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Song JH, Kang C, Park WH, Lee GS, Lee JK, Kim DH, Lee SW. Extended Distal Chevron Osteotomy and Akin Osteotomy Using Bioabsorbable Materials for Treatment of Moderate to Severe Hallux Valgus. J Foot Ankle Surg 2021; 60:1110-1116. [PMID: 34130930 DOI: 10.1053/j.jfas.2021.01.010] [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] [Received: 02/22/2020] [Revised: 09/28/2020] [Accepted: 01/04/2021] [Indexed: 02/03/2023]
Abstract
The purpose of this study was to investigate the suitability of bioabsorbable materials for fixation of extended distal chevron osteotomy and Akin osteotomy for the treatment of moderate to severe hallux valgus. We performed a retrospective analysis of extended distal chevron osteotomy and Akin osteotomy for the treatment of moderate to severe hallux valgus (33 patients, 42 feet). Fixation of extended distal chevron osteotomy and Akin osteotomy was performed using poly-l-lactic acid pins and polylactic acid/polyglycolic acid copolymer sutures, respectively. The radiological outcomes were evaluated based on the preoperative and 3-year follow-up intermetatarsal angle, hallux valgus angle, and hallux interphalangeal angle. The clinical results were assessed according to 3-year follow-up Manchester-Oxford Foot Questionnaire scores, patient satisfaction, and postoperative complications. All radiological and clinical results were compared with those of a control group treated with metallic implants. The mean 3-year follow-up intermetatarsal angle, hallux valgus angle, and hallux interphalangeal angle were significantly corrected from the preoperative values (all p < .001). The mean 3-year follow-up Manchester-Oxford Foot Questionnaire scores score was significantly improved from the preoperative values (p < .001). Regarding patient satisfaction, 88.1% of the patients reported good to excellent results. A total of seven complications were reported. All radiological and clinical results were comparable with those of control group treated with metallic implant. Based on these results, we recommend using bioabsorbable materials as another reliable device for fixation of extended distal chevron osteotomy and Akin osteotomy even for the treatment of moderate to severe hallux valgus.
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Affiliation(s)
- Jae Hwang Song
- Assistant Professor, Department of Orthopedic Surgery, Konyang University Hospital, Daejeon, South Korea
| | - Chan Kang
- Associate Professor, Department of Orthopedic Surgery, Chungnam National University Hospital, Daejeon, South Korea.
| | - Won Ho Park
- Professor, Department of Advanced Organic Materials and Textile Engineering System, Chungnam National University, Daejeon, South Korea
| | - Gi Soo Lee
- Assistant Professor, Department of Orthopedic Surgery, Chungnam National University Hospital, Daejeon, South Korea
| | - Jeong Kil Lee
- Assistant Professor, Department of Orthopedic Surgery, Chungnam National University Hospital, Daejeon, South Korea
| | - Dong Hwan Kim
- Third Year Resident, Department of Orthopedic Surgery, Chungnam National University Hospital, Daejeon, South Korea
| | - Seok Won Lee
- Third Year Resident, Department of Orthopedic Surgery, Konyang University Hospital, Daejeon, South Korea
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Sganga ML, Summers NJ, Barrett B, Matthews MR, Karthas T, Johnson L, Cook JJ, Basile P, Cook EA. Radiographic Union Scoring Scale for Determining Consolidation Rates in the Calcaneus. J Foot Ankle Surg 2018; 57:2-6. [PMID: 29037925 DOI: 10.1053/j.jfas.2017.05.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Indexed: 02/03/2023]
Abstract
The reliable evaluation of osseous consolidation after hindfoot osteotomy can be difficult. Concomitant hindfoot osteotomies often dictate the advancement of weightbearing, and radiographs are the mainstay imaging tool owing to cost, efficiency, and radiation exposure. Understanding the radiographic parameters that can be used to reliably determine osseous healing is paramount. However, currently, no reliable or validated method is available to determine osseous healing of hindfoot osteotomies in irregular bones of the foot. The purpose of the present study was to develop a radiographic healing scoring system that would enhance the diagnostic healing assessment after elective calcaneal osteotomy. We adapted existing orthopedic scales validated for healing in the leg for application in the irregular bones of the foot. A total of 168 cases were evaluated by 6 blinded assessors to test the interrater reliability of subjective healing assessment compared with the proposed scoring system. The radiographs were classified by postoperative period: ≤4 weeks, 5 to 12 weeks, and >12 weeks. The proposed scale had high interrater reliability but was burdensome. Using a priori item reduction protocols, a limited 6-item scale further improved internal consistency and reduced the burden. The result was excellent interrater reliability (α = 0.98, standard deviation 0.02, 95% confidence interval 0.91 to 0.96) among all assessors when using the scoring scale compared with unacceptable reliability (α = 0.438) for subjective osteotomy healing. The reliability of our system appeared superior to that of subjective assessment of osseous healing alone, even in the absence of clinical correlates after osteotomy of the calcaneus.
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Affiliation(s)
- Michael L Sganga
- Chief Resident, Division of Podiatric Surgery, Department of Surgery, Mount Auburn Hospital, Cambridge, MA; Clinical Fellow, Department of Surgery, Harvard Medical School, Boston, MA
| | - N Jake Summers
- Clinical Fellow, Department of Surgery, Harvard Medical School, Boston, MA; Fellow, Foot and Ankle Reconstruction, Coordinated Health, Bethlelem, PA
| | - Brandon Barrett
- Chief Resident, Division of Podiatric Surgery, Department of Surgery, Mount Auburn Hospital, Cambridge, MA; Clinical Fellow, Department of Surgery, Harvard Medical School, Boston, MA
| | - Michael R Matthews
- Clinical Fellow, Department of Surgery, Harvard Medical School, Boston, MA
| | - Timothy Karthas
- Clinical Fellow, Department of Surgery, Harvard Medical School, Boston, MA.
| | - Lindsay Johnson
- Assistant Director of Resident Training, Division of Podiatric Surgery, Department of Surgery, Mount Auburn Hospital, Cambridge, MA
| | - Jeremy J Cook
- Instructor, Department of Surgery, Harvard Medical School, Boston, MA; Director of Research and Quality Assurance, Division of Podiatric Surgery, Department of Surgery, Mount Auburn Hospital, Cambridge, MA
| | - Philip Basile
- Instructor, Department of Surgery, Harvard Medical School, Boston, MA; Chief, Division of Podiatric Surgery, Department of Surgery, Mount Auburn Hospital, Cambridge, MA
| | - Emily A Cook
- Instructor, Department of Surgery, Harvard Medical School, Boston, MA; Director of Resident Training, Division of Podiatric Surgery, Department of Surgery, Mount Auburn Hospital, Cambridge, MA
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Kaufmann G, Handle M, Liebensteiner M, Braito M, Dammerer D. Percutaneous minimally invasive Akin osteotomy in hallux valgus interphalangeus: a case series. INTERNATIONAL ORTHOPAEDICS 2017; 42:117-124. [PMID: 28956114 DOI: 10.1007/s00264-017-3638-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 09/03/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE Phalangeal Akin osteotomy of the greater toe is a frequently used surgical procedure for correcting hallux valgus interphalangeus deformity. However, previous research did not investigate percutaneous techniques of the Akin osteotomy. It was the aim of this study to investigate feasibility, corrective potential, and safety of a percutaneous minimally invasive Akin osteotomy. METHODS We present a series of 81 feet, in which a percutaneous Akin technique was performed using a high-speed burr but no fixation device. The most important outcome parameters were determined as the proximal to distal phalangeal articular angle (PDPAA) (corrective effect of the osteotomy), the osteotomy healing (full, partly, no visibility of the osteotomy gap), and the integrity of the lateral cortical hinge. RESULTS With regard to the main hypothesis we found significant changes in the PDPAA over the whole period of time (p < 0.001). Post-hoc tests determined that the PDPAA changed from 10° pre-operatively (Md, IQR 4.3) to 2.3° post-operatively (Md, IQR 3.7) (p < 0.001). Post-operatively no significant changes in PDPAA were found within the first six weeks and from six weeks to three months (no loss of correction). Osteotomy healing was satisfactory as well. Three months post-operatively, there were no patients with a fully visible osteotomy gap, 28.3% with a partly visible osteotomy gap, and 71.7% had no visible gap. Interestingly, we could not observe a statistically significant correlation between bone healing and the integrity of the lateral cortical hinge. CONCLUSION From our findings we conclude that the minimally invasive Akin osteotomy without osseous fixation provides effective deformity correction without significant loss of correction thereafter. This procedure appears to be safe with regard to osseous healing. Surprisingly, the healing process of the osteotomy showed no dependence on the integrity of the lateral cortical hinge. LEVELS OF EVIDENCE Therapeutic, Level IV, retrospective case series.
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Affiliation(s)
| | - Martin Handle
- Orthopaedic Department, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Michael Liebensteiner
- Orthopaedic Department, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Matthias Braito
- Orthopaedic Department, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Dietmar Dammerer
- Orthopaedic Department, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
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