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Hamre ME, Molund M, Nilsen F. A Cadaveric Study Verifying the Potential of a Rotational Biplanar Chevron Osteotomy to Correct the 3-Dimensional Hallux Valgus Deformity. Foot Ankle Spec 2024; 17:63S-67S. [PMID: 36285686 DOI: 10.1177/19386400221131910] [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] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Metatarsal pronation is present in 87% of patients with hallux valgus (HV) deformity. The chevron osteotomy is commonly used worldwide to correct mild to moderate HV deformities. Many modifications have been described, but few address the rotational deformity of the first metatarsal. The rotational biplanar chevron osteotomy (RBCO), described by M. Prado et al, presents a variation of a biplanar chevron osteotomy that can be used to address first metatarsal rotation. The objective of this study is to investigate and verify the technique of the RBCO. METHODS We conducted our study performing an RBCO on 9 cadaveric limbs. The technique uses a medial-based wedge parallel to the plantar limb of the osteotomy to make the distal fragment free to correct rotation. A goniometer was used by 2 individual surgeons to control the rotational correction achieved. RESULTS The osteotomy was considered simple to perform and we experienced no complications, such as fractures or instability. The result was satisfactory alignment and adequate stability. On average, a 2 mm wedge resulted in 11° of rotational correction. CONCLUSION We predict that RBCO can safely be used for correcting the metatarsal rotation when necessary in mild to moderate HV deformity foot. LEVELS OF EVIDENCE Level IV.
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Affiliation(s)
- Mikaela Engarås Hamre
- Orthopedic Department, Sykehuset i Østfold Kalnes (Østfold Hospital Trust), Grålum, Norway
| | - Marius Molund
- Orthopedic Department, Sykehuset i Østfold Kalnes (Østfold Hospital Trust), Grålum, Norway
| | - Fredrik Nilsen
- Orthopedic Department, Sykehuset i Østfold Kalnes (Østfold Hospital Trust), Grålum, Norway
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Palmanovich E, Ohana N, Tavdi A, Atzmon R, Feldman V, Brin YS, Nyska M, Segal D. A modified minimally invasive osteotomy for hallux valgus enables reduction of malpositioned sesamoid bones. Arch Orthop Trauma Surg 2023; 143:6105-6112. [PMID: 37202550 DOI: 10.1007/s00402-023-04868-0] [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: 06/17/2022] [Accepted: 03/26/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND The current minimally invasive distal metatarsal osteotomy for hallux valgus (HV) is V-shaped, which prevents the correction of the rotational metatarsal head deformity and reduction of the sesamoid bones. We sought to determine the optimal method for sesamoid bone reduction during HV surgery. METHODS We reviewed the medical records of 53 patients who underwent HV surgery between 2017 and 2019 using one of three techniques: open chevron osteotomy (n = 19), minimally invasive V-shaped osteotomy (n = 18), and a modified straight minimally invasive osteotomy (n = 16). The sesamoid position was graded using the Hardy and Clapham method on weight-bearing radiographs. RESULTS When compared to open chevron and V-shaped osteotomies, the modified osteotomy resulted in significantly lower postoperative sesamoid position scores (3.74 ± 1.48, 4.61 ± 1.09, and 1.44 ± 0.81, respectively, P < 0.001). Furthermore, the mean change in postoperative sesamoid position score was greater (P < 0.001). CONCLUSION The modified minimally invasive osteotomy was superior to the other two techniques in correcting HV deformity in all planes, including sesamoid reduction.
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Affiliation(s)
- Ezequiel Palmanovich
- Orthopaedic Department, Meir Hospital, Sapir Medical Center, Kfar Saba, Israel, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 56 Tchernichovsky St., 4428164, Kfar Saba, Israel.
| | - Nissim Ohana
- Orthopaedic Department, Meir Hospital, Sapir Medical Center, Kfar Saba, Israel, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 56 Tchernichovsky St., 4428164, Kfar Saba, Israel
| | - Alex Tavdi
- Orthopaedic Department, Meir Hospital, Sapir Medical Center, Kfar Saba, Israel, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 56 Tchernichovsky St., 4428164, Kfar Saba, Israel
| | - Ran Atzmon
- Assuta Medical Center, Department of Orthopaedic Surgery, Affiliated with the Faculty of Health and Science and Ben Gurion University, 7747629, Ashdod, Israel
| | - Viktor Feldman
- Orthopaedic Department, Meir Hospital, Sapir Medical Center, Kfar Saba, Israel, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 56 Tchernichovsky St., 4428164, Kfar Saba, Israel
| | - Yaron S Brin
- Orthopaedic Department, Meir Hospital, Sapir Medical Center, Kfar Saba, Israel, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 56 Tchernichovsky St., 4428164, Kfar Saba, Israel
| | - Meir Nyska
- Orthopaedic Surgery Specialist, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - David Segal
- Orthopaedic Department, Meir Hospital, Sapir Medical Center, Kfar Saba, Israel, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 56 Tchernichovsky St., 4428164, Kfar Saba, Israel
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Patel TJ, Conti MS, Caolo KC, Miller MC, Conti SF, Ellis SJ. Pronation on weightbearing radiographs does not correlate with pronation from weightbearing CT scans. Foot Ankle Surg 2022; 28:763-769. [PMID: 34674938 DOI: 10.1016/j.fas.2021.10.009] [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] [Received: 03/08/2021] [Revised: 08/16/2021] [Accepted: 10/06/2021] [Indexed: 02/04/2023]
Abstract
INTRODUCTION In hallux valgus (HV), first metatarsal pronation is increasingly recognized as an important aspect of the deformity. The purpose of this study was to compare pronation in HV patients determined from the shape of the lateral head of the first metatarsal on AP weightbearing radiographs with pronation calculated from weightbearing CT (WBCT) scans. METHODS Patients were included in this study if they had preoperative and 5-month postoperative WBCT scans and corresponding weightbearing AP radiographs of the affected foot. Pronation of the first metatarsal on WBCT scans was measured using a 3D CAD model and the alpha angle and categorized into four groups on radiographs. Association between pronation groups on radiographs and WBCT scans was determined using Spearman correlation coefficients (rs) and by comparing mean WBCT pronation of the first metatarsal between plain radiograph pronation groups. RESULTS Agreement between the two observers' pronation on radiographs was good (k = 0.634) and moderate (k = 0.501), respectively. There was no correlation between radiographic pronation and the 3D CAD model (rs < 0.15). Preoperatively, there was weak correlation between the alpha angle and the radiographic pronation groups (rs = 0.371, P = 0.048) although this relationship did not hold postoperatively (rs = 0.330, P = 0.081). There was no difference in mean pronation calculated on WBCT scans between the plain radiographic groups. CONCLUSION Pronation of the first metatarsal measured on weightbearing AP radiographs had moderate interobserver agreement and was only weakly associated with pronation measured from WBCT scans. These results suggest that first metatarsal pronation measured on weightbearing radiographs is not a substitute for pronation measured on WBCT scans. LEVEL OF EVIDENCE III, retrospective cohort study.
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Affiliation(s)
| | | | | | - Mark C Miller
- University of Pittsburgh Swanson School of Engineering, Pittsburgh, PA, United States
| | - Stephen F Conti
- Orthopaedic Specialists - UPMC, Pittsburgh, PA, United States
| | - Scott J Ellis
- Hospital for Special Surgery, New York, NY, United States.
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Okuda R, Yoshimura Y, Shima H. Prevalence and radiological characteristics of the dislocation of the second metatarsophalangeal joint in patients undergoing hallux valgus surgery; a matched control study. J Orthop Sci 2022:S0949-2658(22)00168-3. [PMID: 35803857 DOI: 10.1016/j.jos.2022.06.004] [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] [Received: 02/17/2022] [Revised: 05/19/2022] [Accepted: 06/14/2022] [Indexed: 02/09/2023]
Abstract
BACKGROUND Hallux valgus (HV) is occasionally associated with chronic subluxation or dislocation (CS/D) of the second metatarsophalangeal joint (2MTPj). The present study aimed to radiographically investigate the prevalence and characteristics of HV with CS/D of the 2MTPj compared with matched controls. METHODS Dorsoplantar and lateral weight-bearing radiographs of 79 female patients (79 feet) who had HV with an age of 50 years or more were reviewed. All feet were treated with a proximal supination osteotomy for correction of HV. CS/D of the 2MTPj was evaluated on preoperative dorsoplantar and lateral radiographs. HV and intermetatarsal (IM) angles were measured. Seventy-nine feet were divided into two groups: Group CD (16 feet) had HV with CS/D of the 2MTPj, and Group non-CD had HV without the CS/D of the 2MTPj (63 feet). The severity of HV was divided into two grades according to the HV angle: moderate deformity (Group M, 36 feet, HV angle of less than 40°) and severe deformity (Group S, 43 feet, HV angle of 40° or greater). Group CD and non-CD, and Group M and S were matched by age, gender, and BMI. RESULTS The prevalence of CS/D of the 2MTPj was 20.3%. Group CD had a significantly higher HV angle (p = 0.0001) and a significantly higher IM angle (p = 0.042) than Group non-CD. The prevalence of CS/D of the 2MTPj in Group S (34.9%) were significantly higher than that in Group M (2.8%) (p < 0.001). CONCLUSIONS CS/D of the 2MTPj was significantly associated with greater HV and IM angles compared with matched controls. The prevalence of CS/D of the 2MTPj (34.9%) in Group S was significantly higher than that in Group M. Severe HV can be at higher risk of acquiring CS/D of the 2MTPj in middle-aged and older females.
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Affiliation(s)
- Ryuzo Okuda
- Department of Orthopaedic Surgery, Rakusai-Shimizu Hospital, 13-107 Oe Kutsukake-cho, Nishikyo-ku, Kyoto, 610-1106, Japan.
| | - Yukiko Yoshimura
- Department of Orthopaedic Surgery, Rakusai-Shimizu Hospital, 13-107 Oe Kutsukake-cho, Nishikyo-ku, Kyoto, 610-1106, Japan.
| | - Hiroaki Shima
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-0801, Japan.
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Meyr AJ, Doyle MD, King CM, Kwaadu KY, Nasser EM, Ramdass R, Theodoulou MH, Zarick CS. The American College of Foot and Ankle Surgeons® Clinical Consensus Statement: Hallux Valgus. J Foot Ankle Surg 2022; 61:369-383. [PMID: 34706857 DOI: 10.1053/j.jfas.2021.08.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 08/24/2021] [Indexed: 02/07/2023]
Affiliation(s)
- Andrew J Meyr
- Clinical Professor, Department of Surgery, Temple University School of Podiatric Medicine, Philadelphia, PA.
| | - Matthew D Doyle
- Silicon Valley Reconstructive Foot and Ankle Fellowship - Palo Alto Medical Foundation, Mountain View, CA
| | - Christy M King
- Residency Director, Kaiser San Francisco Bay Area Foot & Ankle Residency Program and Attending Surgeon, Kaiser Foundation Hospital, Oakland, CA
| | - Kwasi Y Kwaadu
- Clinical Associate Professor, Department of Surgery, Temple University School of Podiatric Medicine, Philadelphia, PA
| | | | - Roland Ramdass
- Residency Training Committee, INOVA Fairfax Medical Campus, Fairfax, VA
| | - Michael H Theodoulou
- Chief Division of Podiatric Surgery, Cambridge Health Alliance, and Instructor of Surgery, Harvard Medical School, Boston, MA
| | - Caitlin S Zarick
- Assistant Professor, Department of Plastic Surgery, MedStar Georgetown University Hospital, Washington, DC
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Nishikawa DRC, Saito GH, Mendes AAM, Prado MP. Management of the Tarsometatarsal Joint in the Rotational Correction of Hallux Valgus by the Modified Lapidus Procedure: Intraoperative Technical Tips to Prevent Complications. Foot Ankle Spec 2021; 14:528-533. [PMID: 33461322 DOI: 10.1177/1938640020986686] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The modified Lapidus procedure is considered a useful tool for correction of multiplanar deformities in the hallux valgus, including first metatarsal pronation. It offers a greater power of correction compared to most other osteotomies. However, postoperative complications can occur in up to 12% of cases. The aim of this study was to describe intraoperative technical tips in the management of the tarsometatarsal joint during multiplanar correction of severe hallux valgus deformity using the modified Lapidus procedure. It is not the authors' intention to describe a new technique, but to draw attention to intraoperative details in order to prevent complications as nonunion, extension of the first metatarsal and undercorrection of the deformity. Rotational correction of the first metatarsal with adequate bone coaptation of the first metatarsal and the medial cuneiform are the cornerstone for a satisfactory result.Levels of Evidence: Level V, expert opinion.
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Affiliation(s)
- Danilo Ryuko Cândido Nishikawa
- Department of Orthopaedics, Foot and Ankle Surgery, Hospital of the Municipal Public Servant of São Paulo, São Paulo, SP, Brazil
| | - Guilherme Honda Saito
- Department of Orthopedic Surgery, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | | | - Marcelo Pires Prado
- Department of Orthopedic Surgery, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
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Abstract
Rotation of the first metatarsal (M1) as a potential etiological factor of hallux valgus (HV) deformity was described relatively early in the description of HV pathoanatomy. However, because biplanar radiographs have been the standard method for imaging HV, clinicians primarily developed measurement methods and corrective operations confined to 2 dimensions, medial-lateral and inferior-superior. Recently, as our understanding of HV pathoanatomy has further developed, aided in part by advanced imaging technology, M1 rotation about its axis ("axial rotation") and its implications for HV deformity and treatment has reemerged. The goal of this review is to summarize M1 rotation in HV from a historical perspective, to present the current understanding of its potential role in the etiology/pathogenesis of HV, and to summarize relevant imaging and operative considerations with respect to M1 rotation.Level of Evidence: Level III, systematic review.
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Affiliation(s)
- Jesse Steadman
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA
| | - Alexej Barg
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA.,Department of Orthopaedics, Trauma and Reconstructive Surgery, University of Hamburg, Hamburg, Germany
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Kaufmann G, Giesinger JM, Hofer P, Braito M, Biedermann R, Dammerer D. Does preoperative deformity diminish radiographic outcome after hallux valgus correction with scarf osteotomy?: A retrospective study of 102 cases. Foot Ankle Surg 2020; 26:425-431. [PMID: 31202526 DOI: 10.1016/j.fas.2019.05.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Revised: 02/25/2019] [Accepted: 05/13/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND Scarf osteotomy is a frequently used technique to correct moderate to severe hallux valgus deformities. Recurrence of a deformity is a commonly reported complication after surgery. The aim of our study was to evaluate the impact of preoperative deformity on radiological outcome in terms of postoperative loss of correction after scarf osteotomy. METHODS 102 patients, in which a hallux valgus deformity was corrected with an isolated scarf osteotomy were included. Weightbearing radiographs were analyzed preoperatively, postoperatively, after 6 weeks and after three months (mean 10.9 months SD 17.2 months). The following radiological parameters were used for analysis: the intermetatarsal angle (IMA), the hallux valgus angle (HVA), the distal metatarsal articular angle (DMAA), position of the sesamoids, first metatarsal length, and first metatarsophalangeal joint congruity. RESULTS Significant correction of IMA, HVA, DMAA, sesamoid position and joint congruity was achieved (p < 0.001). The IMA improved from 15.8 ± 2.3 to 4.3 ± 2.8°, the HVA from 32.6 ± 6.8 to 9.1 ± 7.2, and the DMAA from 11.4 ± 6.9 to 8.4 ± 5.2°, respectively. In contrast to DMAA, throughout followup we could detect loss of correction for HVA and for IMA amounting 6.3° ± 5.8 and 3.8° ± 2.8 respectively. Loss of HVA correction revealed a significant correlation with preoperative DMAA, but not with the other preoperative radiological parameters. CONCLUSIONS Preoperative deformity does not correlate with postoperative loss of correction after scarf osteotomy, except DMAA. CLINICAL RELEVANCE Our results may be helpful in counseling patients regarding recurrence of hallux valgus deformity after scarf osteotomy. LEVEL OF EVIDENCE Therapeutic, Level IV, retrospective case series.
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Affiliation(s)
- Gerhard Kaufmann
- OFZ Innsbruck, Orthopedic and Foot Centre Innsbruck, Innrain 2/3. Stock, 6020, Innsbruck, Austria.
| | - Johannes M Giesinger
- Institute of Patient-centered Outcome Research (IIPCOR), Dr. Stumpf Straße 56, 6020, Innsbruck, Austria.
| | - Philipp Hofer
- Department of Medical Statistics, Informatics and Health Economics, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.
| | - Matthias Braito
- Orthopedic Department, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.
| | - Rainer Biedermann
- Orthopedic Department, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.
| | - Dietmar Dammerer
- Orthopedic Department, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.
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Rotational biplanar Chevron osteotomy. Foot Ankle Surg 2020; 26:473-476. [PMID: 31155287 DOI: 10.1016/j.fas.2019.05.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 01/17/2019] [Accepted: 05/14/2019] [Indexed: 02/04/2023]
Abstract
INTRODUCTION The Chevron osteotomy is a reliable and popular osteotomy for treating hallux valgus worldwide. Many modifications have been described, but none of them address the rotational deformity of the first metatarsal. The objective of this study is to describe a variation of biplanar Chevron osteotomy which can address first metatarsal rotation when necessary. METHODS The indications for the Rotational Biplanar Chevron Osteotomy (RBCO) are mild to moderate hallux valgus deformity associated with hallux pronation related to internal rotation of the first metatarsal bone. We describe a technique that uses a medial based wedge parallel to the plantar limb of the osteotomy in order to make the distal fragment free to correct rotation. RESULTS The more recent concern about hallux valgus surgery is the very interesting concept that this deformity really occurs in three different planes, and we may have mistreated the rotation component with our current techniques. Many authors have revisited many common techniques in order to adapt them to correct metatarsal pronation. To our best knowledge, this is the first paper to describe a modification of the Chevron osteotomy to address the rotation of the first metatarsal. CONCLUSION We can conclude that the rotational biplanar Chevron osteotomy can be an useful tool in the treatment of mild hallux valgus associated with metatarsal pronation.
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