1
|
Al-Mohrej OA, Ade-Conde AM, Ade-Conde OS, Argan M, Khan M, Bouchard M, Al-Asiri J. Hemiepiphysiodesis for juvenile hallux valgus deformity: A systematic review. Foot Ankle Surg 2023; 29:448-454. [PMID: 37419765 DOI: 10.1016/j.fas.2023.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 05/27/2023] [Accepted: 06/24/2023] [Indexed: 07/09/2023]
Abstract
BACKGROUND Among the numerous surgical interventions for correcting hallux valgus deformity in skeletally immature patients, hemiepiphysiodesis is a simple technique with a low complication rate yet its effectiveness remains unclear. This systematic review evaluates hemiepiphysiodesis of the first metatarsal for treating juvenile hallux valgus (JHV) deformities with respect to radiological outcomes, postoperative clinical outcomes, and postoperative complications. METHODS EMBASE, MEDLINE, PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), and Cumulative Index to Nursing and Allied Health Literature (CINAHL) database were searched from inception to September 15th, 2022, for studies investigating hemiepephysiodesis for JHV and its effect on clinical and radiological outcomes. The search, data extraction and methodologic assessment were performed in duplicate for all included studies. RESULTS Six studies out of 488 with a total of 147 feet in 85 patients were included in the final qualitative synthesis. The American Orthopaedic Foot & Ankle Society hallux metatarsophalangeal interphalangeal scale (AOFAS Hallux MTP-IP scale) was used in two studies. The mean pooled preoperative score was 62.2 ± 8.9 and improved to 88.6 ± 4.8 postoperatively in 33 patients. All six studies reported significant improvement in the hallux valgus angle (HVA) from mean preoperative angle of 29.2° ± 3.7-23.8° ± 4.5° postoperatively, while the intermetatarsal angle (IMA) preoperative and postoperative means corrected from 13.9° ± 1.1-11.4° ± 1.2°, respectively. Out of 147 feet, 21 (14.2%) had reported complications including recurrence and need for revision surgery. CONCLUSION This systematic review confirms that hemiepiphysiodesis of the first metatarsal in patients with JHV has improved clinical and radiological outcomes. LEVEL OF EVIDENCE Level IV, Systematic review.
Collapse
Affiliation(s)
- Omar A Al-Mohrej
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada; Section of Orthopedic Surgery, Department of Surgery, King Abdullah Bin Abdulaziz University Hospital, Princess Nourah Bint Abdul Rahman University, Riyadh, Saudi Arabia.
| | | | | | - Mohaned Argan
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Moin Khan
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada; Division of Orthopaedic Surgery, Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Maryse Bouchard
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Canada; Division of Orthopaedics, The Hospital for Sick Children, Toronto, Canada
| | - Jamal Al-Asiri
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| |
Collapse
|
2
|
Batar S, Söylemez MS, Kemah B, Cepni SK. A cross-sectional study on reliability and quality of YouTube® videos related to hallux valgus and evaluation of newly developed hallux valgus-specific survey tool. Digit Health 2023; 9:20552076231171239. [PMID: 37113253 PMCID: PMC10126661 DOI: 10.1177/20552076231171239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 04/05/2023] [Indexed: 04/29/2023] Open
Abstract
Objective Previous studies have reported low quality and reliability on YouTube videos about various medical issues including videos related to hallux valgus (HV) treatment. Therefore, we aimed to evaluate the reliability and quality of YouTube videos on HV and develop a new HV-specific survey tool that physicians, surgeons, and the medical industry can use to create high-quality videos. Methods Videos viewed over 10,000 times were included in the study. We used the Journal of the American Medical Association (JAMA) benchmark criteria, global quality score (GQS), DISCERN tool, and new HV-specific survey criteria (HVSSC) developed by us to evaluate the quality, educational utility and reliability of the videos, the popularity of which was assessed using the Video Power Index (VPI) and view ratio (VR). Results Fifty-two videos were included in this study. Fifteen videos (28.8%) were posted by medical companies producing surgical implants and orthopedic products, 20 (38.5%) by nonsurgical physicians, and 16 (30.8%) by surgeons. The HVSSC indicated that the quality, educational value, and reliability of only 5 (9.6%) videos were adequate. Videos posted by physicians and surgeons tended to be more popular (p = 0.047 and 0.043). Although no correlation was detected among the DISCERN, JAMA, and GQS scores, or between the VR and VPI, we found correlations of the HVSSC score with the number of views and the VR (p = 0.374 and p = 0.006, respectively). A good correlation was detected among the DISCERN, GQS, and HVSSC classifications (rho = 0.770, 0.853, and 0.831, respectively, p = 0.001). Conclusions The reliability of HV-related videos on YouTube is low for professionals and patients. The HVSSC can be used to evaluate the quality, educational value, and reliability of videos.
Collapse
Affiliation(s)
| | - Mehmet Salih Söylemez
- Mehmet Salih Söylemez, Department of
Orthopaedics and Traumatology, Umraniye Training and Research Hospital, Yaprak
Street, Acıbadem District, No. 32, D: 12, 34660 Uskudar, Istanbul, Turkey.
| | | | | |
Collapse
|
3
|
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. Foot Ankle Surg 2022; 28:1021-1028. [PMID: 35190276 DOI: 10.1016/j.fas.2022.02.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 01/11/2022] [Accepted: 02/14/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Bosch 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. METHODS Seventy 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. RESULTS The 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. CONCLUSION Mini-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 EVIDENCE Prognostic Level III, retrospective cohort study.
Collapse
|
4
|
Lewis TL, Patel K, Shepherd KL, MacInnes P, Ray R, Kokkinakis M. Hallux valgus surgery in children with cerebral palsy: A systematic review. Foot Ankle Surg 2022; 28:476-482. [PMID: 35012870 DOI: 10.1016/j.fas.2021.12.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 12/20/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Children with cerebral palsy are highly likely to develop foot deformities, some of which may require surgical intervention. Hallux valgus is a common forefoot deformity which can cause issues with pain, footwear, orthotic splints and soft tissues. It remains unclear what the optimal surgical treatment is for children with cerebral palsy and hallux valgus deformity. OBJECTIVE To systematically review studies reporting the clinical and radiological outcomes of surgical correction of hallux valgus deformity in children with cerebral palsy. METHODS A systematic review of studies published in electronic databases (Medline, Embase, Pubmed and Cochrane library) from inception until January 2021. Keywords related to hallux valgus and cerebral palsy were included. RESULTS 58 studies were identified of which 7 met the criteria for inclusion. 200 feet in 134 patients with a mean age of 13.5 years were included, with a mean follow up period of 43 months. A range of clinical and radiographic outcomes were assessed. A treatment framework for the assessment and management of hallux valgus in children with cerebral palsy based on the published evidence is presented. CONCLUSION Non-ambulant children with cerebral palsy with symptomatic hallux valgus should primarily undergo first MTPJ arthrodesis whilst those who are ambulant should undergo first metatarsal osteotomy± soft tissue correction.
Collapse
Affiliation(s)
- T L Lewis
- Evelina Children's Hospital, St Thomas Hospital, Westminster Bridge Road, London, UK; King's Foot and Ankle Unit, King's College NHS Foundation Trust, UK.
| | - K Patel
- Evelina Children's Hospital, St Thomas Hospital, Westminster Bridge Road, London, UK
| | - K L Shepherd
- Evelina Children's Hospital, St Thomas Hospital, Westminster Bridge Road, London, UK
| | - P MacInnes
- Evelina Children's Hospital, St Thomas Hospital, Westminster Bridge Road, London, UK
| | - R Ray
- King's Foot and Ankle Unit, King's College NHS Foundation Trust, UK
| | - M Kokkinakis
- Evelina Children's Hospital, St Thomas Hospital, Westminster Bridge Road, London, UK
| |
Collapse
|
5
|
Squibb M, Sheerin K, Francis P. Measurement of the Developing Foot in Shod and Barefoot Paediatric Populations: A Narrative Review. CHILDREN 2022; 9:children9050750. [PMID: 35626927 PMCID: PMC9139892 DOI: 10.3390/children9050750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 05/15/2022] [Accepted: 05/17/2022] [Indexed: 11/16/2022]
Abstract
The theory that footwear may change foot shape dates back 100 years. Since this period, research has revealed the anatomical and functional consequences that footwear can cause to the foot. Children’s feet remain malleable as they undergo developmental changes until adolescence, which is why childhood is arguably a crucial period to understand how footwear can affect natural foot development. This review explored the development of the foot in children and adolescents and the methods used to measure the different foot structures; it comments on the key issues with some of these methods and gives direction for future research. Various internal and external factors can affect foot development; the main factors are age, gender, ethnicity, body mass index (BMI) and footwear habits. Research on how footwear can affect foot development has increased over the years and the final section of this review aimed to unpick the findings. Studies investigating the influence of footwear habits on foot length and width have established inconsistent findings. Many of the studies in the review did not control for internal and external factors that can affect foot development. There was also a limited number of studies that investigated hallux valgus angle and muscle strength differences in those with different footwear habits. Moreover, multiple studies in the final section of this review did not successfully examine the footwear habits of the participants and instead used observations or self-assessments, which is a major limitation. Future research should examine footwear behaviors and other confounding factors when investigating the development of the foot in children and adolescents. Moreover, researchers should critically evaluate the methods used to quantify the different structures of the foot to ensure valid and reliable parameters are being used.
Collapse
Affiliation(s)
- Maisie Squibb
- Department of Science and Health, South East Technological University, Kilkenny Road, Moanacurragh, R93 V960 Carlow, Ireland;
- Correspondence:
| | - Kelly Sheerin
- Sports Performance Research Institute New Zealand (SPRINZ), School of Sport and Recreation, Auckland University of Technology, 1010 Auckland, New Zealand;
| | - Peter Francis
- Department of Science and Health, South East Technological University, Kilkenny Road, Moanacurragh, R93 V960 Carlow, Ireland;
| |
Collapse
|
6
|
Seidenstein AH, Torrez TW, Andrews NA, Patch DA, Conklin MJ, Shah A. Pediatric hallux valgus: An overview of history, examination, conservative, and surgical management. Paediatr Child Health 2022; 27:75-81. [PMID: 35599675 PMCID: PMC9113854 DOI: 10.1093/pch/pxab074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 08/20/2021] [Indexed: 09/17/2023] Open
Abstract
Pediatric hallux valgus (PHV), while relatively rare, is still often encountered by general pediatricians. Herein, we concisely summarize the existing literature regarding the pathogenesis, associated conditions, clinical diagnosis, radiographic characteristics, conservative management, and surgical management of PVH. Though PHV is generally considered benign, the progression of hallux valgus can result in complications. The presence of an open physis in the pediatric age group delineates first line treatment choices, whenever possible, as nonoperative. The general exception to this recommendation is for children with neuromuscular and connective tissues disease who may benefit from earlier surgical management. If conservative approaches fail prior to skeletal maturity, the risk of recurrence and need for revision surgery should be discussed with patients and their families before surgical referral is made. The current review was conducted to aid primary care providers in better understanding the pathogenesis, associated conditions, and intervention options available to manage PHV.
Collapse
Affiliation(s)
| | - Timothy W Torrez
- The University of Alabama at Birmingham - Orthopaedic Surgery, Birmingham, Alabama, USA
| | - Nicholas A Andrews
- The University of Alabama at Birmingham - Orthopaedic Surgery, Birmingham, Alabama, USA
| | - David A Patch
- The University of Alabama at Birmingham - Orthopaedic Surgery, Birmingham, Alabama, USA
| | - Michael J Conklin
- The University of Alabama at Birmingham - Orthopaedic Surgery, Birmingham, Alabama, USA
| | - Ashish Shah
- The University of Alabama at Birmingham - Orthopaedic Surgery, Birmingham, Alabama, USA
| |
Collapse
|
7
|
Abstract
Treatment of juvenile hallux valgus can be challenging. Initial treatment with conservative measures is appropriate until exhausted. Surgical treatment should be delayed until after skeletal maturity when possible. Before any intervention, a thorough understanding of the whole patient and any underlying systemic contributors to their hallux valgus, in addition to the radiographic foot parameters, is imperative. Careful and individualized surgical planning should be done to optimize results and decrease the risk for recurrence.
Collapse
Affiliation(s)
- Susan T Mahan
- Department of Orthopaedics and Sports Medicine, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA.
| | - Emily O Cidambi
- Department of Orthopaedics, Rady Children's Hospital, UC San Diego Medical School, 3020 Children's Way, MC 5062, San Diego, CA 92123, USA
| |
Collapse
|
8
|
Kotlarsky P, Gannot G, Katsman A, Eidelman M. Treatment of Adolescent Hallux Valgus With Percutaneous Distal Metatarsal Osteotomy. Foot Ankle Spec 2021; 14:238-248. [PMID: 32228233 DOI: 10.1177/1938640020913182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background. Hallux valgus is a complex deformity of the first ray of the foot, and a significant number of adolescents develop this deformity. More than 130 surgical procedures have been described to treat hallux valgus, but there is no compelling evidence to prefer one method over another. Minimal invasive techniques have been proposed and reported to be successful and cost-effective. The objective of this study was to describe the clinical course of adolescent patients treated with percutaneous distal metatarsal osteotomy. Methods. A retrospective study included patients who had a percutaneous hallux valgus correction during the years 2008 to 2015. The following measurements were compared before surgery up to last follow-up: AOFAS Hallux-Metatarsophalangeal-Interphalangeal questionnaire and radiological measurements (HVA, IMA, DMAA). Any postoperative complications were extracted from the medical records. Results. The procedure was performed on 32 feet (27 patients). All patients were <18 years of age. There were 10 male patients (12 feet) and 17 female patients (20 feet). Average age at surgery was 15.8 years (range = 13-18 years). Average follow-up time was 43 months (range= 24-94 months). The average AOFAS score before surgery was 66, and after surgery, at last follow-up was 96. This difference was significant (P value <.0001). Most patients were pain free after the procedure and returned to appropriate age functioning. Significant improvement was noted in all radiological criteria. Conclusions. Percutaneous distal metatarsal osteotomy is safe, reliable, and effective for the correction of mild to moderate symptomatic hallux valgus in adolescents.Levels of Evidence: Level IV.
Collapse
Affiliation(s)
- Pavel Kotlarsky
- Pediatric Orthopedics, Ruth Children's Hospital, Rambam Health Care Campus, Haifa, Israel
| | - Gil Gannot
- Pediatric Orthopedics, Ruth Children's Hospital, Rambam Health Care Campus, Haifa, Israel
| | - Alexander Katsman
- Pediatric Orthopedics, Ruth Children's Hospital, Rambam Health Care Campus, Haifa, Israel
| | - Mark Eidelman
- Pediatric Orthopedics, Ruth Children's Hospital, Rambam Health Care Campus, Haifa, Israel
| |
Collapse
|
9
|
A Simple Corrective Strategy for Adolescent Hallux Valgus by Ilizarov Method. Tech Orthop 2021. [DOI: 10.1097/bto.0000000000000528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
10
|
Abstract
Complications following hallux valgus (HV) reconstruction will have an expected incidence of between 10% and 55% of cases. The more commonly reported complications include undercorrection/recurrence, overcorrection (hallux varus), transfer metatarsalgia, nonunion, malunion, avascular necrosis, arthritis, hardware removal, nerve injury, and ultimately patient dissatisfaction. The presence of arthritis will be an indication for fusion, whereas osteotomies will be the procedure of choice if the first metatarsophalangeal joint is healthy. Wide experience in primary HV surgery is advised before dealing with complex cases of failed HV surgery.
Collapse
Affiliation(s)
- Manuel Monteagudo
- Orthopaedic Foot and Ankle Unit, Orthopaedic and Trauma Department, Hospital Universitario Quironsalud Madrid, Calle Diego de Velázquez 1, Madrid 28223, Spain; Faculty of Medicine, UEM Madrid, Madrid, Spain.
| | - Pilar Martínez-de-Albornoz
- Orthopaedic Foot and Ankle Unit, Orthopaedic and Trauma Department, Hospital Universitario Quironsalud Madrid, Calle Diego de Velázquez 1, Madrid 28223, Spain; Faculty of Medicine, UEM Madrid, Madrid, Spain
| |
Collapse
|
11
|
Abstract
Foot and ankle pathology is common in the pediatric population. Common issues may be traumatic in nature, congenital, or age dependent. This article reviews common problems and pathology found in the pediatric foot and ankle.
Collapse
Affiliation(s)
- Aron Green
- Seaview Orthopedic & Medical Associates, 1200 Eagle Avenue, Ocean, NJ 07712, USA.
| |
Collapse
|
12
|
Heineman N, Liu G, Pacicco T, Dessouky R, Wukich DK, Chhabra A. Clinical and imaging assessment and treatment of hallux valgus. Acta Radiol 2020; 61:56-66. [PMID: 31084192 DOI: 10.1177/0284185119847675] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Hallux valgus is a common condition estimated to affect as many as 23% of adults. The condition is associated with a variety of debilitating symptoms leading to significant morbidity and quality of life issues. Proper evaluation of this deformity and the timely management of its symptoms can improve hallux valgus-related symptomatology and quality of life. The most commonly used and readily reproduced measurements for assessing hallux valgus are the inter-metatarsal angle and the hallux valgus angle. These angles are helpful for choosing and planning surgical intervention for patients who fail initial conservative measures with distal osteotomies reserved for mild or moderate hallux valgus and proximal osteotomies indicated for more moderate to severe deformities. After reading this review article, readers will gain knowledge of the etiopathogenesis of hallux valgus, measurement parameters, and treatment strategies with representative case examples.
Collapse
Affiliation(s)
- Nathan Heineman
- Department of Radiology, UT Southwestern Medical Center, Dallas, TX, USA
- Department of Orthopaedic Surgery, UT Southwestern Medical Center, Dallas, TX, USA
| | - George Liu
- Department of Orthopaedic Surgery, UT Southwestern Medical Center, Dallas, TX, USA
| | - Thomas Pacicco
- Department of Radiology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Riham Dessouky
- Department of Radiology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Dane K Wukich
- Department of Orthopaedic Surgery, UT Southwestern Medical Center, Dallas, TX, USA
| | - Avneesh Chhabra
- Department of Radiology, UT Southwestern Medical Center, Dallas, TX, USA
| |
Collapse
|
13
|
Chiang MH, Wang TM, Kuo KN, Huang SC, Wu KW. Management of Juvenile Hallux Valgus Deformity: the role of combined Hemiepiphysiodesis. BMC Musculoskelet Disord 2019; 20:472. [PMID: 31651315 PMCID: PMC6813977 DOI: 10.1186/s12891-019-2867-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 10/09/2019] [Indexed: 12/25/2022] Open
Abstract
Background This study aimed to investigate the efficacy of percutaneous hemiepiphysiodesis for gradual correction of symptomatic juvenile hallux valgus (HV) deformity. Methods Between 2012 to 2014, 24 patients with symptomatic juvenile HV were treated by combined percutaneous medial drilling hemiepiphysiodesis of the first proximal phalanx and lateral transphyseal screw hemiepiphysiodesis of the first metatarsal at our institution. Twenty-one of 24 patients fulfilled inclusion criteria had a complete radiological and clinical follow-up of at least 2 years. Preoperative and postoperative radiographs of the feet were reviewed for measurements of hallux valgus angle (HVA), intermetatarsal angle (IMA), proximal metatarsal articular angle (PMAA), proximal phalangeal articular angle (PPAA), and metatarsal length ratio (MTLR). Clinical outcomes were assessed using the AOFAS hallux metatarsophalangeal-interphalangeal score. Results The study included 21 consecutive patients (37 ft) for analysis. The mean age at surgery was 12.0 years (SD = 1.3) and mean follow-up after surgery was 35.1 months (SD = 6.0). With the data available, the HV deformity improved in terms of the reduction of HVA by a mean of 4.7 degrees (P < .001) and the reduction of IMA by 2.2 degrees (P < .001). The PMAA and PPAA also improved significantly in the anteroposterior plane; however, the PMAA difference was insignificant in lateral plane as expected. The mean difference in the MTLR was 0.00 (P = .216) which was indicative of no length discrepancy between first and second metatarsals. The AOFAS score increased from 68.7 to 85.2 (P < .001). In correlation analysis, time to physeal closure was significantly correlated with the final HVA change (r = −.611, P = .003). Conclusion Although combined hemiepiphysiodesis does not create a large degree of correction as osteotomy, yet it did improve HV deformity with adequate growth remaining in our series. It is a procedure that can be of benefit to patients with symptomatic juvenile HV from this minimal operative approach before skeletal maturity. Level of evidence Level IV, retrospective case series.
Collapse
Affiliation(s)
- Ming-Hung Chiang
- Department of Orthopaedic Surgery, National Taiwan University Hospital Hsin-Chu Branch, No.25, Lane 442, Sec.1, Jingguo Rd., Hsinchu City, 300, Taiwan
| | - Ting-Ming Wang
- Department of Orthopaedic Surgery, National Taiwan University Hospital, No.7, Chung Shan S. Rd., Zhongzheng Dist., Taipei City, 10002, Taiwan.,Department of Orthopaedic Surgery, School of Medicine, National Taiwan University, No1, Sec. 1, Jen-Ai Rd., Taipei City, 10051, Taiwan
| | - Ken N Kuo
- Department of Orthopaedic Surgery, National Taiwan University Hospital, No.7, Chung Shan S. Rd., Zhongzheng Dist., Taipei City, 10002, Taiwan.,Cochrane Taiwan, Taipei Medical University, No. 250 Wu-Xing Street, Taipei City, 11031, Taiwan
| | - Shier-Chieg Huang
- Department of Orthopaedic Surgery, National Taiwan University Hospital, No.7, Chung Shan S. Rd., Zhongzheng Dist., Taipei City, 10002, Taiwan
| | - Kuan-Wen Wu
- Department of Orthopaedic Surgery, National Taiwan University Hospital, No.7, Chung Shan S. Rd., Zhongzheng Dist., Taipei City, 10002, Taiwan. .,Institute of Biomedical Engineering, National Taiwan University, No1, Sec. 1, Jen - Ai Rd., Taipei, 100, Taiwan.
| |
Collapse
|
14
|
Jentzsch T, Renner N, Niehaus R, Farei-Campagna J, Deggeller M, Scheurer F, Palmer K, Wirth SH. Radiological and Clinical Outcome After Reversed L-Shaped Osteotomy: A Large Retrospective Swiss Cohort Study. J Foot Ankle Surg 2019; 58:86-92. [PMID: 30583785 DOI: 10.1053/j.jfas.2018.08.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Indexed: 02/03/2023]
Abstract
The objective was to report radiological and clinical outcomes after reversed L-shaped osteotomy (ReveL) for hallux valgus (HV). A retrospective cohort study was performed between January 2004 and December 2013. The primary outcome was radiological recurrence of HV (HV angle [HVA] >15°). There were various exposure and secondary outcome variables. The results showed a median follow-up of 12.0 months (N = 827). Radiological recurrence, limited patient satisfaction, complication, revision surgery, and elective hardware removal were found in 25.0%, 15.3%, 4.6%, 2.5%, and 26.7%. Median pre- to postoperative changes were highest for HVA (delta = -16.7°). Recurrence was more likely in cases with preoperative HVA ≥40° (adjusted odds ratio [ORadjusted]) 3.63, p < .001). Revisions were more likely with concomitant diseases and bilateral surgery (ORadjusted 12.53, p = .010; ORadjusted 3.35, p = .030). Hardware removal was less likely in patients ≥50 years (ORadjusted 0.67, p = .014). In conclusion, ReveL was a good surgical option for HV because of the relatively low rates of unfavorable outcomes.
Collapse
Affiliation(s)
- Thorsten Jentzsch
- Attending Physician, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.
| | - Niklas Renner
- Attending Physician, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Richard Niehaus
- Resident, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Jan Farei-Campagna
- Resident, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | | | | | - Katie Palmer
- Epidemiologist, Fondazione Ospedale San Camillo IRCCS, Venice, Italy
| | - Stephan H Wirth
- Chief-of-Service, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| |
Collapse
|
15
|
Liszka H, Gądek A. Results of Scarf Osteotomy Without Implant Fixation in the Treatment of Hallux Valgus. Foot Ankle Int 2018; 39:1320-1327. [PMID: 30005168 DOI: 10.1177/1071100718786498] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The main goal of the study was to evaluate the costs, clinical and radiologic results, and complications of hallux valgus surgery using scarf osteotomy, depending on the type of fixation (with or without screws). METHODS We evaluated 169 patients who underwent scarf osteotomy between January 2013 and August 2016. The patients were separated into 3 groups depending on the type of stabilization: A, 2 screws (50 patients); B, modified with 1 screw (55 patients); C, modified without implant (64 patients). We assessed duration of surgery, additional procedures, pre- and postoperative hallux valgus angle (HVA) and intermetatarsal angle (IMA) on anteroposterior and lateral foot weightbearing radiographs, the American Orthopaedic Foot & Ankle Society (AOFAS) hallux-metatarsophalangeal-interphalangeal scale for the clinical assessment preoperatively and at the 12-month follow-up. We recorded all the complications and compared the costs between the groups. RESULTS Both the average HVA (A: from 33.7 to 12.6 degrees, B: 35.0 to 13.2 degrees, C: 34.7 to 12.4 degrees) and IMA (A: from 14.9 to 7.5 degrees, B: 15.2 to 6.9 degrees, C: 15.5 to 7.8 degrees) decreased in all groups without significant intergroup differences. The average AOFAS score improved in all the groups (A: from 40 to 88 points, B: 38 to 89 points, C: 42 to 91 points). A similar complication rate was observed (A: 9%, B: 10%, C: 11%). In group C, we noted a shorter time of surgery, and the procedure was the most cost-effective. CONCLUSION Scarf osteotomy without implant stabilization was faster and cost-effective and gave comparable results. It was technically demanding and required patient compliance. LEVEL OF EVIDENCE Level III, retrospective comparative study.
Collapse
Affiliation(s)
- Henryk Liszka
- 1 Department of Orthopedics and Rehabilitation, University Hospital in Krakow, Krakow, Poland
| | - Artur Gądek
- 1 Department of Orthopedics and Rehabilitation, University Hospital in Krakow, Krakow, Poland.,2 Department of Orthopedics and Physiotherapy, Jagiellonian University Collegium Medicum, Krakow, Poland
| |
Collapse
|