Distal First Metatarsal Dome (Crescentic) Osteotomy for Repair of Mild to Moderate Hallux Valgus Deformity

Hallux valgus is one of the most common foot deformities. Despite the large number of techniques described for hallux valgus correction, there has been much controversy regarding the best procedure to use. Distal osteotomies have long been done for mild to moderate deformities. Although presented previously, based on a review of the literature, this technique does not appear to be regularly used by many surgeons. This article presents a distal metatarsal osteotomy as easy to perform and useful for the repair of mild to moderate hallux valgus deformity, wherein the first metatarsal angle measures less than 14 degrees.     

Rail External Fixation for Stabilization of Closing Base Wedge Osteotomies and Lapidus Procedures: A Retrospective Analysis of Sixteen Cases

This is a retrospective study of 16 cases of proximal first-ray procedures with rail external fixation. Arthrodesis of the first metatarsal-cuneiform joint was performed on 11 feet, and a closing base-wedge osteotomy was performed on 5 feet. Heel weightbearing in a surgical shoe with ankle joint mobilization was the standard postoperative protocol. Thirteen women and one man with an average age of 41 years (range, 16-64 years) were evaluated, with an average follow-up of 15.12 months (range, 10-24 months). The mean duration of frame application among all patients was 6.75 weeks (range, 2-10 weeks; 7 weeks for the base wedge procedures; 6.64 weeks for the lapidus). Multiple complications developed. Ten patients developed pin-tract infections: 5 required isolated pin removal, whereas 2 required removal of the entire frame because of the severity of infection. Seven patients developed pin loosening. Two patients developed cellulitis requiring long-term intravenous antibiotic therapy. Two nonunions occurred, both with the lapidus procedure, and one was symptomatic. Ten of the 16 patients reported they would have surgery again. Monolateral external rail fixation in combination with heel weightbearing and ankle mobilization demonstrated a high complication rate when used for proximal first-ray procedures. The technique as described is not recommended for routine use with the lapidus and base wedge osteotomy procedures.     

Mechanical Comparison of Cortical Screw Fixation Versus Locking Plate Fixation in First Metatarsal Base Osteotomy

The oblique closing base wedge osteotomy has been used for surgical treatment of moderate to severe hallux valgus deformities with an intermetatarsal angle typically greater than 15°. Several postoperative complications have been identified that relate to failure of the fixation construct used to fixate the osteotomy, especially when that construct has been subjected to a vertical load. We performed a mechanical analysis comparing 2 constructs used to fixate oblique osteotomies of the first metatarsal using composite first metatarsals. An oblique base osteotomy was uniformly performed on 40 composite first metatarsals. Of the 40 specimens, 20 were fixated with a locking plate construct and 18 with a cortical screw construct, consisting of an anchor and compression screw (2 specimens from the latter group were excluded because of hinge fracture). Each specimen was loaded in a materials testing machine to measure the maximum load at construct failure when a vertical force was applied to the plantar aspect of the metatarsal head. The mean load to failure for the locking plate construct was significantly greater than the cortical screw construct (190.0 ± 70 N versus 110.3 ± 20.3 N, p < .001). Our study results have demonstrated that the locking plate construct was able to withstand a significantly greater vertical load before failure than was the 2-cortical screw construct in oblique osteotomies performed at the base of composite first metatarsals.     

Distal Oblique Metatarsal Osteotomy for Hallux Valgus Deformity: A Clinical Analysis

We compared the outcomes of the distal oblique metatarsal (DOM) osteotomy, which is parallel to the articulation surface of the proximal phalanx, with those of the chevron osteotomy and evaluated whether displacement and shortening of the first metatarsal have any effect on the incidence of metatarsalgia and patient satisfaction. Patients treated with the DOM osteotomy (n = 30) or distal chevron osteotomy (n = 31) were evaluated retrospectively. The chevron and DOM osteotomies both provided significant improvement in the first intermetatarsal angle (p < .001), hallux valgus angle (p < .001), distal metatarsal articular angle (p < .001), range of first metatarsophalangeal joint motion (p < .001), American Orthopaedic Foot and Ankle Society score (p < .001), and sesamoid position (p < .001), without any significant differences between the 2 groups. Patient satisfaction and metatarsalgia also were not different between the study groups. The DOM osteotomy group had higher plantar displacement (0.1 ± 0.1 mm versus 1.0 ± 0.1 mm; p < .001) and absolute shortening of the first metatarsal (1.0 ± 0.4 mm versus 6.8 ± 1.0 mm; p < .001). In conclusion, the DOM osteotomy is an alternative treatment method for mild and moderate hallux valgus.     

Early Results of the Mau Osteotomy for Correction of Moderate to Severe Hallux Valgus: A Review of 24 Cases

In our retrospective study, we report the objective results of the Mau osteotomy in the treatment of hallux valgus. We reviewed the results of 24 cases of moderate to severe hallux valgus deformities corrected with the Mau osteotomy of the first metatarsal combined with a distal soft-tissue procedure. Follow-up was possible in 24 cases. Preoperatively the mean hallux valgus and first intermetatarsal angles were 31.3 degrees and 16.6 degrees respectively, and were corrected postoperatively to an average of 13.00 degrees+/-7.15 degrees and 9.80 degrees+/-2.43 degrees respectively (P< .001). In the sagittal plane, the first metatarsal was shortened by an average of 2.00 mm. Two (8.3%) cases had dorsal elevation of the osteotomy fragment. Complications included 3 recurrences of the deformity, 1 frank nonunion, 8 dorsal cortical nonunions, 5 cases of undercorrection, and 1 case of broken hardware that was present in the nonunion that went on to revision. There were no superficial or deep infections, and no cases of transfer metatarsalgia were noted. In this series, the use of an oblique first metatarsal osteotomy with a dorsal shelf resulted in reliable and powerful correction of the first intermetatarsal angle in patients with moderate to severe hallux valgus. Particular attention should be paid to severe IM angles and the possibility of undercorrections. Despite ambulation postoperatively, the Mau osteotomy minimized dorsal malunion and the incidence of transfer metatarsalgia. LEVEL OF CLINICAL EVIDENCE: 4.     

距足母囊近端截骨并钛板内固定治疗中重度足母外翻

目的探讨距足母囊近端2.0 cm处Z型截骨并T型微型钛板内固定治疗中重度足母外翻的临床疗效。方法2009年11月至2013年6月,对50例(81足)中重度足母外翻患者行第一跖骨远端Z型截骨后T型微型钛板内固定治疗。结果术后随访3~36个月,患者足母外翻角(halluxv algus angle,HVA)减少了11°~23°,平均13.1°,跖骨间角(intermetatarsal angle,IMA)减少了5°~10°,平均6.6°。采用美国足踝矫形学会Maryland足功能评分系统评分:90~100分,79足,80~89分2足,优良率100%,未见感染,截骨处均获骨性愈合,畸形无复发。结论距足母囊近端截骨并微型钛板内固定治疗中重度足母外翻疗效可靠,值得推广。     

改良旋转Scarf截骨术在中重度踇外翻治疗中的应用

目的 探讨改良旋转Scarf截骨术在中重度踇外翻手术治疗中的临床疗效。方法 回顾性分析2018年1月至2019年6月于我院手术治疗的100例中重度踇外翻病人的临床资料,平均年龄为47.6岁（17~84岁）,其中男13例,女87例,双足病例38例,共138足,均应用改良旋转Scarf截骨术手术治疗。术前、术后均经X线负重正侧位检查,双盲法测量踇外翻角（HVA）、第一、二跖骨间夹角（IMA）、近端关节面固有角（DMAA）、胫侧籽骨位置。采用美国足踝外科医师协会（American Orthopaedic Foot and Ankle Society,AOFAS）足踇趾、跖趾关节、趾间关节功能评分评价疗效。结果 术后平均随访18.7个月（12~30个月）。病人术后HVA、IMA、DMAA、胫侧籽骨位置均明显低于术前,差异均有统计学意义（P＜0.05）。末次随访时AOFAS评分[（94.7±5.8）分]较术前[（45.4±5.1）分]明显提高,差异有统计学意义（P＜0.05）。病人足疼痛、外形、功能明显改观,穿鞋及生活质量得到极大提高。结论 对于中重度踇外翻,采取改良旋转Scarf截骨术具有明确的临床疗效。     

Comparison between Pin Fixation and Combined Screw Fixation in Proximal Chevron Metatarsal Osteotomy for Hallux Valgus Deformity Correction

BackgroundProblems associated with hallux valgus deformity correction using Kirschner-wire (K-wire) fixation include pin pullout and loss of stability. These complications are pronounced in the osteopenic bone, and few reports have focused on pin versus screw fixation. We examined the use of additional screw fixation to avoid these problems. The aim of this study was to compare outcomes of K-wire fixation (KW) and a combined K-wire and screw fixation (KWS).MethodsTwo groups with hallux valgus deformity, who were treated with a proximal chevron metatarsal osteotomy (PCMO), were compared based on the fixation method used. The KW group included 117 feet of 98 patients, and the KWS group included 56 feet of 40 patients. Clinically, the preoperative and final follow-up visual analog scale (VAS) pain score, American Orthopedic Foot & Ankle Society (AOFAS) hallux score, and patient satisfaction score were evaluated. Radiographically, hallux valgus angle (HVA) and intermetatarsal angle (IMA) were measured.ResultsThe mean VAS score decreased from 6.3 preoperatively to 1.6 postoperatively in the KW group and from 5.7 preoperatively to 0.5 postoperatively in the KWS group (p < 0.001). The mean AOFAS scores of the KW and KWS groups improved from 59.4 and 58.2, respectively, to 88.9 and 95.3, respectively (p < 0.001). Eighty-five percent in the KW group and 93% in the KWS group were satisfied with surgery. Clinical differences were not significant. The mean HVAs decreased from 34.7° to 9.1° in the KW group and from 38.5° to 9.2° in the KWS group (p < 0.001). The mean IMA decreased from 14.5° (range, 11.8°–17.2°) to 6.4° (range, 2.7°–10.1°) in the KW group and from 18.0° (range, 14.8°–21.2°) to 5.3° (range, 2.5°–8.1°) in the KWS group (p < 0.001). When IMA values at the 3-month postoperative and the final follow-up were compared, the IMA was significantly increased only in the KW group (p < 0.001) and no difference was found in the KWS group (p = 0.280).ConclusionsWe found a statistically significant difference in the decrease in IMA between the 2 groups. We recommend the combined pin and screw fixation in PCMO to enhance fixation stability and prevent potential hallux valgus correction loss.