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Arzac Ulla I. Tratamiento del hallux valgus rigidus con osteotomía tipo Mitchell modificada. Descripción de la técnica quirúrgica y evaluación funcional a mediano plazo. REVISTA DE LA ASOCIACIÓN ARGENTINA DE ORTOPEDIA Y TRAUMATOLOGÍA 2023. [DOI: 10.15417/issn.1852-7434.2023.88.1.1578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
Objetivo: Describir la técnica quirúrgica de Mitchell modificada para el tratamiento del hallux valgus rigidus grado 2, y evaluar los resultados a mediano plazo.
Materiales y Métodos: Estudio prospectivo observacional. Entre agosto de 2015 y enero de 2019, 21 pacientes (23 pies) con hallux valgus rigidus grado 2 fueron sometidos a una osteotomía tipo Mitchell modificada.
Resultados: Se comunican los resultados sobre la base de la edad, el sexo, el seguimiento posoperatorio, el puntaje de la AOFAS, el pie afectado, la pérdida de reducción, el colapso de la cabeza del metatarsiano, el dolor residual y la necesidad de plantillado para el alta. El puntaje de la AOFAS a los 18 meses fue de 94,78. Los pacientes retornaron a su actividad laboral, en promedio, a los 16.6 días y a sus actividades previas, a los 3.43 meses.
Conclusión: Presentamos una técnica quirúrgica que combina los beneficios de la osteotomía de Chevron y la de Mitchell, con excelentes resultados clínicos y funcionales.
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Li Y, Wang Y, Tang K, Tao X. Modified scarf osteotomy for hallux valgus: From a finite element model to clinical results. J Orthop Surg (Hong Kong) 2022; 30:10225536221143816. [PMID: 36459594 DOI: 10.1177/10225536221143816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
PURPOSE Finite element (FE) analysis and clinical follow-up were used to evaluate the efficacy of modified scarf osteotomy for moderate-to-severe hallux valgus (HV). METHOD We retrospectively evaluated 42 patients (44 feet) who underwent modified rotational scarf osteotomy for moderate-to-severe HV at our institution between January 2010 and January 2019. Radiological indicators and subjective scores were recorded at different time points. To compare the results and elemental characteristics, a FE model of the metatarsophalangeal (MTP) joint that included anatomically realistic geometrical and structural characteristics was built. The biomechanical features and correction differences in dynamic loads as well as the incidence of troughing were estimated. RESULTS Both the hallux valgus angle (HVA) and intermetatarsal angle (IMA) showed significant improvement 6 weeks postoperatively (p < 0.05); additionally, the HVA increased from 6 weeks postoperatively to the last follow-up, while the IMA showed no significant changes (p > 0.05). The subjective scores significantly improved from the preoperative period to the last follow-up. The percentages of troughing and recurrence were remarkably low in our pilot study because of the innate stability of the modified rotated fixation. CONCLUSION Our preliminary findings suggest that modified rotational scarf osteotomy offers sufficient stability, correct HV deformity effectively, and good clinical outcomes for moderate to severe HV.
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Affiliation(s)
- Yan Li
- Department of Orthopaedics, Sports Medicine Center, 12525The First Affiliated Hospital of Army Military Medical University, Chongqing, China
| | - Yue Wang
- College of Physical Education and Health, 12524Chongqing Normal University, Chongqing, China
| | - Kanglai Tang
- Department of Orthopaedics, Sports Medicine Center, 12525The First Affiliated Hospital of Army Military Medical University, Chongqing, China
| | - Xu Tao
- Department of Orthopaedics, Sports Medicine Center, 12525The First Affiliated Hospital of Army Military Medical University, Chongqing, China
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Biomechanical comparison between bioabsorbable and medical titanium screws in distal chevron osteotomy of first metatarsal in hallux valgus treatment. J Mech Behav Biomed Mater 2022; 131:105260. [DOI: 10.1016/j.jmbbm.2022.105260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 04/10/2022] [Accepted: 04/29/2022] [Indexed: 11/22/2022]
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Pisecky L, Luger M, Klasan A, Gotterbarm T, Klotz MC, Hochgatterer R. Bioabsorbable implants in forefoot surgery: a review of materials, possibilities and disadvantages. EFORT Open Rev 2021; 6:1132-1139. [PMID: 35839087 PMCID: PMC8693227 DOI: 10.1302/2058-5241.6.200157] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Bioabsorbable and biodegradable implants offer new possibilities in orthopaedic and trauma surgery. As soon as the initial stability of the degradable implants has reached the qualities of conventional materials, new devices may find usage in younger and more demanding patients. Residual conventional osteosynthetic material or the necessity to remove metal increasingly seems to be more of an adverse event than daily practice in forefoot surgery. Nevertheless, some drawbacks need to be discussed. Recent literature screened for the use of bioabsorbable and biodegradable materials in forefoot surgery, available implants and indications in forefoot surgery were analysed and summarized. Apart from common indications in forefoot surgery, points of interest were the type of biomaterial, the process of biodegradation and biointegration, and possible adverse events. Materials were comprehensively discussed for each indication based on the available literature. Polylactide, polyglycoside and polydioxanone are considered safe and sufficiently stable for use in forefoot surgery. Low complication rates (e.g. 0.7% for pin fixation in hallux deformities) are given. Magnesium implants suffered from an extensive corrosive process in the first generation but now seem to be safe in forefoot surgery and offer good options compared with conventional titanium screws, especially in procedures of the first ray. Allograft bone has proven feasibility in small case series, but still lacks larger or randomized clinical trials. The first results are promising. Bioresorbable and osseointegrating devices offer attractive new possibilities for surgeons and patients. Despite all the known advantages, the difficulties and possible complications must not be forgotten, such as soft tissue reactions, unwanted osteolysis and a lower primary mechanical load capacity. Cite this article: EFORT Open Rev 2021;6:1132-1139. DOI: 10.1302/2058-5241.6.200157
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Affiliation(s)
- Lorenz Pisecky
- Department for Orthopaedics and Traumatology, Kepler University Hospital GmbH, Johannes Kepler University Linz, Linz, Austria
| | - Matthias Luger
- Department for Orthopaedics and Traumatology, Kepler University Hospital GmbH, Johannes Kepler University Linz, Linz, Austria
| | - Antonio Klasan
- Department for Orthopaedics and Traumatology, Kepler University Hospital GmbH, Johannes Kepler University Linz, Linz, Austria
| | - Tobias Gotterbarm
- Department for Orthopaedics and Traumatology, Kepler University Hospital GmbH, Johannes Kepler University Linz, Linz, Austria
| | - Matthias C. Klotz
- Department for Orthopaedics and Traumatology, Kepler University Hospital GmbH, Johannes Kepler University Linz, Linz, Austria
| | - Rainer Hochgatterer
- Department for Orthopaedics and Traumatology, Kepler University Hospital GmbH, Johannes Kepler University Linz, Linz, Austria
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Ayoubi R, Darwish M, Aouad D, Maalouly J, Hanna J, Abboud G, Cortbawi C. Modified Mitchell technique for treating hallux valgus: Retrospective case series on a Middle-Eastern population and literature review. Ann Med Surg (Lond) 2021; 65:102259. [PMID: 33996042 PMCID: PMC8091872 DOI: 10.1016/j.amsu.2021.102259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 03/23/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction The hallux valgus deformity is a complex deformity of the first ray of the foot, with more than 100 procedures developed for its treatment. The aim of this retrospective study was to assess the clinical and radiographic outcomes of a modified Mitchell's technique. Methods Between 2007 and 2018, 75 patients underwent the procedure. Clinical results were assessed by the AOFAS score. Radiological studies were evaluated by measuring pre-operative and post-operative HVA and IMA angles as well as the relative shortening of the first metatarsal. Results Of the initial 75 patients, 42 patients remained eligible with a total of 67 feet. The mean age and follow-up were 47.8 and 5.2 years respectively. Global AOFAS score improved from 45.3 to 88.8 (p < 0.01). Mean HVA and IMA improved from 37.0 to 10.2 (p < 0,01) and 12.1 to 5.6 (p < 0.01), respectively. The mean metatarsal shortening was 3.0 mm (p < 0.01). The statistical analysis showed no significant correlation between preoperative HVA and IMA angles with postoperative shortening, metatarsalgia, AOFAS scores nor the difference between the preoperative and postoperative AOFAS scores. Conclusion Short- and long-term outcomes of this modified Mitchell's osteotomy have been reported. Compared to other studies, these modifications proved to result in very good clinical and radiological outcomes even in severe cases with HVA>40. It has shown to be reliable, reproducible, and cost-efficient with low complication rates. We would like to highlight the importance of proper patient selection, limited soft tissue stripping, and adherence to the proposed surgical steps to avoid unwanted complications. The Modified Mitchell Technique has been shown to be reliable, reproducible, and cost-efficient with low complication rates. The addition of intra-articular lateral soft tissue release, preventing a lateral incision, decreasing wound and soft tissue complications. The use of autologous bone graft adjacent to the osteotomy stump helps improve union.
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Affiliation(s)
- Rami Ayoubi
- Department of Orthopedic Surgery and Traumatology Saint Georges University Medical Center, Balamand University, P.O.Box 166378 Achrafieh, Beirut, 1100 2807, Lebanon
| | - Mohammad Darwish
- Department of Orthopedic Surgery and Traumatology Saint Georges University Medical Center, Balamand University, P.O.Box 166378 Achrafieh, Beirut, 1100 2807, Lebanon
| | - Dany Aouad
- Department of Orthopedic Surgery and Traumatology Saint Georges University Medical Center, Balamand University, P.O.Box 166378 Achrafieh, Beirut, 1100 2807, Lebanon
- Corresponding author. St Georges University Medical Center, Beirut, Achrafieh, St Georges Street, Lebanon.
| | - Joseph Maalouly
- Department of Orthopedic Surgery and Traumatology Saint Georges University Medical Center, Balamand University, P.O.Box 166378 Achrafieh, Beirut, 1100 2807, Lebanon
| | - Jason Hanna
- Department of Orthopedic Surgery and Traumatology Saint Georges University Medical Center, Balamand University, P.O.Box 166378 Achrafieh, Beirut, 1100 2807, Lebanon
| | - Ghadi Abboud
- Department of Medical Imaging Saint Georges University Medical Center, Balamand University, P.O.Box 166378 Achrafieh, Beirut, 1100 2807, Lebanon
| | - Chawki Cortbawi
- Department of Orthopedic Surgery and Traumatology Saint Georges University Medical Center, Balamand University, P.O.Box 166378 Achrafieh, Beirut, 1100 2807, Lebanon
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Hernández-Castillejo LE, Álvarez-Bueno C, Garrido-Miguel M, Torres-Costoso A, Reina-Gutiérrez S, Martínez-Vizcaíno V. The effect of hallux valgus open and percutaneous surgery on AOFAS scale: a systematic review and meta-analysis. Qual Life Res 2021; 30:957-966. [PMID: 33387287 DOI: 10.1007/s11136-020-02715-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2020] [Indexed: 01/02/2023]
Abstract
PURPOSE To estimate the comparative effect of open and percutaneous hallux valgus (HV) surgery on patients' quality of life (QoL) using the American Orthopedic Foot and Ankle Society (AOFAS) scale including total score and individual domains (pain, function, and alignment). METHODS MEDLINE, EMBASE, Cochrane Library, and Web of Science databases were systematically searched from inception to March 2020 for studies on the effect of HV surgery on patients' QoL using the AOFAS score. A standardized mean difference score was calculated on the total AOFAS score and on each AOFAS domain (pain, function, and alignment) using Cohen's d index. RESULTS Considering the 53 published studies included, the pooled effect size (ES) estimates for the AOFAS total score were 3.69 (95% CI 3.37-4.01; I2 = 95.5%) for open surgery and 3.40 (95% CI 2.99-3.80, I2 = 88.2%) for percutaneous surgery. The total pooled ES estimate was 3.61 (95% CI 3.35-3.87, I2 = 94.5%). Considering the pain domain, the pooled ES estimates were 2.21 (95% CI 1.98-2.43, I2 = 64%) for open surgery and 2.52 (95% CI 1.83-3.20, I2 = 92.6%) for percutaneous surgery. For the function domain, the pooled ES estimates were 1.37 (95% CI 0.93-1.81, I2 = 91%) for open surgery and 2.28 (95% CI 1.10-3.47, I2 = 96.8%) for percutaneous surgery. Finally, the pooled ES estimates for the alignment domain were 3.99 (95% CI 3.51-4.47, I2 = 85.7%) for open surgery and 2.66 (95% CI 2.23-3.09, I2 = 78.5%) for percutaneous surgery. CONCLUSION Our data support that HV surgery increases the total AOFAS score as well as the AOFAS scores by domain (pain, function, and alignment). Furthermore, our data show that HV surgery increases patients' QoL, after both open and percutaneous surgery, without differences between them.
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Affiliation(s)
| | - Celia Álvarez-Bueno
- Health and Social Research Center, Universidad de Castilla La Mancha, Cuenca, Spain. .,Universidad Politécnica y Artística del Paraguay, Asunción, Paraguay.
| | | | - Ana Torres-Costoso
- School of Nursing and Physiotherapy, Universidad de Castilla-La Mancha, Toledo, Spain
| | - Sara Reina-Gutiérrez
- Health and Social Research Center, Universidad de Castilla La Mancha, Cuenca, Spain
| | - Vicente Martínez-Vizcaíno
- Health and Social Research Center, Universidad de Castilla La Mancha, Cuenca, Spain.,Facultad de Ciencias de La Salud, Universidad Autónoma de Chile, Talca, Chile
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Brilakis EV, Kaselouris E, Markatos K, Mastrokalos D, Provatidis C, Efstathopoulos N, Chronopoulos E. Mitchell's osteotomy augmented with bio-absorbable pins for the treatment of hallux valgus: A comparative finite element study. JOURNAL OF MUSCULOSKELETAL & NEURONAL INTERACTIONS 2019; 19:234-244. [PMID: 31186396 PMCID: PMC6587079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/29/2022]
Abstract
BACKGROUND There is an inadequacy of conventional means to assess the surgical outcomes of a bunion surgery. We used the Finite Element Analysis for evaluating the typical Mitchell's procedure outcomes with or without bio-absorbable pins. METHODS We developed a 3D FE model based on the CT images of a female volunteer with hallux valgus. A typical procedure was simulated on the foot model and two pins were virtually inserted for enhancing the fixation. We validated our model by comparing the predicted pressure results with the plantar pressure measured by a specific platform. RESULTS The comparison of the plantar pressure distribution revealed similar patterns. A greater displacement was observed on the medial side of the osteotomy, but it was decreased after using pins. The maximum average pressure under the 1st metatarsal head was decreased after the osteotomy. The respective pressure under the 3rd and 5th metatarsal head was decreased more after using pins, while, under the 2nd and 4th metatarsal head, an increase was developed. CONCLUSION The use of pins had no significant influence on the healing process but gave additional stability inside the osteotomy and could be used in cases where enhancement is needed. The surgeon should be familiar with the expected stress rising to the other metatarsal, considering the concomitant pathology or the additional interventions that should be performed.
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Affiliation(s)
- Emmanouil V. Brilakis
- 3rd Orthopaedic Department of “Hygeia” General Hospital, Athens, Greece,Corresponding author: Emmanouil Brilakis, 30A Str. Aiolou, 17561 Palaio Faliro, Greece E-mail:
| | | | | | - Dimitrios Mastrokalos
- 1st Orthopaedic Department of National and Kapodistrian University of Athens, Athens, Greece
| | - Christopher Provatidis
- Mechanical Design & Control Systems Section National Technical University of Athens, Athens, Greece
| | - Nicolas Efstathopoulos
- 2nd Orthopaedic Department of National and Kapodistrian University of Athens, Athens, Greece
| | - Efstathios Chronopoulos
- 2nd Orthopaedic Department of National and Kapodistrian University of Athens, Athens, Greece
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Crespo Romero E, Peñuela Candel R, Gómez Gómez S, Arias Arias A, Arcas Ordoño A, Gálvez González J, Crespo Romero R. Percutaneous forefoot surgery for treatment of hallux valgus deformity: an intermediate prospective study. Musculoskelet Surg 2017; 101:167-172. [PMID: 28168637 DOI: 10.1007/s12306-017-0464-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 01/22/2017] [Indexed: 06/06/2023]
Abstract
BACKGROUND This study aims to illustrate the results of percutaneous forefoot surgery (PFS) for correction of hallux valgus. MATERIALS AND METHODS A prospective study of 108 patients, with hallux valgus deformity, who underwent PFS was conducted. The minimum clinical and radiological follow-up was two years (mean 57.3 months, range 22-112). RESULTS Preoperative mean visual analog scale was 6.3 ± 1.5 points, and AOFAS scores were 50.6 ± 11 points. At the last follow-up, both scores improved to 1.9 ± 2.4 points and 85.9 ± 1.83 points, respectively. Mean hallux valgus angle changed from 34.3° ± 9.3° preoperatively to 22.5° ± 11.1° at follow-up. At follow-up, 76.5% of the subjects were satisfied or very satisfied. Recurrence of medial 1st MT head pain happened in 22 cases (16.7%). CONCLUSIONS PFS, in our study, does not improve the radiological and patient satisfaction rate results compared with conventional procedures. The main advantage is a low postoperative pain level, but with an insufficient HVA correction. LEVEL OF EVIDENCE II, prospective study.
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Affiliation(s)
- E Crespo Romero
- Orthopaedic and Traumatology Unit, Hospital Mancha-Centro, Avenida de la Constitución s/n, Alcázar de San Juan, CP: 13600, Ciudad Real, Spain.
| | - R Peñuela Candel
- Orthopaedic and Traumatology Unit, Hospital Mancha-Centro, Avenida de la Constitución s/n, Alcázar de San Juan, CP: 13600, Ciudad Real, Spain
| | - S Gómez Gómez
- Orthopaedic and Traumatology Unit, Hospital Mancha-Centro, Avenida de la Constitución s/n, Alcázar de San Juan, CP: 13600, Ciudad Real, Spain
| | - A Arias Arias
- Research Support Unit, Hospital Mancha-Centro, Avenida de la Constitución s/n, Alcázar de San Juan, CP: 13600, Ciudad Real, Spain
| | - A Arcas Ordoño
- Orthopaedic and Traumatology Unit, Hospital Mancha-Centro, Avenida de la Constitución s/n, Alcázar de San Juan, CP: 13600, Ciudad Real, Spain
| | - J Gálvez González
- Orthopaedic and Traumatology Unit, Hospital Mancha-Centro, Avenida de la Constitución s/n, Alcázar de San Juan, CP: 13600, Ciudad Real, Spain
| | - R Crespo Romero
- Orthopaedic and Traumatology Unit, Hospital Mancha-Centro, Avenida de la Constitución s/n, Alcázar de San Juan, CP: 13600, Ciudad Real, Spain
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Primary Stability of Absorbable Screw Fixation for Intra-articular Calcaneal Fractures: A Finite Element Analysis. J Med Biol Eng 2015. [DOI: 10.1007/s40846-015-0019-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Buciuto R. Prospective randomized study of chevron osteotomy versus Mitchell's osteotomy in hallux valgus. Foot Ankle Int 2014; 35:1268-76. [PMID: 25209122 DOI: 10.1177/1071100714550647] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND We conducted a prospective randomized trial to compare the most popular osteotomy types of operative treatment of hallux valgus (HV) used in Norway, Mitchell's osteotomy (MO) and chevron osteotomy (CO). METHODS One hundred twenty adult female patients were prospectively randomized to treatment with either MO or CO. All operative procedures were performed with ankle block and with tourniquet applied. None of the patients received any antibiotic or antithrombotic prophylaxis. The follow-up period was 3 years. Clinical results were rated according to the American Orthopaedic Foot and Ankle Society (AOFAS) Clinical Rating System (CRS). RESULTS HV in the MO group was reduced from 30 (range, 20 to 44) to 15 (range, 8 to 24) degrees and IM angle from 11 (range, 6 to 14) to 7 (range, 4 to 11) degrees. HV in the CO group was reduced from 31 (range, 22 to 42) to 16 (range, 6 to 24) degrees and IM angle from 14 (range, 8 to 20) to 6 (range, 2 to 10) degrees. Transfer metatarsalgia occurred in 36 (60%) patients and hammertoe in 6 (10%) patients in the MO group. In the CO group, metatarsalgia occurred in 5 patients. The median loss of postoperative HV correction was 4 (range, 2 to 10) degrees in mild deformity and 6 (6 to 10) degrees in moderate deformity. CONCLUSION Patients treated with CO had significantly better results for AOFAS CRS, number of postoperative complications, patient satisfaction, and length of sick leave for the employed patients. Based on our results, we consider that in female patients CO should be regarded as the first-line procedure for treatment of mild and moderate HV. LEVEL OF EVIDENCE Level I, prospective randomized study.
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Affiliation(s)
- Robert Buciuto
- Orthopaedic Department, St Olavs Hospital University Hospital, Trondheim, Norway
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Badekas A, Georgiannos D, Lampridis V, Bisbinas I. Proximal opening wedge metatarsal osteotomy for correction of moderate to severe hallux valgus deformity using a locking plate. INTERNATIONAL ORTHOPAEDICS 2013; 37:1765-70. [PMID: 23873174 DOI: 10.1007/s00264-013-2019-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Accepted: 07/02/2013] [Indexed: 11/28/2022]
Abstract
PURPOSE Hallux valgus is a complex deformity of the first metatarsophalangeal joint, with varus angulation of the first metatarsal, valgus deviation of the great toe and lateral displacement of the sesamoids and the extensor tendons. The aim of the surgery is to achieve correction of the varus deviation of the 1st metatarsal which is considered by some as the primary intrinsic predisposing factor to hallux valgus deformity. METHODS We retrospectively reviewed 85 patients (107 feet) who underwent an opening wedge osteotomy of the 1st metatarsal for correction of moderate to severe hallux valgus and metatarsus primus varus. A medially applied anatomic pre-contoured locking plate was used for fixation of the osteotomy. RESULTS The mean IMA was decreased from 15.8 (range 12-22) degrees to 7.8 (range 0-12) degrees. The mean pre-operative HVA was 39 (range 21-52) degrees and the mean postoperative HVA was 11.8 (6-19) degrees. The pre-operative AOFAS score was 52 (SD 3.1) and the postoperative score was 85 (SD 5.2). CONCLUSION The proximal opening wedge metatarsal osteotomy is a safe, effective and reproducible technique for correction of moderate to severe hallux valgus deformity. The use of a locking plate provides enough control at the fragments, enhancing healing of osteotomy and maintenance of the correction even with a violated proximal lateral cortex.
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Affiliation(s)
- Athanasios Badekas
- Department of Foot and Ankle Surgery, Metropolitan Hospital, Athens, Greece
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12
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Giannini S, Faldini C, Nanni M, Di Martino A, Luciani D, Vannini F. A minimally invasive technique for surgical treatment of hallux valgus: simple, effective, rapid, inexpensive (SERI). INTERNATIONAL ORTHOPAEDICS 2013; 37:1805-13. [PMID: 23820757 DOI: 10.1007/s00264-013-1980-8] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Accepted: 06/12/2013] [Indexed: 11/25/2022]
Abstract
PURPOSE Several bony and soft tissue procedures have been described for the treatment of hallux valgus, and currently mini-invasive surgical techniques are preferred in order to reduce surgical trauma, complications, time of surgery and to allow an earlier recovery. The aim of this study is to analyse a series of 1,000 consecutive cases of hallux valgus, surgically treated by the minimally invasive SERI technique, reporting results at mid-term follow-up. METHODS We prospectively studied 641 patients (1,000 feet) with symptomatic hallux valgus surgically treated by SERI osteotomy. Inclusion criteria were: age between 20 and 65 years, reducible mild or moderate hallux valgus, HVA ≤ 40°, IMA ≤ 20°, and arthritis of the first metatarsophalangeal joint up to grade 2 according to the Regnauld classification. RESULTS The American Orthopaedic Foot and Ankle Society (AOFAS) score rose from 46.8 ± 6.7 preoperatively to 89 ± 10.3 at last follow-up. Radiographic control at follow-up showed a complete healing of the osteotomy and remodelling of the metatarsal bone. Low rate of complication has been reported. CONCLUSIONS This study demonstrated that the SERI technique is effective in treating mild to moderate hallux valgus in terms of relief from symptoms and functional improvement. This technique allowed correction of the main parameters of the deformity, with durable clinical and radiographic results at a mid-term follow-up.
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Affiliation(s)
- Sandro Giannini
- I Clinic of Orthopaedic and Traumatology, Rizzoli Orthopaedic Institute, University of Bologna, Italy
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Faour-Martín O, Martín-Ferrero MA, Valverde García JA, Vega-Castrillo A, de la Red-Gallego MA. Long-term results of the retrocapital metatarsal percutaneous osteotomy for hallux valgus. INTERNATIONAL ORTHOPAEDICS 2013; 37:1799-803. [PMID: 23722318 DOI: 10.1007/s00264-013-1934-1] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Accepted: 05/07/2013] [Indexed: 11/29/2022]
Abstract
PURPOSE The current trend in hallux valgus surgery is directed toward percutaneous procedures. However, no evidence that any of these methods of treatment are superior to the others has been described, excepting studies in the long term. The aim of this study was to analyse a series of patients who had undergone a percutaneous distal retrocapital osteotomy of the first metatarsal, and had been followed up for ten years. METHODS We carried out a clinical and radiological evaluation of 115 feet ten years after surgery. RESULTS The AOFAS scale results in the tenth postoperative year remained significantly favourable compared to their corresponding values in the preoperative period, yielding an improvement of 42.2 points overall on average. In relation to radiological findings, the mean hallux angle was maintained below 20 °, with a mean intermetatarsal angle of 8.1 °. CONCLUSION Percutaneous retrocapital metatarsal osteotomy for treatment of mild to moderate hallux valgus is effective in the long term, with the advantages of a minimally invasive procedure.
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Affiliation(s)
- Omar Faour-Martín
- Orthopaedic Surgery and Traumatology, Hospital of Ávila-Sacyl, Spain.
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Fuhrmann RA, Zollinger-Kies H, Kundert HP. Mid-term results of Scarf osteotomy in hallux valgus. INTERNATIONAL ORTHOPAEDICS 2010; 34:981-9. [PMID: 20157812 PMCID: PMC2989042 DOI: 10.1007/s00264-010-0958-z] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2009] [Revised: 01/10/2010] [Accepted: 01/11/2010] [Indexed: 11/29/2022]
Abstract
We performed a retrospective study on 178 Scarf osteotomies with a mean follow-up of 44.9 months (range 15-83 months). Clinical rating was based on the forefoot score of the American Orthopaedic Foot and Ankle Society (AOFAS). Weight bearing X-rays were used to perform angular measurements and assess the first metatarsophalangeal joint (MTP 1). At follow-up the mean AOFAS score had improved significantly (p < 0.001), but only 55% of the feet showed a perfect realignment of the first ray. Patients with a hallux valgus angle exceeding 30° and pre-existing degenerative changes at the MTP 1 joint displayed inferior clinical results (p < 0.05). Nearly 20% of the patients suffered from pain at the MTP 1 joint. This was clearly attributed to an onset or worsening of distinct radiographic signs of arthritis (p < 0.05) resulting in painfully decreased joint motion. Comparing radiographic appearance three months postoperatively and at follow-up, we found that radiographic criteria (hallux valgus, first intermetatarsal angle, hallux valgus interphalangeus, MTP 1 joint congruency, arthritic lesions at MTP 1) worsened with time.
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Affiliation(s)
- Renée A. Fuhrmann
- Department of Orthopaedic Surgery, Rudolf-Elle-Hospital, University of Jena, Klosterlausnitzerstr. 81, 07607 Eisenberg, Germany
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