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International Orthopaedics
Published in: International Orthopaedics 7/2014

01-07-2014 | Original Paper

Extra-articular dorsal closing-wedge osteotomy to treat late-stage Freiberg disease using polyblend sutures: technical tips and clinical results

Authors: Kazuya Ikoma, Masahiro Maki, Masamitsu Kido, Kan Imai, Yuji Arai, Hiroyoshi Fujiwara, Yasuo Mikami, Toshikazu Kubo

Published in: International Orthopaedics | Issue 7/2014

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Abstract

Purpose

The purpose of this study was to evaluate the clinical outcomes regarding the dorsal wedge osteotomy fixed using a polyblend suture and describe the usefulness of this fixation method for the treatment of Freiberg disease.

Methods

The subjects consisted of 13 feet from 13 cases suffering from Freiberg disease that underwent extra-articular dorsal closing-wedge osteotomy using a polyblend suture. The average age was 31.7 (range 13–72) years. The average follow-up period was 17 (range 14–24) months. Regarding image findings, time to bone union and metatarsal shortening was reviewed. The investigation was carried out using the range of motion (ROM), visual analog scale (VAS), and Japanese Society of the Surgery of Foot lesser toe scale (JSSF score) in the MTP joint before surgery and at the latest follow-up.

Results

Calluses under the metatarsal head were not observed in any cases. The mean metatarsal shortening was 2.33 ± 2.07 mm at follow-up. The bone union required an average of 8.4 ± 0.8 weeks. The average ROM of dorsal flexion improved from 37.2 ± 5.3° before surgery to 73.6 ± 9.9° at latest follow-up (p < 0.0001). The average ROM of plantar flexion improved from 16.0 ± 10.1° before surgery to 19.5 ± 8.6° at latest follow-up (p = 0.35). The average VAS significantly improved from 75.3 ± 8.5 before surgery to 4.9 ± 4.2 at latest follow-up (p < 0.0001). The average JSSF score significantly improved from 67.3 ± 9.4 points before surgery to 98.8 ± 3.0 points at the latest follow-up (p < 0.0001).

Conclusion

Extra-articular dorsal closing-wedge osteotomy using a polyblend suture was carried out to treat Freiberg disease. The bone union was observed in all cases with improved clinical results. Fixation using a polyblend suture was considered to be useful.
Literature
1.
Smillie IS (1957) Treatment of osteochondritis dissecans. J Bone Joint Surg (Br) 39:248–60
2.
Capar B, Kutluay E, Mujde S (2007) Dorsal closing-wedge osteotomy in the treatment of Freiberg’s disease. Acta Orthop Traumatol Turc 41:136–139PubMed
3.
Chao KH, Lee CH, Lin LC (1999) Surgery for symptomatic Freiberg’s disease: extraarticular dorsal closing-wedge osteotomy in 13 patients followed for 2–4 years. Acta Orthop Scand 7:483–486CrossRef
4.
Gauthier G, Elbaz R (1979) Freiberg’s infraction: a subchondral bone fatigue fracture. A new surgical treatment. Clin Orthop Relat Res 142:93–95PubMed
5.
Hayashi K, Ochi M, Uchio Y, Takao M, Kawasaki K, Yamagami N (2002) A new surgical technique for treating bilateral Freiberg disease. Arthroscopy 18:660–664PubMedCrossRef
6.
Helal B, Gibb P (1987) Freiberg’s disease: a suggested pattern of management. Foot Ankle 8:94–102PubMedCrossRef
7.
8.
Kinnard P, Lirette R (1989) Dorsiflexion osteotomy in Freiberg’s disease. Foot Ankle Int 9:226–231CrossRef
9.
Lee HJ, Kim JW, Min WK (2013) Operative treatment of Freiberg disease using extra-articular dorsal closing-wedge osteotomy: technical tip and clinical outcomes in 13 patients. Foot Ankle Int 34:111–116PubMed
10.
Lee SK, Chung MS, Baek GH, Oh JH, Lee YH, Gong HS (2007) Treatment of Freiberg disease with intra-articular dorsal wedge osteotomy and absorbable pin fixation. Foot Ankle Int 28:43–8PubMedCrossRef
11.
Miyamoto W, Takao M, Uchio Y, Kono T, Ochi M (2008) Late-stage Freiberg disease treated by osteochondral plug transplantation: a case series. Foot Ankle Int 29:950–5PubMedCrossRef
12.
Tsuda E, Ishibashi Y, Yamamoto Y, Maeda S, Kimura Y, Sato H (2011) Osteochondral autograft transplantation for advanced stage Freiberg disease in adolescent athletes: a report of 3 cases and surgical procedures. Am J Sports Med 39:2470–2475PubMedCrossRef
13.
Abbi G, Espinoza L, Odell T, Mahar A, Pedowitz R (2006) Evaluation of 5 knots and 2 suture materials for arthroscopic rotator cuff repair: very strong sutures can still slip. Arthroscopy 22:38–43PubMedCrossRef
14.
Anderson CN, Nyman JS, McCullough KA, Song Y, Uppuganti S, O’Neill KR, Anderson AF, Dunn WR (2013) Biomechanical evaluation of physeal-sparing fixation methods in tibial eminence fractures. Am J Sports Med 41(7):1586–1594. doi:10.​1177/​0363546513488505​ PubMedCrossRef
15.
16.
17.
Komatsu F, Mori R, Uchio Y (2006) Optimum surgical suture material and methods to obtain high tensile strength at knots: problems of conventional knots and the reinforcement effect of adhesive agent. J Orthop Sci 11:70–74PubMedCrossRef
18.
Lo IK, Burkhart SS, Chan KC, Athanasiou K (2004) Arthroscopic knots: determining the optimal balance of loop security and knot security. Arthroscopy 20:489–502PubMedCrossRef
19.
Mahar AT, Moezzi DM, Serra-Hsu F, Pedowitz RA (2006) Comparison and performance characteristics of 3 different knots when tied with 2 suture materials used for shoulder arthroscopy. Arthroscopy 22(614):E1–2PubMed
20.
21.
Yamagami N, Mori R, Yotsumoto T, Hatanaka H, Takao M, Uchio Y (2006) Biomechanical differences resulting from the combination of suture materials and repair techniques. J Orthop Sci 11:614–619PubMedCrossRef
22.
Niki H, Tatsunami S, Haraguchi N, Aoki T, Okuda R, Suda Y, Takao M, Tanaka Y (2011) Development of the patient-based outcome instrument for the foot and ankle. Part 1: project description and evaluation of the outcome instrument version 1. J Orthop Sci 16:536–554PubMedCrossRef
23.
Niki H, Tatsunami S, Haraguchi N, Aoki T, Okuda R, Suda Y, Takao M, Tanaka Y (2011) Development of the patient-based outcome instrument for foot and ankle: part 2: results from the second field survey: validity of the outcome instrument for the foot and ankle version 2. J Orthop Sci 16:556–564PubMedCrossRef
Metadata
Title
Extra-articular dorsal closing-wedge osteotomy to treat late-stage Freiberg disease using polyblend sutures: technical tips and clinical results
Authors
Kazuya Ikoma
Masahiro Maki
Masamitsu Kido
Kan Imai
Yuji Arai
Hiroyoshi Fujiwara
Yasuo Mikami
Toshikazu Kubo
Publication date
01-07-2014
Publisher
Springer Berlin Heidelberg
Published in
International Orthopaedics / Issue 7/2014
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI
https://doi.org/10.1007/s00264-014-2381-3

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