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Kraus J, Ziegele MJ, Wang M, Law B. First Tarsometatarsal Joint Loading After Sequential Correction of Hallux Valgus Using a Proximal Opening Wedge Metatarsal Osteotomy and Distal Soft Tissue Procedure. FOOT & ANKLE ORTHOPAEDICS 2021; 6:24730114211026934. [PMID: 35097462 PMCID: PMC8702668 DOI: 10.1177/24730114211026934] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background: The proximal opening wedge osteotomy (POWO) of the first metatarsal (TMT-1) is commonly performed in the operative treatment of hallux valgus. Limited work has been dedicated to study POWO’s effect on the TMT-1 joint, however. The purpose of this study is to evaluate the changes in TMT-1 joint contact stress following POWO of the first metatarsal. Methods: Five fresh-frozen cadaveric below-knee specimens (mean age: 73 years) with hallux valgus deformities (mean hallux valgus angle [HVA]: 37.4 ± 8.5 degrees) were studied. The specimens were loaded to 400 N on an MTS servohydraulic load frame. Joint contact characteristics at TMT-1 joint were measured with a Tekscan pressure sensor (Model 6900, 1100 psi; Tekscan Inc, Boston, MA) with various opening wedge sizes of 3, 5, and 7 mm both without and with a distal soft tissue release (DSTR). The contact force, area, and peak contact stress were compared among groups using analysis of variance and post hoc multiple comparisons over the untreated (Dunnett test, P < .05). Results: The mean contact force was 47.7 ± 33.5 N for untreated specimens. This increased sequentially with opening wedge size and reached statistical significance for 7-mm opening wedge (129.7 ± 62.3 N, P = .01) and 7-mm wedge + DSTR (134.8 ± 60.5 N, P = .008). The mean peak contact stress was 2.8 ± 1.3 MPa for the untreated specimens and increased incrementally with wedge size to 5.7 ± 3.0 MPa for 7-mm wedge only (P = .03) and 5.6 ± 2.5 MPa for 7-mm wedge + DSTR (P = .05). The contact area increased with corrections, but none reached significance. Conclusion: With increasing opening wedge size, loading of the TMT-1 joint increases. Joint stresses higher than 4.7 MPa have been shown to be chondrotoxic, potentially predisposing patients to arthritic joint changes following POWO. Level of Evidence: XXXXXX
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Affiliation(s)
| | | | - Mei Wang
- Medical College of Wisconsin, Milwaukee, WI, USA
| | - Brian Law
- Medical College of Wisconsin, Milwaukee, WI, USA
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Abstract
Minimal incision surgical principals rely on the soft tissue envelope to maintain stability that is supplemented by a variety of clinically recommended fixation methods. The extended distal first metatarsal osteotomy has renewed interest because of the ability to laterally translate, angulate, and rotate the metatarsal head in proper alignment with the sesamoids to a neutral alignment. The soft tissue envelope of capsule, ligaments, and tendons will re-align once the bone deformity is corrected. The periosteum is maintained to provide a biologic scaffold for new bone formation and must be minimally disrupted during the intervention."
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Affiliation(s)
- David B Kay
- Orthopedic Surgery, Northeast Ohio Medical University, 3975 Embassy Parkway, Akron, OH 44333, USA.
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Seki H, Oki S, Suda Y, Takeshima K, Kokubo T, Nagura T, Ishii K. Three-Dimensional Analysis of the First Metatarsal Bone in Minimally Invasive Distal Linear Metatarsal Osteotomy for Hallux Valgus. Foot Ankle Int 2020; 41:84-93. [PMID: 31535939 DOI: 10.1177/1071100719875222] [Citation(s) in RCA: 8] [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 Modified Bösch osteotomy (distal linear metatarsal osteotomy [DLMO]) is one of the minimally invasive correctional surgeries for hallux valgus. The 3-dimensional correctional angles and distances of the first metatarsal bone in DLMO have not been clarified. The purpose of this study was to analyze the 3-dimensional postoperative morphological changes of the first metatarsal bone in DLMO. METHODS Twenty patients (30 feet) who underwent DLMO were enrolled. Preoperative plain radiographs and computed tomography (CT) scans of the feet were examined. Postoperative radiographs and CT scans were also obtained after bone union. The surface data of the pre- and postoperative first metatarsals were reconstructed from the CT data. The positions of the distal ends of the first metatarsals described with respect to the proximal ends were calculated using CT surface-matching technique. RESULTS The distal end of the first metatarsal after DLMO was significantly supinated (10.2 ± 6.0 degrees, P < .001), adducted (6.0 ± 11.8 degrees, P = .004), dorsiflexed (11.1 ± 10.9, P < .001), shortened (7.4 ± 2.5 mm, P < .001), elevated (2.3 ± 3.1 mm, P = .001), and laterally shifted (8.2 ± 3.0 mm, P < .001) compared to the preoperative metatarsal distal end. Supination correction demonstrated a significant correlation with adduction correction (r = 0.659, P < .001) on correlation analyses between these parameters. CONCLUSION The 3-dimensional corrections of the first metatarsal bone after DLMO were evaluated. Pronation and abduction were successfully corrected. Furthermore, adduction correction might be an important factor affecting correction of pronation. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
- Hiroyuki Seki
- Department of Orthopaedic Surgery, International University of Health and Welfare (IUHW) Mita Hospital, Minato-ku, Tokyo, Japan.,Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare (IUHW), Narita City, Chiba, Japan
| | - Satoshi Oki
- Department of Orthopaedic Surgery, Saiseikai Utsunomiya Hospital, Utsunomiya City, Tochigi, Japan.,Department of Clinical Biomechanics, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Yasunori Suda
- Department of Orthopaedic Surgery, International University of Health and Welfare (IUHW) Mita Hospital, Minato-ku, Tokyo, Japan.,Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare (IUHW), Narita City, Chiba, Japan.,Department of Orthopaedic Surgery, International University of Health and Welfare (IUHW) Shioya Hospital, Yaita City, Tochigi, Japan
| | - Kenichiro Takeshima
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare (IUHW), Narita City, Chiba, Japan.,Department of Orthopeadic Surgery, International University of Health and Welfare (IUHW) Ichikawa Hospital, Ichikawa City, Chiba, Japan
| | - Tetsuro Kokubo
- Department of Orthopaedic Surgery, Tachikawa Hospital, Tachikawa City, Tokyo, Japan
| | - Takeo Nagura
- Department of Clinical Biomechanics, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Ken Ishii
- Department of Orthopaedic Surgery, International University of Health and Welfare (IUHW) Mita Hospital, Minato-ku, Tokyo, Japan.,Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare (IUHW), Narita City, Chiba, Japan
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