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Navarro-Cano E, Guevara-Noriega KA, Carrera A, Tubbs RS, Sanjuan-Castillo MA, Iwanaga J, Vizcaya S, Reina F. Distal osteotomy of the first metatarsal bone for the correction of hallux valgus: comparison of the sagittal stability of two percutaneous techniques-a cadaveric study. J Orthop Surg Res 2023; 18:213. [PMID: 36934263 PMCID: PMC10024453 DOI: 10.1186/s13018-023-03702-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 03/12/2023] [Indexed: 03/20/2023] Open
Abstract
BACKGROUND Distal first metatarsal osteotomy is used to correct mild or moderate hallux valgus (HV). We designed a cadaveric study to compare the resistance to axial load between two percutaneous distal first metatarsal osteotomies: Bösch osteotomy and percutaneous chevron. The first aim of this study was to develop a systematic technique for measuring the sagittal displacement on lateral foot X-rays. Our second objective was to measure the resistance to axial load for both of these osteotomies. METHODS Ten pairs of freshly frozen cadaveric feet were randomly assigned to one of the two techniques investigated. Pre- and post-operative lateral X-rays were obtained. After surgery, the feet were placed under progressive axial loads up to 60 kg. Metaphyseo-diaphyseal angle (MDA) and the distance between bone fragments were measured, and the differences between the two techniques were statistically assessed. RESULTS The MDA decreased in both surgical techniques. The mean plantar tilt was -6.90 degrees (SD = 10.251) for chevron osteotomy and -5.34 degrees (SD = 16.621) for Bösch osteotomy. There was no significant difference between the techniques (p = 0.41). Regarding the distance between the bone fragments, the Bösch osteotomy produced more plantar displacement than the chevron osteotomy, which was statistically significant for the 10 and 20 kg loads (p = 0.031 and 0.04, respectively). At loads ≥ 30 kg, the bone fragment distance did not differ significantly between the techniques (p = 0.114). CONCLUSIONS Although the chevron technique confers higher stability regarding fragment displacement during axial loading, both techniques increase the plantar angulation of the metatarsal head. LEVEL OF EVIDENCE Cadaveric study. LEVEL V
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Affiliation(s)
- Ester Navarro-Cano
- Orthopedic Surgery Department, Sant Celoni Hospital, Sant Celoni, Spain
- Medical Sciences Department, Clinical Anatomy, Embryology and Neurosciences Research Group (NEOMA), Faculty of Medicine, University of Girona, 77 Emili Grahit St., 17003, Girona, Spain
| | | | - Anna Carrera
- Medical Sciences Department, Clinical Anatomy, Embryology and Neurosciences Research Group (NEOMA), Faculty of Medicine, University of Girona, 77 Emili Grahit St., 17003, Girona, Spain
| | - R Shane Tubbs
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA, USA
- Department of Neurology, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA, USA
- Department of Structural and Cellular Biology, Tulane University School of Medicine, New Orleans, LA, USA
- Department of Neurosurgery and Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, LA, USA
- Department of Anatomical Sciences, St. George's University, True Blue, Grenada
| | | | - Joe Iwanaga
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA, USA
- Department of Neurology, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA, USA
- Department of Structural and Cellular Biology, Tulane University School of Medicine, New Orleans, LA, USA
- Department of Oral and Maxillofacial Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Sara Vizcaya
- Radiology Department, Sant Celoni Hospital, Sant Celoni, Spain
| | - Francisco Reina
- Medical Sciences Department, Clinical Anatomy, Embryology and Neurosciences Research Group (NEOMA), Faculty of Medicine, University of Girona, 77 Emili Grahit St., 17003, Girona, Spain.
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Mikhail CM, Markowitz J, Di Lenarda L, Guzman J, Vulcano E. Clinical and Radiographic Outcomes of Percutaneous Chevron-Akin Osteotomies for the Correction of Hallux Valgus Deformity. Foot Ankle Int 2022; 43:32-41. [PMID: 34293943 DOI: 10.1177/10711007211031218] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Hallux valgus is a common cause of pain and dysfunction of the foot, sometimes requiring surgical correction when conservative measures fail. Although there are many methods of correction, one of the newer techniques is minimally invasive chevron-Akin (MICA). The aim of the current study is to evaluate clinical and radiographic effectiveness of MICA and narcotic use in a large patient cohort. METHODS All patients in this retrospective study were treated by a single fellowship-trained foot and ankle orthopaedic surgeon. Patient demographics were collected for all cases. Preoperative and postoperative intermetatarsal angle (IMA) and hallux valgus angle (HVA) were measured in all patients on weightbearing 3-views radiographs. The Foot Function Index (FFI) was obtained pre- and postoperatively at each visit. All patients were prescribed regular use of ibuprofen for 3 days with acetaminophen and oxycodone reserved for breakthrough pain. Use of narcotic pain medication was recorded. RESULTS A total of 274 feet in 248 patients were included in the study. Overall, 87.9% were female and 12.1% were male. The mean preoperative IMA and HVA were 13.4 and 29.1 degrees, respectively. The postoperative IMA and HVA were 4.9 and 8.9 degrees, respectively. The mean FFI score part A was 92 preoperatively and 43 postoperatively. Patient satisfaction was 91.6%. The mean postoperative 5 mg oxycodone pill consumption was 2.2. CONCLUSION MICA is good method to correct hallux valgus deformity with low postoperative narcotic use. LEVEL OF EVIDENCE Level III, restrospective cohort study of a single surgeon practice.
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Affiliation(s)
- Christopher M Mikhail
- Department of Orthopedics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jonathan Markowitz
- Department of Orthopedics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Luca Di Lenarda
- Department of Orthopedics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Javier Guzman
- Department of Orthopedics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ettore Vulcano
- Department of Orthopedics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Kaufmann G, Weiskopf D, Liebensteiner M, Ulmer H, Braito M, Endstrasser F, Wagner M, Ban M, Dammerer D. Midterm Results Following Minimally Invasive Distal Chevron Osteotomy: Comparison With the Minimally Invasive Reverdin-Isham Osteotomy by Means of Meta-analysis. In Vivo 2021; 35:2187-2196. [PMID: 34182496 PMCID: PMC8286526 DOI: 10.21873/invivo.12490] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 04/20/2021] [Accepted: 05/19/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM To date, multiple different surgical techniques have been established for hallux valgus surgery, with each technique having its unique advantages and limitations. The open distal chevron osteotomy is widely accepted, but increasing patient demands have led several minimally invasive (MIS) techniques to be described in recent years. The aim of this study was to compare outcomes after minimally invasive (MIS) distal chevron osteotomy and the minimally invasive Reverdin-Isham method. PATIENTS AND METHODS We assessed clinical and radiographic outcomes after MIS chevron osteotomy in 57 feet of 49 consecutive patients with a mean follow-up of 58.9 (range=39.0-85.4) months. Outcomes after MIS Reverdin-Isham osteotomy were analyzed by means of a systematic literature review with a minimum follow-up of 6 months. RESULTS Radiographic outcomes were significantly better in the MIS chevron cohort for intermetatarsal angle (p<0.001), hallux valgus angle and distal metacarpal articular angle (p<0.05). Concerning clinical outcomes, both methods provided comparable improvement. CONCLUSION MIS distal chevron osteotomy in mild to moderate hallux valgus deformity correction results in superior radiographic outcomes compared to the MIS Reverdin-Isham osteotomy. Sufficient correction of IMA cannot be achieved with the MIS Reverdin-Isham osteotomy.
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Affiliation(s)
- Gerhard Kaufmann
- OFZ Innsbruck, Orthopedic and Foot Center Innsbruck, Innsbruck, Austria
| | - Daniel Weiskopf
- Department of Orthopaedics and Traumatology, Medical University of Innsbruck, Innsbruck, Austria
| | - Michael Liebensteiner
- Department of Orthopaedics and Traumatology, Medical University of Innsbruck, Innsbruck, Austria
| | - Hanno Ulmer
- Department of Medical Statistics, Informatics and Health Economics, Medical University of Innsbruck, Innsbruck, Austria
| | - Matthias Braito
- Department of Orthopaedics and Traumatology, St. Johann in Tirol, Austria
| | - Franz Endstrasser
- Department of Orthopaedics and Traumatology, St. Johann in Tirol, Austria
| | - Moritz Wagner
- Department of Orthopaedics and Traumatology, St. Johann in Tirol, Austria
| | - Michael Ban
- Department of Orthopaedics and Traumatology, Medical University of Innsbruck, Innsbruck, Austria
| | - Dietmar Dammerer
- Department of Orthopaedics and Traumatology, Medical University of Innsbruck, Innsbruck, Austria;
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Severyns M, Carret P, Brunier-Agot L, Debandt M, Odri GA, Rouvillain JL. Reverdin-Isham procedure for mild or moderate hallux valgus: clinical and radiographic outcomes. Musculoskelet Surg 2018; 103:161-166. [PMID: 30151785 DOI: 10.1007/s12306-018-0563-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 08/21/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND In the last decade, interests in minimal incision surgery have been growing. Theoretically, this kind of procedure could decrease time to recovery and rehabilitation, with a reduction in morbidity. The present study assessed clinical and radiological outcomes and complications of percutaneous surgery for mild-to-moderate hallux valgus using Reverdin-Isham and Akin osteotomies without fixation after 60 months of follow-up. METHODS A series of 48 patients (57 cases) with medium-to-moderate hallux valgus underwent the same percutaneous surgery, between 2003 and 2011. Data collection involved preoperative dorsal flexion, plantar flexion, M1P1, M1M2, DMAA angles, AOFAS scale score, and subjective satisfaction. RESULTS AOFAS scale score rose from a preoperative median of 55.9-89.2/100 postoperatively (p < 0.001); 51 surgical procedures (89.5%) were considered as satisfactory or very satisfactory by patients at the end of follow-up. Hallux valgus and distal metatarsal articular angle (DMAA) were significantly reduced (29.3° and 14.1°-15.4° and 7.7°, p < 0.001, respectively). There was a significant increase in MTPJ 1 stiffness (p < 0.001). DISCUSSION Percutaneous correction by Reverdin-Isham and Akin osteotomies seems to be effective in isolated medium-to-moderate hallux valgus. Stiffness observed is comparable to other percutaneous and open procedures but needs to be compared in a randomized controlled clinical trial to extra-articular percutaneous procedures without capsule detachment in association with an internal fixation which allows an early mobilization. LEVEL OF CLINICAL EVIDENCE IV.
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Affiliation(s)
- M Severyns
- Department of Orthopedic and Traumatology Surgery, University Hospital of Martinica, BP 632, 97200, Fort-de-France, France.
| | - P Carret
- Department of Orthopedic and Traumatology Surgery, University Hospital of Martinica, BP 632, 97200, Fort-de-France, France
| | - L Brunier-Agot
- Department of Rheumatology, University Hospital of Martinica, BP 632, 97200, Fort-de-France, France
| | - M Debandt
- Department of Rheumatology, University Hospital of Martinica, BP 632, 97200, Fort-de-France, France
| | - G A Odri
- Orthopaedic and Traumatologic Department, Lariboisière University Hospital, Rue Ambroise Paré, 75010, Paris, France
| | - J-L Rouvillain
- Department of Orthopedic and Traumatology Surgery, University Hospital of Martinica, BP 632, 97200, Fort-de-France, France
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