Planning tool for first metatarsal length in hallux valgus surgery |
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| Institution: | 1. Department of Orthopaedics, Balgrist University Hospital, Zurich, Switzerland;2. Computer Assisted Research and Development Group, Balgrist University Hospital, Zurich, Switzerland;1. Department of Orthopedic Surgery, Keio University School of Medicine, 35 Shinano-machi, Shinjuku-ku, Tokyo, Japan;2. Department of Orthopedic Surgery, International University of Health and Welfare (IUHW) Mita Hospital, 1-4-3 Mita, Minato-ku, Tokyo, Japan;3. Department of Orthopedic Surgery, International University of Health and Welfare (IUHW) Shioya Hospital, 77 Tomita, Yaita-shi, Tochigi-ken, Japan;4. Department of Orthopedic Surgery, International University of Health and Welfare (IUHW) Ichikawa Hospital, 6-1-14 Kokuhudai, Ichikawa-shi, Chiba-ken, Japan;5. Department of Orthopedic Surgery, International University of Health and Welfare (IUHW), 4-3 Kozunomori, Narita-shi, Chiba-ken, Japan;6. Department of Orthopedic Surgery, Tachikawa Hospital, 4-2-22 Nishiki-cho, Tachikawa-shi, Tokyo, Japan;1. Department of Orthopaedics, Hospital Raja Permaisuri Bainun, Ipoh, Perak, Malaysia;2. Prince Court Medical Centre. 39 Jalan Kia Peng, 50450 Kuala Lumpur, Malaysia;1. Department of Orthopaedic Surgery, Chosun University Hospital, Dong-Gu, GwangJu, Republic of Korea;2. Assistant Professor, Department of Biomedical Engineering, Catholic University of Daegu College of Medical Science, Hayang-Eup, Gyeongsan-Si, Gyeongbuk, Republic of Korea;1. Hospital General Universitario Gregorio Marañón, Calle del Dr. Esquerdo, 46, 28007 Madrid, Spain;2. Hospital Universitario Infanta Cristina, Avda 9 de julio, 28981, Parla, Spain;1. Department of Orthopaedics of Herz Jesu Krankenhaus Vienna, Baumgasse 20A, 1030 Wien, Austria;2. Johannes Kepler University Linz, Medical Faculty, Altenbergerstraße 69, 4040 Linz, Austria;3. maz – Microsurgical Training and Research Center, Industriezeile 36/7, 4020 Linz, Austria |
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| Abstract: | BackgroundThe precise planning of metatarsal (MT) I length in hallux valgus surgery is important. However, currently no tool exists which allows the surgeon to reliably predict this parameter.Methods30 virtual 3-dimensional hallux valgus surgeries were performed on varied deformation models based on cadaveric feet scans. The shortening of the first ray during distal metatarsal I osteotomy for different osteotomy angles were measured. An algebraic 2-dimensional calculation was done and compared to the results obtained from the 3-dimensional models.ResultsInadvertent shortening of the first metatarsal bone can be as much as 8 mm depending on the amount of intermetatarsal angle (IMA) correction and osteotomy angle. Comparison of the 3 dimensional simulations and the 2 dimensional model resulted in a very strong correlation (R > 0.99 p < 0.00001). Based on our findings an anterior pointing osteotomy of approximately 10° is necessary to restore the length in distal metatarsal I hallux valgus surgery.ConclusionA slight misdirection of the osteotomy plane in distal hallux valgus surgery may result in relevant unwanted alterations in first metatarsal bone length and triangulation by eye is insufficient in this complex geometrical situation without appropriate planning. The present study provides surgeons a practical tool to plan and control the change of first metatarsal length during hallux valgus procedure through exact orientation of the osteotomy angle. If no alteration of length is intended, it may be generalized that an anterior direction of the cut relative to the second metatarsal bone will preserve the length of the first metatarsal bone. |
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| Keywords: | Technical guide Hallux valgus Transfermetatarsalgia Shortening |
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