Extended Distal Chevron Osteotomy and Akin Osteotomy Using Bioabsorbable Materials for Treatment of Moderate to Severe Hallux Valgus

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.     

Minimal invasive Hallux valgus Korrektur über intraartikuläre perkutane Chevron Akin-Osteotomie (PECA)

BackgroundThe minimally invasive correction of hallux valgus is also becoming increasingly popular in German-speaking countries. Numerous percutaneous techniques for correcting the first ray have been published in recent years. To this day, there is still no clarity about the benefits of each technique.Material and MethodsFrom 2019 to 2021, a percutaneous intra-articular Chevron-Akin osteotomy (PECA) with fixation of the metatarsal osteotomy via a double-threaded screw was performed on 70 feet. The radiological parameters (intermetatarsal angle, hallux valgus angle) and the American Orthopedic Foot and Ankle score (AOFAS) were evaluated pre- and postoperatively.ResultsAfter a mean follow-up of 6 months, the radiological parameters were significantly improved. The intermetatarsal angle improved from 13.1° to 5.9°, the hallux valgus angle from 27.4° to 9.3°. The AOFAS improved from 51.4 points preoperatively to 91.2 points postoperatively. There were 2 relevant complications in the group studied, a screw irritation necessitating early metal removal and a secondary dislocation of the 1st metatarsal head necessitating open revision.ConclusionsThe results show the good correction potential of the PECA technique used to treat a mild to moderate hallux valgus deformity. However, further investigations with long-term results and studies comparing the various established percutaneous distal osteotomy procedures are urgently needed in order to increase the comparability of the different procedures.     

Minimally invasive surgery for young female patients with mild-to-moderate juvenile hallux valgus deformity

BackgroundWe aimed to compare the clinical and radiographic outcomes of minimally invasive surgery (MIS) and distal chevron metatarsal osteotomy (DCMO) for young female patients with mild-to-moderate juvenile hallux valgus deformity.MethodsWe retrospectively reviewed the radiographs and clinical findings of young female patients with mild-to-moderate juvenile hallux valgus who underwent MIS (25 feet) or DCMO (30 feet). In 12 of 25 MIS feet, 2.0-mm bio-absorbable pins were used as an additional fixation device crossing the osteotomy site, and 1.4-mm Kirschner wires were used in the remaining 13 feet.ResultsRadiographic and clinical parameters preoperatively and at the final follow-up were not significantly different between the 2 groups. There were no significant differences in the increments of hallux valgus angle (HVA), distal metatarsal articular angle, medial sesamoid position, first metatarsal length, metatarsal length index, or relative second metatarsal length. Two MIS subgroups according to the additional fixation device showed no significant differences in HVA, the first to second intermetatarsal angle lateral translation ratio, or plantar offset at the final follow-up.ConclusionsMIS for young female patients with mild-to-moderate juvenile hallux valgus deformity had similar radiographic and clinical outcomes compared to DCMO. Regarding additional fixation crossing the osteotomy site, both temporary Kirschner wires and absorbable pins showed no radiographic differences in terms of correction maintenance.Level of evidence: 3.     

Comparison of screw fixation versus non-fixation in dorsal opening wedge medial cuneiform osteotomy of adult acquired flatfoot

BackgroundThe aim of this study was to compare the radiographic and functional results between fixation and non-fixation in the Cotton osteotomy for the treatment of adult acquired flatfoot.MethodsA retrospective, case-controlled study of consecutive stage IIB posterior tibial tendon dysfunction (PTTD) patients treated with the same bony reconstructive surgery including cotton osteotomy between 2013 and 2017. Meary’s angle, the medial arch sag angle (MASA), and medial cuneiform cobb angle (MCCA) were evaluated pre-operation, at first weight bearing after surgery, and 12 months post operation.ResultsForty feet were included in the study. The cotton osteotomy utilized screw fixation (n = 20) or non-fixation technique (n = 20). No significant differences between groups were found in pre-operative and follow-up radiographic parameters, union rate, and functional results.ConclusionThe non-fixation with press fit technique is a reliable procedure for Cotton osteotomy and as effective as screw fixation.Level of evidenceLevel III, case control study     

Plate fixation for proximal chevron osteotomy has greater risk for hallux valgus recurrence than Kirschner wire fixation

Purpose

The purpose of this study was to compare the results of hallux valgus surgery between feet fixed with Kirschner wires and those fixed with a plate and screws.

Methods

Between December 2008 and November 2009, 53 patients (62 feet) were treated with proximal chevron osteotomy and distal soft tissue procedure for symptomatic moderate to severe hallux valgus deformity. Thirty-four patients (41 feet) were stabilised with Kirschner wires (K-wire group) and 19 patients (21 feet) were stabilised with a locking plate (plate group). Clinical results were assessed using American Orthopaedic Foot and Ankle Society (AOFAS) score. Radiographic parameters were compared between these groups. Recurrence rate at the last follow-up was compared between the K-wire and plate groups.

Results

Mean AOFAS score was lower in the plate group, however, the difference between the groups was not statistically significant in AOFAS score at the last follow-up. Hallux valgus angle and intermetatarsal angle were significantly larger in the plate group at the last follow-up. Mean 1–2 metatarsal (MT) distance on immediately postoperative radiographs was significant larger in the plate group. Four (9.8 %) of the 41 feet in the K-wire group and 7 (33.3 %) of the 21 feet in the plate group showed hallux valgus recurrence at the last follow-up. The plate group had a significantly higher risk of recurrence than the K-wire group.

Conclusions

Fixation of proximal chevron osteotomy using a plate and screws has a greater risk of hallux valgus recurrence than fixation using Kirschner wires.     

Fixation of the Chevron Osteotomy With an Absorbable Copolymer Pin for Treatment of Hallux Valgus Deformity

This study investigated the use of a bioabsorbable pin made of an oriented poly-L-lactic acid/polyglycolic acid (82:18 ratio) copolymer to fix distal chevron osteotomies in 15 patients (18 feet), with an average follow-up of 18 months. This material absorbs faster than poly-L-lactic acid and slower than poly-p-dioxanone, 2 bioabsorbable polymers that have a clinical history in fixation of distal chevron osteotomies. The average intermetatarsal angle significantly decreased from 11.9+/-1.7 degrees to 0.9+/-3.8 degrees (P < .001) while the average hallux valgus angle significantly decreased from 19.4+/-4.7 degrees to 6.2+/-6.4 degrees (P < .001). The preoperative American Orthopaedic Foot and Ankle Society's hallux-metatarsophalangeal-interphalangeal score averaged 44.6+/-15.1, which increased significantly to 87.4+/-14.9 (P < .001) postoperatively. In 1 procedure, a giant cell granuloma developed that was treated with debridement. Overall, these results were comparable to those derived from the use of other methods of fixation used for bunionectomies.     

Bunionette deformity corrected with “shortening” scarf osteotomy of the fifth metatarsal: mid-term results of a 34-cases

BackgroundThe aim of this study was to evaluate the clinical and radiological outcomes (in mid-term) after “shortening” scarf osteotomy of the fifth metatarsal for the treatment of bunionette deformity.MethodsWe retrospectively reviewed the functional score — American Orthopaedic Foot and Ankle Society (AOFAS) Lesser Toe Metatarsophalangeal-Interphalangeal Scale, radiographic results — 4th/5th intermetatarsal angle, varus angle of the 5th metatarsophalangeal joint and complications in a consecutive series of 34 feet (27 patients) with bunionette. Nine males and 18 females (mean age: 45 years) were included in the study. Three males and four females were operated bilaterally The patients were operated on between 2004 and 2015, and evaluated during 2017.ResultsThe average AOFAS score improved from 59.4 to 93 at a mean follow-up of 7.2 years. The 4th/5th intermetatarsal angle and varus angle of the 5th metatarsophalangeal joint decreased from 13.9°/19.5° preoperatively to 6°/5.9° at final follow-up. No neurovascular damage was recorded. Complications arose in five feet (14.7%): delayed union (n = 1), early infection (n = 1), distal screw migration (n = 1), asymptomatic non-union (n = 1), transverse metatarsalgia (n = 1). The osteotomy healed within less than three months except twoo (delayed union, non-union). Three feet needed additional surgery: screw removal (n = 2), Weil osteotomy of 2nd–4th metatarsals (n = 1).Conclusions“Shortening” scarf osteotomy is an acceptable, but not complication-free, treatment option for the bunionette deformity and offers promising results in the mid-term.     

Early results using a biodegradable magnesium screw for modified chevron osteotomies

This is the first larger study analyzing the use of magnesium‐based screws for fixation of modified Chevron osteotomies in hallux valgus surgery. Forty‐four patients (45 feet) were included in this prospective study. A modified Chevron osteotomy was performed on every patient and a magnesium screw used for fixation. The mean clinical follow up was 21.4 weeks. The mean age of the patients was 45.5 years. Forty patients could be provided with the implant, in four patients the surgeon decided to change to a standard metallic implant. The AOFAS, FAAM and pain NRS‐scale improved markedly. The hallux valgus angle, intermetatarsal angle and sesamoid position improved significantly. Seven patients showed dorsal subluxation, rotation or medial shifting of the metatarsal heads within the first 3 months. One of these patients was revised, in all others the findings were considered clinically not significant or the patients refused revision. This study shows the feasibility of using magnesium screws in hallux valgus‐surgery. Surgeons starting with the use of these implants should be aware of the proper handling of these implants and should know about corrosion effects during healing and its radiographic appearance. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:2207–2214, 2016.     

Fixation of Mitchell’s osteotomy with bioabsorbable pins for treatment of hallux valgus deformity

We hypothesised that the use of bioabsorbable pins in Mitchell's osteotomy would improve the outcome of patients treated for hallux valgus deformity. A total of 68 patients underwent Mitchell's osteotomy to correct hallux valgus deformity: 33 patients (group A) underwent Mitchell's osteotomy augmented with bioabsorbable pins and 35 patients were treated with the classic operative procedure (group B). Hallux valgus angle (HVA), intermetatarsal angle (IMA), the American Orthopaedic Foot and Ankle Society (AOFAS) hallux metatarsophalangeal-interphalangeal scale and the visual analogue score (VAS) for pain were measured preoperatively and postoperatively. There was no statistically significant difference between the two groups as far as the improvement of the IMA, HVA and AOFAS scale were concerned. Patients of group A had significantly less postoperative pain and returned to their previous activities earlier than patients of group B. The use of the pins did not improve the final outcome of the osteotomy. However, it allowed for faster rehabilitation due to less postoperative pain.     

PACS和Photoshop辅助下等腰三角形截骨并克氏针张力扣固定治疗儿童肘内翻

目的：应用影像归档和通信系统（picture archiving and communication system,PACS）和Photoshop系统辅助等腰三角形截骨并克氏针张力扣固定治疗儿童肘内翻的疗效分析。方法：回顾性分析自2014年10月至2019年10月采用肱骨远端等腰三角形截骨并克氏针张力扣固定治疗儿童肘内翻20例的临床资料,男13例,女7例;年龄3.2～13.5岁,中位数6.65岁;左侧12例,右侧8例。均为肱骨远端骨折畸形愈合后的远期并发症。术前用PACS系统设计截骨,模拟测量顶角位置及底边长度。再将图片导入Photoshop系统,画出术后模拟效果图,指导模拟截骨。结果：20例患儿均获得随访,时间20～24个月,中位数22.5个月。最后一次复查时患肢提携角5°～13°,中位数8.3°。疗效根据Flynn肘关节功能评分标准评价：优16例,良2例,可2例。结论：PACS和Photoshop系统辅助下等腰三角形截骨并克氏针张力扣固定治疗儿童肘内翻取得良好的临床疗效。     

Analysis of Three Types of Fixation of the Weil Osteotomy

This study assessed 3 methods of fixation for the Weil osteotomy. A total of 40 bone models were divided equally into 4 groups: a control group consisting of intact lesser rays; and Weil osteotomies that were fixated with 2 crossed Kirschner wires (0.045-in K-wires), 2.0-mm cortical screws, or cannulated 2.4-mm cortical screws. Each specimen was stressed in a computer-controlled hydraulic tensile testing machine, and maximum load, energy to failure, and stiffness were recorded. The following mean load to failure measurements were found: control, 62.9 Newtons (N); K-wire, 22.9 N; cannulated screw, 31.3 N; and noncannulated screw, 19.9 N. There was no statistical difference among the 3 groups of fixation methods in terms of the maximum load. The mean energy to failure of the control group was 326 joule (J); K-wire, 79 J; cannulated screw, 163 J; and noncannulated screw, 66 J. The cannulated screw generated a statistically greater amount of energy at failure than the noncannulated screw (P < .05). The mean structural stiffness of the control group was 7.3 N/mm; K-wire, 2.8 N/mm; cannulated screw 3.3 N/mm; and noncannulated screw, 3.2 N/mm. There was no statistical difference in structural stiffness among the 3 groups of fixation methods. The results indicated a trend toward better biomechanical stability with the 2.4-mm cannulated screw than the 2.0-mm noncannulated screw for fixation of the Weil osteotomy.     

Fixation of the offset V osteotomy: Mechanical testing of 4 constructs

The purpose of this study was to assess 4 methods of fixation for the offset V osteotomy. Maximum load, failure energy, and stiffness were determined in a control group and in 4 different test models. There were 10 specimens for each group. The control group consisted of intact first ray sawbones. An offset V osteotomy was performed on each specimen in each of the 4 test groups. The osteotomies were fixated either with two 2.0-mm cortical screws, two 2.7-mm cortical screws, two 3.5-mm cortical screws, or one 2.7-mm cortical screw and a 0.045-in Kirschner wire, respectively. Each model was then loaded to failure with a computerized hydraulic-tensile testing machine. Results for maximum load to failure for all 4 fixation constructs showed a mean ranging from 113.0 to 144.0 N, a mean energy to failure ranging from 272.2 to 365.0 J, and a mean stiffness ranging from 21.3 to 27.0 N/mm. There were no statistically significant differences detected among the individual constructs. In the group fixated with 3.5-mm screws, there were statistically significant differences in all 3 parameters compared with the control group. In the groups fixated with 2.7-mm screws, 2.0-mm screws, and the 2.7-mm screw and Kirschner wire, there were statistically significant differences in the maximum load and the failure energy, but not in stiffness, when compared with the control group. These findings suggest that all 4 constructs provide similar mechanical properties when utilized for the fixation of the offset V osteotomy.     

经皮微创截骨术联合8字绷带和分趾垫外固定治疗中度拇外翻

目的:探讨经皮微创截骨术联合“8”字绷带和分趾垫外固定治疗中度拇外翻的临床疗效。方法:自2019年8月至2021年1月采用经皮微创截骨术联合“8”字绷带和分趾垫外固定治疗中度拇外翻患者23例,失访1例,最终纳入22例(30足),男4例6足,女18例24足,年龄27～66 (50.59±11.95)岁。比较术前和术后6个月患足拇外翻角(hallux valgus angle,HVA),第1、2跖骨间角(intermetatarsal angle,IMA),跖骨跨度(第1、5跖骨头之间的距离)和软组织宽度变化情况,并采用美国足踝外科协会踝-后足评分标准(American Orthopaedic Foot and Ankle Society,AOFAS)进行临床疗效评价,采用视觉模拟评分(visual analogue scale,VAS)评价足部自觉疼痛情况。结果:22例患者获得随访,时间5.7～6.4(6.13±0.85)个月。患者第1跖骨截骨处均获得骨性愈合,足趾外观畸形得到纠正,术后患足未出现跖骨头缺血性坏死、转移性跖骨痛等并发症。术后6个月患足HVA、IMA、跖骨跨度、软组织宽度、...     

Bilateral and concomitant pathology’ surgeries do not affect the outcomes of mini-open distal linear metatarsal osteotomy (Bosch osteotomy) with manipulation for hallux valgus deformity

BackgroundBosch osteotomy for hallux valgus (HV) deformity has advantages of reduction both the operating time and surgical dissection, and may be performed bilaterally and with fewer complications than other surgical procedures as well as early weight-bearing. However, there are few reports on the effects of bilateral simultaneous surgery, simultaneous surgery on concomitant pathologies, and the preoperative HV angle on the postoperative results. The present assessed the factors that might affect the improvement in clinical outcomes following mini-open Bosch osteotomy with manipulation to treat HV deformity.MethodsSeventy patients with 110 feet were included. They were divided into groups as follows: unilateral and bilateral simultaneous surgery groups, Bosch osteotomy alone and simultaneous surgeries for concomitant pathologies groups, and preoperative HV angle< 40° and ≥ 40° groups. Subjective clinical outcome scores using the Self-Administered Foot Evaluation Questionnaire (SAFE-Q) and the HV and intermetatarsal first and second metatarsal (M1M2) angles according to the anteroposterior (A-P) view of the weighted foot X-ray were assessed preoperatively and at 12 months after surgery.ResultsThe mean HV angle, M1M2 angle and all subscales of the SAFE-Q score showed significant improvement at 12 months after surgery, regardless of simultaneous bilateral surgery, simultaneous surgery for concomitant pathologies, or the preoperative HV angle. On comparing the groups, there were no significant differences in the HV angle at 12 months after surgery. Significant inferiority at 12 months after surgery was found in the intermetatarsal angle in the simultaneous surgery for concomitant pathologies group and in all subscales of the SAFE-Q score in the HV angle ≥ 40° group.ConclusionMini-open Bosch osteotomy with manipulation for HV deformity demonstrated good results in both radiological assessments and subjective clinical scores at 12 months after surgery, even for simultaneous bilateral surgery, simultaneous concomitant pathologies’ surgery, and severe HV deformity.Level of EvidencePrognostic Level III, retrospective cohort study.     

Comparison of mid-term clinical results between lag screw fixation and Kirschner wire fixation after close reduction in adolescent triplane distal tibia epiphyseal fracture

ObjectiveTo compare the mid-term clinical results of lag screw and Kirschner wire fixation(KWF) for close reduction in triplane distal tibia epiphyseal fracture.MethodsA retrospective analysis of 25 cases of triplane fractures of the distal tibia treated in our department from Jan 2017 to Dec 2019 was performed, Lag screw fixation(LSF) was used in 14 cases and Kirschner wire fixation in 11 cases, the clinical results were evaluated by premature epiphyseal closure(PPC) rate, the American Orthopaedic Foot and Ankle Score (AOFAS) Ankle-hindfoot foot scoring system, the lateral distal tibial angle (LDTA) from X-ray.ResultsAll the 25 children were followed up for a mean of 34(ranging 26–52) months. AOFAS scores improved from a mean of 33(ranging 29–43) pre-op, to 82(ranging 77–88) at three month follow up, to 92 (ranging 88–98) at last follow-up in all 25 cases. Till last follow up there was no cases premature physeal closure in LSF group but 4 cases in KWF group, LDTA in both groups at last follow up shows no ankle varus or valgus deformity, and the ankle joint function was not limited in all cases.ConclusionLag screw and Kirschner wire fixation methods can both achieve good clinical effects for triplane distal tibia epiphyseal fracture. Lag screw fixation provide lower PPC rate but Kirschner wire fixation save one anesthesia and surgery.     

Short-term results of modified chevron osteotomy with soft tissue technique and guide wire fixation--a prospective study

AIM: A Chevron osteotomy with lateral soft-tissue release was performed at our department in 1993. In 1994 a prospective study to evaluate the temporary Kirschner wire fixation was started. Aim of this prospective study was to analyse the short-term clinical and radiological results with special attention to stability, necroses, and luxation of the first metatarsal head. METHOD: Between February 1994 and October 1995 45 patients (55 feet) were treated with a Chevron osteotomy combined with a lateral soft-tissue release and temporary Kirschner wire fixation. The average follow-up was 33.9 months. All patients were seen and evaluated preoperatively and at a minimum follow-up of 24 months using a standardized questionnaire based on the Hallux metatarsophalangeal interphalangeal Scale (HMIS) of the American Foot and Ankle Society. RESULTS: Results of the survey of patient satisfaction revealed excellent and good results in 83%, fair in 8%, and poor in 9%. The median HMIS at final follow-up was 86.9 pints of 100 points. The average hallux valgus angle correction was 19.8 (from 28.7 to 8.9) and the average first intermetatarsal angel correction was, 8.2 (from 14.4 to 6.2). No avascular necrosis of the first metatarsal head and no loss of correction were noted. In one case a luxation of the metatarsal head was observed. CONCLUSION: Combining the Chevron osteotomy with an excessive lateral soft-tissue release increases the likelihood of instability of the metatarsal head and consecutive loss of correction. The temporary Kirschner wire fixation increases the stability of the Chevron osteotomy and prevents the loss of correction. The disadvantage of this method is, that the wire has to be removed after 6 weeks.     

Long oblique distal osteotomy of the fifth metatarsal for correction of tailor''s bunion: A retrospective review

A long-term retrospective review of a long oblique distal osteotomy of the fifth metatarsal for correction of a tailor's bunion deformity is presented. The technique, results, and follow-up of this procedure are described. The long oblique distal osteotomy was performed on 25 feet on 16 patients. Follow-up ranged from 11 to 110 months with an average of 64.4 months. The average preoperative intermetatarsal 4-5 angle and lateral deviation angle improved from 10.88 degrees and 4.24 degrees, respectively, to 5.52 degrees and -4.24 degrees postoperatively, respectively. A modified scoring scale for lesser metatarsal procedures was used, showing an average postoperative score of 94 out of 100 possible points. Subjectively, 96% (24 of 25) of feet that underwent surgery were rated as excellent or good. Complications included one patient with paresthesias, one soft-tissue infection, and 2 patients had irritation from screws. The authors conclude that the long oblique distal osteotomy is a viable alternative in the correction of tailor's bunion deformity.     

Modified chevron osteotomy fixed with stofella pin for hallux valgus

BACKGROUND: The purpose of this study was to present the mid-term results of hallux valgus patients who underwent a modified chevron osteotomy. MATERIALS AND METHODS: Fifty-six patients (73 feet) with mild to moderate hallux valgus underwent a modified chevron osteotomy and Stoffella pin fixation between January 1999 and December 2004. Patients were evaluated clinically by the American Orthopedic Foot and Ankle Society (AOFAS) score. Pre- and postoperative radiographs were evaluated for the hallux valgus and intermetatarsal angles and sesamoid position. RESULTS: An improvement of 44.8 points in the AOFAS score was found. A change of 17.4 degrees in the hallux valgus angle and by 5.3 degrees in the intermetatarsal angle was achieved (p < 0.05). The change in the sesamoid position was significantly improved. Superficial skin infection in 3 cases, transient hypoesthesia in 2 cases, and bursitis due to screw irritation in 4 cases were the complications. CONCLUSION: Stable and rigid fixation by modified chevron osteotomy using Stoffella pins allows early mobilization and weightbearing without a cast. We believe early mobilization of the joint provides better functional outcomes with fewer complications compared to other fixation techniques.     

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.     

Minimally Invasive Retrocapital Osteotomy of the First Metatarsal in Hallux Valgus Deformity

OBJECTIVE: Percutaneous retrocapital distal osteotomy of the first metatarsal for surgical treatment of hallux valgus. INDICATIONS: Mild to moderate hallux valgus deformity in both juveniles and adults. Recurrent hallux valgus deformity after previous surgery. CONTRAINDICATIONS: Severe degenerative changes of the first metatarsophalangeal joint (hallux valgus et rigidus). Previous Keller's procedure. SURGICAL TECHNIQUE: A percutaneous distal linear osteotomy of the first metatarsal is performed and stabilized with a Kirschner wire. The surgical technique follows these steps: distal Kirschner wire insertion; skin incision; sparse periosteal detachment; distal retrocapital osteotomy of the first metatarsal; correction of the first intermetatarsal angle by lateral displacement of the capital fragment; stabilization with Kischner wire insertion into the proximal metatarsal; postoperative taping. RESULTS: The patients were satisfied following 107 (91%) of 118 consecutive percutaneous procedures with a follow-up of 35.9 months (range 24-78 months). According to the American Orthopaedic Foot and Ankle Society (AOFAS) hallux metatarsophalangeal-interphalangeal scale for the clinical assessment, a mean score of 88.2 +/- 12.9 was obtained at follow-up. The clinical results can be compared to those obtained with open techniques, with the advantages of a minimally invasive procedure.