199, Augsburg, Deutschland. .,Labor für Biomechanik und Biomaterialien, Orthopädische Klinik der Medizinischen Hochschule Hannover, Anna-von-Borries Str. 1-7, 30625, Hannover, Deutschland.
| | - B Bouillon
- Klinik für Orthopädie, Unfallchirurgie und Sporttraumatologie Köln Merheim, Ostmerheimer Str. 200, 51109, Köln, Deutschland
| | - C Stukenborg-Colsman
- Department Fuß- und Sprunggelenkchirurgie, DIAKOVERE Annastift, Orthopädische Klinik der Medizinischen Hochschule Hannover (MHH), Anna-von-Borries-Str. 1-7, 30625, Hannover, Deutschland
| | - L Claaßen
- Department Fuß- und Sprunggelenkchirurgie, DIAKOVERE Annastift, Orthopädische Klinik der Medizinischen Hochschule Hannover (MHH), Anna-von-Borries-Str. 1-7, 30625, Hannover, Deutschland
| | - K Danniilidis
- Sporthopaedicum Straubing, Bahnhofplatz 27, 94315, Straubing, Deutschland
| | - C Plaaß
- Department Fuß- und Sprunggelenkchirurgie, DIAKOVERE Annastift, Orthopädische Klinik der Medizinischen Hochschule Hannover (MHH), Anna-von-Borries-Str. 1-7, 30625, Hannover, Deutschland
| | - D Arbab
- Orthopädische Klinik, Fakultät Gesundheit Universität Witten/Herdecke, Klinikum Dortmund, Beurhausstr. 40, 44137, Dortmund, Deutschland
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Arbab D, Wingenfeld C, Frank D, Bouillon B, König DP. [Distal soft-tissue procedure in hallux valgus deformity]. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2015. [PMID: 26199033 DOI: 10.1007/s00064-015-0406-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Distal, lateral soft tissue release to restore mediolateral balance of the first metatarsophalangeal (MTP) joint in hallux valgus deformity. Incision of the adductor hallucis tendon from the fibular sesamoid, the lateral capsule, the lateral collateral ligament, and the lateral metatarsosesamoid ligament. INDICATIONS Hallux valgus deformities or recurrent hallux valgus deformities with an incongruent MTP joint. CONTRAINDICATIONS General medical contraindications to surgical interventions. Painful stiffness of the MTP joint, osteonecrosis, congruent joint. Relative contraindications: connective tissue diseases (Marfan syndrome, Ehler-Danlos syndrome). SURGICAL TECHNIQUE Longitudinal, dorsal incision in the first intermetatarsal web space between the first and second MTP joint. Blunt dissection and identification of the adductor hallucis tendon. Release of the adductor tendon from the fibular sesamoid. Incision of the lateral capsule, the lateral collateral ligament, and the lateral metatarsosesamoid ligament. POSTOPERATIVE MANAGEMENT Postoperative management depends on bony correction. In joint-preserving procedures, dressing for 3 weeks in corrected position. Subsequently hallux valgus orthosis at night and a toe spreader for a further 3 months. Passive mobilization of the first MTP joint. Postoperative weight-bearing according to the osteotomy. RESULTS A total of 31 patients with isolated hallux valgus deformity underwent surgery with a Chevron and Akin osteotomy and a distal medial and lateral soft tissue balancing. The mean preoperative intermetatarsal (IMA) angle was 12.3° (range 11-15°); the hallux valgus (HV) angle was 28.2° (25-36°). The mean follow-up was 16.4 months (range 12-22 months). The mean postoperative IMA correction ranged between 2 and 7° (mean 5.2°); the mean HV correction was 15.5° (range 9-21°). In all, 29 patients (93%) were satisfied or very satisfied with the postoperative outcome, while 2 patients (7%) were not satisfied due to one delayed wound healing and one recurrent hallux valgus deformity. There were no infections, clinical and radiological signs of avascular necrosis of the metatarsal head, overcorrection with hallux varus deformity, or significant stiffness of the first MTP joint.
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Affiliation(s)
- D Arbab
- LVR Klinik Orthopädie, Mitglied der Fakultät Gesundheit Universität Witten/Herdecke, Viersen, Deutschland.
| | | | - D Frank
- Klinik für Orthopädie, Unfallchirurgie, und Handchirurgie, Florence Nightingale Krankenhaus Düsseldorf, Düsseldorf, Deutschland
| | - B Bouillon
- Klinik für Orthopädie, Unfallchirurgie und Sporttraumatologie Köln Merheim, Köln, Deutschland
| | - D P König
- LVR Klinik Orthopädie, Viersen, Deutschland
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Windhagen H, Radtke K, Weizbauer A, Diekmann J, Noll Y, Kreimeyer U, Schavan R, Stukenborg-Colsman C, Waizy H. Biodegradable magnesium-based screw clinically equivalent to titanium screw in hallux valgus surgery: short term results of the first prospective, randomized, controlled clinical pilot study. Biomed Eng Online 2013; 12:62. [PMID: 23819489 PMCID: PMC3702514 DOI: 10.1186/1475-925x-12-62] [Citation(s) in RCA: 246] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Accepted: 06/25/2013] [Indexed: 02/06/2023] Open
Abstract
Purpose Nondegradable steel-and titanium-based implants are commonly used in orthopedic surgery. Although they provide maximal stability, they are also associated with interference on imaging modalities, may induce stress shielding, and additional explantation procedures may be necessary. Alternatively, degradable polymer implants are mechanically weaker and induce foreign body reactions. Degradable magnesium-based stents are currently being investigated in clinical trials for use in cardiovascular medicine. The magnesium alloy MgYREZr demonstrates good biocompatibility and osteoconductive properties. The aim of this prospective, randomized, clinical pilot trial was to determine if magnesium-based MgYREZr screws are equivalent to standard titanium screws for fixation during chevron osteotomy in patients with a mild hallux valgus. Methods Patients (n=26) were randomly assigned to undergo osteosynthesis using either titanium or degradable magnesium-based implants of the same design. The 6 month follow-up period included clinical, laboratory, and radiographic assessments. Results No significant differences were found in terms of the American Orthopaedic Foot and Ankle Society (AOFAS) score for hallux, visual analog scale for pain assessment, or range of motion (ROM) of the first metatarsophalangeal joint (MTPJ). No foreign body reactions, osteolysis, or systemic inflammatory reactions were detected. The groups were not significantly different in terms of radiographic or laboratory results. Conclusion The radiographic and clinical results of this prospective controlled study demonstrate that degradable magnesium-based screws are equivalent to titanium screws for the treatment of mild hallux valgus deformities.
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Affiliation(s)
- Henning Windhagen
- Department of Orthopaedic Surgery, Hannover Medical School, Anna-von-Borries-Str,1-7, 30625 Hannover, Germany
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