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International Orthopaedics
Published in: International Orthopaedics 9/2013

01-09-2013 | Original Paper

Proximal opening wedge metatarsal osteotomy for correction of moderate to severe hallux valgus deformity using a locking plate

Authors: Athanasios Badekas, Dimitrios Georgiannos, Vasilios Lampridis, Ilias Bisbinas

Published in: International Orthopaedics | Issue 9/2013

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Abstract

Purpose

Hallux valgus is a complex deformity of the first metatarsophalangeal joint, with varus angulation of the first metatarsal, valgus deviation of the great toe and lateral displacement of the sesamoids and the extensor tendons. The aim of the surgery is to achieve correction of the varus deviation of the 1st metatarsal which is considered by some as the primary intrinsic predisposing factor to hallux valgus deformity.

Methods

We retrospectively reviewed 85 patients (107 feet) who underwent an opening wedge osteotomy of the 1st metatarsal for correction of moderate to severe hallux valgus and metatarsus primus varus. A medially applied anatomic pre-contoured locking plate was used for fixation of the osteotomy.

Results

The mean IMA was decreased from 15.8 (range 12–22) degrees to 7.8 (range 0–12) degrees. The mean pre-operative HVA was 39 (range 21–52) degrees and the mean postoperative HVA was 11.8 (6–19) degrees. The pre-operative AOFAS score was 52 (SD 3.1) and the postoperative score was 85 (SD 5.2).

Conclusion

The proximal opening wedge metatarsal osteotomy is a safe, effective and reproducible technique for correction of moderate to severe hallux valgus deformity. The use of a locking plate provides enough control at the fragments, enhancing healing of osteotomy and maintenance of the correction even with a violated proximal lateral cortex.
Literature
1.
Nikolaou V, Korres D, Xypnitos F, Lazarettos J, Lallos S, Sapkas G, Efstathopoulos N (2009) Fixation of Mitchell’s osteotomy with bioabsorbable pins for the treatment of hallux valgus deformity. Int Orthop 33:701–706PubMedCrossRef
2.
Mann R, Coughlin M (1981) Hallux valgus—etiology, anatomy, treatment and surgical considerations. Clin Orthop Relat Res 157:31–41PubMed
3.
Reize P, Schanbacher J, Wulker N (2007) K-wire transfixation or distraction following the Keller-Brandes arthroplasty in hallux rigidus and hallux valgus? Int Orthop 31:325–331PubMedCrossRef
4.
Coughlin M, Mann R (2007) Surgery of the foot and ankle, 8th edn. CV Mosby, St Louis, pp 183–362
5.
Chuchpaiwong B (2012) Comparing proximal and distal metatarsal osteotomy for moderate to severe hallux valgus. Int Orthop 36(11):2275–2278CrossRef
6.
Jawish R, Assoum H, Saliba E (2010) Opening wedge osteotomy of the first cuneiform for the treatment of hallux valgus. Int Orthop 34:361–368PubMedCrossRef
7.
Mann R, Rudicel S, Graves S (1992) Repair of hallux valgus with a distal soft-tissue procedure and proximal metatarsal osteotomy. J Bone Joint Surg Am 74-A:124–129
8.
Sammarco GJ, Brainard BJ, Sammarco VJ (1983) Bunion correction using proximal chevron osteotomy. Foot Ankle 14:8–14CrossRef
9.
Park CH, Ahn JY, Kim YM, Lee WC (2013) Plate fixation for proximal chevron osteotomy has greater risk for hallux valgus recurrence than Kirschner wire fixation. Int Orthop 37(6):1085–1092
10.
Barouk LS (2005) Scarf osteotomy for hallux valgus correction. Local anatomy, surgical technique, and combination with other forefoot procedures. Foot Ankle Clin 5:525–558
11.
Fuhrmann R, Zollinger-Kies H, Kundert HP (2010) Mid-term results of scarf osteotomy in hallux valgus. Int Orthop 34:981–989PubMedCrossRef
12.
Nyska M, Trnka HJ, Parks B, Myerson M (2003) The Ludloff metatarsal osteotomy: guidelines for optimal correction based on a geometric analysis conducted on a sawbone model. Foot Ankle Int 24(1):34–39PubMed
13.
Mau C, Lauber HJ (1926) Die operative Behandlung des Hallux Valgus. Deutsche Zeit Orthop 197:361–377
14.
Sammarco VJ (2007) Surgical strategies; Mau osteotomy for correction of moderate and severe hallux valgus deformity. Foot Ankle Int 28:857–864PubMedCrossRef
15.
Nigro JS, Geger GM, Catanzariti AR (1991) Closing base wedge osteotomy. J Foot Surg 30(5):494–505PubMed
16.
Trethowan J (1923) A system of surgery. PB Hoeber, New York, pp 1046–1049
17.
Mothershed RA (2001) Osteotomies of the first metatarsal base. In: Banks AS, Downey MS, Martin DE, Miller SJ (eds) McGlamry’s comprehensive textbook of foot and ankle surgery. Lippincott Williams & Wilkins, Philadelphia
18.
Budiman-Mak E, Conrad KJ, Roach K (1991) The foot function index: a measure of foot pain and disability. J Clin Epidemiol 4:561–570CrossRef
19.
Kitaoka H, Alexander I, Adelaar R, Nunley J, Myerson M, Sanders M (1994) Clinical rating systems for the ankle-hindfoot, midfoot, hallux and lesser toes. Foot Ankle Int 15(12):349–353PubMedCrossRef
20.
Richter M, Zech S, Geerling J, Frink M, Knobloch K, Krettek C (2006) A new foot and ankle outcome score: questionnaire based, subjective, visual-analogue-scale, validated and computerized. Foot Ankle Surg 12:191–199CrossRef
21.
Cooper M, Berlet G, Shurnas P, Lee T (2007) Proximal opening-wedge osteotomy of the first metatarsal for correction of hallux valgus. Surg Technol Int 16:215–219PubMed
22.
Amarnek D, Juda E, Oloff L, Jacobs A (1986) Opening base wedge osteotomy of the first metatarsal utilizing rigid external fixation. J Foot Surg 25:321–326PubMed
23.
Haddad R (1975) Hallux valgus and metatarsus primus varus treated by bunionectomy and proximal metatarsal osteotomy. South Med J 68(6):684–686PubMedCrossRef
24.
Sollito RJ, Hart TJ, Sergi AR (1991) Opening base wedge osteotomy with first metatarsophalangeal joint implantation arthroplasty—a retrospective study. J Foot Surg 30:165–169
25.
Wanivenhaus AH, Feldner-Busztin H (1988) Basal osteotomy of the first metatarsal for the correction of metatarsus primus varus associated with hallux valgus. Foot Ankle 8:337–343PubMedCrossRef
26.
Shurnas P, Watson T, Crislip T (2009) Proximal first metatarsal opening wedge osteotomy with a low profile plate. Foot Ankle Int 30(9):865–872PubMedCrossRef
27.
Wukich D, Roussel A, Dial D (2009) Correction of metatarsus primus varus with an opening wedge plate: a review of 18 procedures. J Foot Ankle Surg 48(4):420–426PubMedCrossRef
28.
Kumar S, Konan S, Oddy M, Madhav R (2012) Basal medial opening wedge first metatarsal osteotomy stabilized with a low profile wedge plate. Acta Orthop Belg 78:362–368PubMed
29.
Randhawa S, Pepper D (2009) Radiographic evaluation of hallux valgus treated with opening wedge osteotomy. Foot Ankle Int 30:427–431PubMedCrossRef
30.
Saragas N (2009) Proximal opening-wedge osteotomy of the first metatarsal for hallux valgus using a low profile plate. Foot Ankle Int 30:976–980PubMedCrossRef
31.
Easley ME, Trnka HJ (2007) Current concepts review: hallux valgus part ii: operative treatment. Foot Ankle Int 28:748–758PubMedCrossRef
32.
Watson T, Shurnas P (2008) The proximal opening wedge osteotomy for the correction of hallux valgus deformity. Tech Foot Ankle Surg 7(1):17–24CrossRef
33.
Smith W, Hyer C, DeCarbo W, Berlet G, Lee T (2009) Opening wedge osteotomies for correction of hallux valgus. A review of wedge plate fixation. Foot Ankle Spec 2(6):277–282PubMedCrossRef
Metadata
Title
Proximal opening wedge metatarsal osteotomy for correction of moderate to severe hallux valgus deformity using a locking plate
Authors
Athanasios Badekas
Dimitrios Georgiannos
Vasilios Lampridis
Ilias Bisbinas
Publication date
01-09-2013
Publisher
Springer Berlin Heidelberg
Published in
International Orthopaedics / Issue 9/2013
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI
https://doi.org/10.1007/s00264-013-2019-x

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