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Cingoz T, Ziroglu N, Bozdag E, Yamak F, Yozgatli TK, Bayramoglu A, Kocaoglu B, Esemenli BT. Biomechanical comparison of reverse offset-L osteotomy and chevron osteotomy in cadaveric hallux valgus surgery. J Foot Ankle Res 2024; 17:e12046. [PMID: 39072917 DOI: 10.1002/jfa2.12046] [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: 03/06/2024] [Accepted: 07/18/2024] [Indexed: 07/30/2024] Open
Abstract
OBJECTIVE Chevron osteotomy offers near-excellent clinical results and adequate stability at lower shift percentages, among the techniques used to correct hallux valgus deformity. This cadaveric study aimed to compare the Chevron osteotomy with the reverse offset-L osteotomy, which may provide a greater surface area and a more stable geometry to withstand higher cantilever forces at higher shift percentages. METHODS Metatarsal bones obtained from 20 human cadavers with similar bone quality were divided into two groups: Chevron osteotomy was applied to the 1st group and reverse offset-L osteotomy was applied to the 2nd group. The load-to-failure, displacement in the y-axis, and total displacement values of both groups were compared statistically. Furthermore, bone densities were compared between the groups with computed tomography imaging. RESULTS When outliers in both groups were excluded, a statistically significant difference was found in favor of reverse offset-L (143 ± 42 vs. 204 ± 51.2 N, p = 0.02) in terms of failure load. The groups were similar in terms of displacement on the y-axis and total displacement values. Bone densities were similar. CONCLUSION The reverse offset-L osteotomy has been shown to withstand greater loads before failure compared to the standard Chevron osteotomy. This significant difference in load-to-failure may enable reverse offset-L to provide reliable stability in osteotomies performed in advanced HV cases requiring higher shifts.
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Affiliation(s)
- Tunca Cingoz
- Department of Orthopedic Surgery, Acibadem University Faculty of Medicine, Istanbul, Turkey
| | - Nezih Ziroglu
- Department of Orthopedic Surgery, Acibadem University Faculty of Medicine, Istanbul, Turkey
| | - Ergun Bozdag
- Faculty of Mechanical Engineering Istanbul, Istanbul Technical University, Istanbul, Turkey
| | - Fatih Yamak
- Faculty of Mechanical Engineering Istanbul, Istanbul Technical University, Istanbul, Turkey
| | - Tahir Koray Yozgatli
- Department of Orthopedic Surgery, Acibadem University Faculty of Medicine, Istanbul, Turkey
| | - Alp Bayramoglu
- Department of Anatomy, Acibadem University Faculty of Medicine, Istanbul, Turkey
| | - Baris Kocaoglu
- Department of Orthopedic Surgery, Acibadem University Faculty of Medicine, Istanbul, Turkey
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So Tamil Selven D, Shajahan Mohamed Buhary K, Yew A, Kumarsing Ramruttun A, Tay KS, Eng Meng Yeo N. Biomechanical Consequences of Proximal Screw Placement in Minimally Invasive Surgery for Hallux Valgus Correction. J Foot Ankle Surg 2024:S1067-2516(24)00140-6. [PMID: 38909965 DOI: 10.1053/j.jfas.2024.06.007] [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: 01/25/2024] [Revised: 06/06/2024] [Accepted: 06/08/2024] [Indexed: 06/25/2024]
Abstract
Hallux valgus is one of the most common surgically corrected forefoot deformities. Studies evaluating clinical outcomes of minimally invasive chevron and akin (MICA) procedure have shown shorter operation time, faster recovery, and smaller scars compared to the open approach. Previous biomechanical cadaveric studies have largely focused on the open approach with minimal on MICA. To our knowledge, no studies have compared different proximal screw placements in MICA which can either be three-point fixation or intramedullary. This study aims to compare the biomechanical properties of fixation between these 2 techniques in MICA. Six matched pairs of human fresh frozen cadaveric feet were randomized to either 3-point fixation or intramedullary groups. Both procedures were performed by a single fellowship-trained orthopedic foot and ankle surgeon. Using a material testing machine, each specimen underwent 1000 cycles of plantar-to-dorsal uniaxial loads from 0 to 31 N in cantilever configuration while monitoring bending stiffness and distal fragment dorsal angulation. They were then subjected to load until failure at a compression rate of 10 mm/min. Specimens from both groups tolerated the walking fatigue test. Mean bending stiffness of 3-point fixation was 84% higher than intramedullary constructs (p = .002). Mean dorsal angulation of intramedullary was thrice that of 3-point fixation constructs (p = .008). Mean load to failure of 3-point fixation was 30% higher than intramedullary constructs (p = .001). Three-point fixation provide superior biomechanical stability compared to intramedullary proximal screw placement. The surgical technique using 3-point proximal screw fixation can offer robust fixation and lead to better clinical outcomes.
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Affiliation(s)
| | | | - Andy Yew
- Division of Musculoskeletal Sciences, Singapore General Hospital, Singapore
| | - Amit Kumarsing Ramruttun
- Department of Orthopaedic Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Kae Sian Tay
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
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Trost M, Yarkin S, Knieps M, Frey S, Neiss WF, Eysel P, Gick S, Dargel J. Biomechanical comparison of different fixation methods in tibiotalocalcaneal arthrodesis: a cadaver study. J Orthop Surg Res 2023; 18:971. [PMID: 38105223 PMCID: PMC10726638 DOI: 10.1186/s13018-023-04444-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 12/05/2023] [Indexed: 12/19/2023] Open
Abstract
BACKGROUND Various fixation methods are available for tibiotalocalcaneal arthrodesis: nail, plate, or screws. An intramedullary bone stabilization system within a balloon catheter has not previously been used in tibiotalocalcaneal arthrodesis. The aim of this study was to compare the stability of these techniques. METHODS Twenty-four lower legs from fresh-frozen human cadavers were used. Tibiotalocalcaneal arthrodesis was performed with a retrograde nail, a lateral locking plate, three cancellous screws, or an intramedullary bone stabilization system. The ankles were loaded cyclically in plantarflexion and dorsiflexion. RESULTS For cyclic loading at 125 N, the mean range of motion was 1.7 mm for nail, 2.2 mm for plate, 6.0 mm for screws, and 9.0 mm for the bone stabilization system (P < .01). For cyclic loading at 250 N, the mean range of motion was 4.4 mm for nail, 7.5 mm for plate, 12.1 mm for screws, and 14.6 mm for the bone stabilization system (P < .01). The mean cycle of failure was 4191 for nail, 3553 for plate, 3725 for screws, and 2132 for the bone stabilization system (P = .10). CONCLUSIONS The stability of the tibiotalocalcaneal arthrodesis differs depending on the fixation method, with nail or plate showing the greatest stability and the bone stabilization system the least. When three screws are used for tibiotalocalcaneal arthrodesis, the stability is intermediate. As the biomechanical stability of the bone stabilization system is low, it cannot be recommended for tibiotalocalcaneal arthrodesis.
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Affiliation(s)
- Matthias Trost
- Department of Orthopaedics and Traumatology, Saint Josef Hospital, Ruhr University Bochum, Gudrunstrasse 56, 44791, Bochum, Germany.
| | - Suzan Yarkin
- Department of Orthopaedics and Traumatology, Protestant Hospital Cologne Weyertal, Cologne, Germany
| | - Matthias Knieps
- Department of Orthopaedics and Traumatology, Cologne University Hospital, Cologne, Germany
| | - Sönke Frey
- Department of Orthopaedics and Traumatology, Florence Nightingale Hospital, Düsseldorf, Germany
| | | | - Peer Eysel
- Department of Orthopaedics and Traumatology, Cologne University Hospital, Cologne, Germany
- Cologne Center for Musculoskeletal Biomechanics (CCMB), University of Cologne, Cologne, Germany
| | - Sascha Gick
- Department of Traumatology, Orthopaedics and Hand Surgery, Saint Vinzenz Hospital, Cologne, Germany
| | - Jens Dargel
- Department of Orthopaedics, Saint Josefs Hospital, Wiesbaden, Germany
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Eidmann A, Vinke W, Jakuscheit A, Rudert M, Stratos I. The influence of partial weight bearing on plantar peak forces using three different types of postoperative shoes. Foot Ankle Surg 2022; 28:1384-1388. [PMID: 35872119 DOI: 10.1016/j.fas.2022.07.007] [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: 04/08/2022] [Revised: 07/12/2022] [Accepted: 07/14/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Therapeutic shoes and partial weight bearing regimes are used after foot surgery to prevent the operated region from excessive load. It remains unclear to which extent partial weight bearing reduces the plantar peak forces. Therefore, we investigated the correlation of weight bearing and plantar peak forces in commonly used therapeutic shoes. METHODS Three different weight bearing regimes (20 kg, 40 kg, full weight) were investigated in 20 healthy volunteers. Sensor insoles were used to measure peak forces of the forefoot, midfoot, heel and the complete foot using four kind of shoes (bandage shoe, forefoot relief shoe, short walker and standard sneaker). Peak forces were compared between shoes using one-way ANOVA. The influence of partial weight bearing relative to the peak forces was examined by linear regression analysis. RESULTS All therapeutic shoes reduced significantly peak forces of the fore- and midfoot when compared to the reference shoe; the largest reduction was achieved by the forefoot relief shoe (-70 % at forefoot). Weight load and the resulting peak force showed a positive linear correlation for all regions and shoe types. Partial weight bearing significantly reduced the forefoot's force ratio compared to full weight bearing for all shoes except the forefoot relief shoe. CONCLUSIONS Partial weight bearing is a strong instrument to reduce plantar peak forces of the forefoot, additionally to the proven offloading effect of therapeutic shoes.
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Affiliation(s)
- Annette Eidmann
- Julius-Maximilians University Wuerzburg, Department of Orthopaedic Surgery, Koenig-Ludwig-Haus, Brettreichstrasse 11, 97074 Wuerzburg, Germany
| | - Wiebke Vinke
- Julius-Maximilians University Wuerzburg, Department of Orthopaedic Surgery, Koenig-Ludwig-Haus, Brettreichstrasse 11, 97074 Wuerzburg, Germany
| | - Axel Jakuscheit
- Julius-Maximilians University Wuerzburg, Department of Orthopaedic Surgery, Koenig-Ludwig-Haus, Brettreichstrasse 11, 97074 Wuerzburg, Germany
| | - Maximilian Rudert
- Julius-Maximilians University Wuerzburg, Department of Orthopaedic Surgery, Koenig-Ludwig-Haus, Brettreichstrasse 11, 97074 Wuerzburg, Germany
| | - Ioannis Stratos
- Julius-Maximilians University Wuerzburg, Department of Orthopaedic Surgery, Koenig-Ludwig-Haus, Brettreichstrasse 11, 97074 Wuerzburg, Germany.
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Chen J, Black NR, Morris R, Panchbhavi VK. Biomechanical Comparison of a Novel Method of Tricortical Kirschner Wire Fixation of Distal Chevron Osteotomies of the First Metatarsal Versus Traditional Kirschner Wire and Versus Screw Fixation. Foot Ankle Spec 2022; 15:426-431. [PMID: 33090018 DOI: 10.1177/1938640020965339] [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] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Traditional Kirschner wire (K-wire) stabilization of first metatarsal distal chevron osteotomy involves 1 cortex of fixation; however, unicortical fixation is associated with a high complication rate, including pin migration. A method of K-wire fixation utilizing 3 cortices may be biomechanically superior and potentially equivalent to single-screw fixation. METHODS Cadaveric specimens fixed with tricortical K-wires were tested in both the physiologic and cantilever conditions against specimens fixed with unicortical K-wires (N = 8) and single screws (N = 9) utilizing matched-pair comparison groups. Differences in physiologic and cantilever fixed/intact stiffness ratio and cantilever failure load were determined. RESULTS The tricortical fixation specimens had a significantly higher stiffness ratio in cantilever loading than the unicortical fixation specimens (60.50% tricortical, 34.17% unicortical, P = .02) but not in physiologic load (15.34% tricortical, 25.75% unicortical, P = .23). In cantilever failure loading, the tricortical fixation specimens had a significantly higher load to failure than the unicortical fixation specimens (132.81 N tricortical, 58.58 N unicortical, P < .01). Stiffness ratio under physiologic load, cantilever load, and ultimate load to failure were not significantly different between tricortical K-wire and screw-fixation groups. CONCLUSION Tricortical K-wire fixation for distal chevron osteotomies is biomechanically superior to traditional unicortical K-wire fixation, and equivalent to single-screw fixation. LEVELS OF EVIDENCE Level V: Cadaver study.
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Affiliation(s)
- Jie Chen
- Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch, Galveston, Texas
| | - Natalie R Black
- School of Medicine, The University of Texas Medical Branch, Galveston, Texas
| | - Randall Morris
- Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch, Galveston, Texas
| | - Vinod K Panchbhavi
- Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch, Galveston, Texas
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Biomechanical comparison between bioabsorbable and medical titanium screws in distal chevron osteotomy of first metatarsal in hallux valgus treatment. J Mech Behav Biomed Mater 2022; 131:105260. [DOI: 10.1016/j.jmbbm.2022.105260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 04/10/2022] [Accepted: 04/29/2022] [Indexed: 11/22/2022]
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Sahin A, Gulabi D, Buyukdogan H, Agar A, Kilic B, Mutlu I, Erturk C. Is the magnesium screw as stable as the titanium screw in the fixation of first metatarsal distal chevron osteotomy? A comparative biomechanical study on sawbones models. J Orthop Surg (Hong Kong) 2022; 29:23094990211056439. [PMID: 34872420 DOI: 10.1177/23094990211056439] [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: 11/16/2022] Open
Abstract
Background: Distal chevron osteotomy (DCO) is commonly performed in hallux valgus surgery. The fixation of the osteotomy is provided by various implants. The usage of biodegradable implants such as magnesium is gradually increasing due to the advantages they provide. In this study, we aimed to compare the fixation of DCO with magnesium or titanium screw biomechanically. Methods: Twenty sawbones were used. The samples were divided into two equal groups, including ten sawbones for fixation with single headless titanium (group-1) or magnesium screw (group-2). DCO and screw fixations were performed on all samples using the same technique. Biomechanical testing was applied to five samples in each group in cantilever and the other five in a physiological configuration using a computer connected to the electromechanical test machine. The obtained data were evaluated using the Shapiro-Wilk test, Student's t-test and Mann-Whitney U test on the IBM® SPSS (Statistical Package for the Social Sciences) V22.0 software. Significance was accepted at the p < 0.05 level. Results: There was no statistically significant difference between the magnesium screw and the titanium screw in terms of maximum force, maximum displacement and stiffness measurements in cantilever and physiological loadings (p > 0.05 for all). Conclusion: This study found no significant difference in biomechanical stability between the magnesium and titanium screws in DCO fixation on sawbones. Further studies with real bones are needed.
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Affiliation(s)
- Adem Sahin
- Orthopaedic and Traumatology Department, 147006Saglik Bilimleri University, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey
| | - Deniz Gulabi
- Orthopaedic and Traumatology Department, 147006Saglik Bilimleri University, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey
| | - Halil Buyukdogan
- Orthopaedic and Traumatology Department, 147006Saglik Bilimleri University, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey
| | - Anil Agar
- Orthopaedic and Traumatology Department, 147006Saglik Bilimleri University, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey
| | - Bulent Kilic
- Orthopaedic and Traumatology Department, 147006Saglik Bilimleri University, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey
| | - Ibrahim Mutlu
- Biomedical Engineering Department, 52980Kocaeli University, Kocaeli, Turkey
| | - Cemil Erturk
- Orthopaedic and Traumatology Department, 147006Saglik Bilimleri University, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey
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Biomechanical comparison of different fixation methods in metatarsal shaft fractures: A cadaver study. Clin Biomech (Bristol, Avon) 2022; 92:105588. [PMID: 35121348 DOI: 10.1016/j.clinbiomech.2022.105588] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 01/23/2022] [Accepted: 01/25/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Various fixation methods are available for the operative treatment of metatarsal shaft fractures: Kirschner wire, Titanium elastic nail, plate, or an intramedullary bone stabilization system within a balloon catheter. The aim of this study was to compare the stability of these techniques. METHODS 72 metatarsals II to V from fresh frozen human cadaver feet were used. A shaft fracture was performed and fixed with a 1.6-mm Kirschner wire, a 1.5-mm Titanium elastic nail, a locking 6-hole-plate, or an intramedullary bone stabilization system. In a cantilever configuration, the head of the metatarsals was loaded statically (2 mm/min until failure; all groups) or cyclically (0 to 20 N for 1000 cycles with 10 mm/s, after 1000 cycles 2 mm/min until failure; plate and bone stabilization system). FINDINGS The mean failure strength for static loading was 17 N for Kirschner wire, 13 N for Titanium elastic nail, 73 N for plate and 34 N for the bone stabilization system (P < .01). For cyclic loading, the mean cycle of failure was 1000 for plate and 961 for the bone stabilization system (P = .76). The mean failure strength after cyclic loading was 73 N for plate and 48 N for the bone stabilization system (P = .03). INTERPRETATION Stability differs depending on the fixation method, with a plate showing the greatest stability and Kirschner wire or Titanium elastic nail the least. The stability of the bone stabilization system for fixing metatarsal shaft fractures is intermediate.
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Aiyer A, Massel DH, Siddiqui N, Acevedo JI. Biomechanical Comparison of 2 Common Techniques of Minimally Invasive Hallux Valgus Correction. Foot Ankle Int 2021; 42:373-380. [PMID: 33161779 DOI: 10.1177/1071100720959029] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Hallux valgus is one of the most common surgically corrected forefoot deformities. Compared to open procedures, minimally invasive (MIS) treatment of hallux valgus has resulted in decreased operative time, reduced complication rates, and greater patient satisfaction. Historically, distal chevron osteotomies are the standard for moderate hallux valgus correction. To our knowledge, no studies have evaluated biomechanical strength of transverse and chevron distal first metatarsal osteotomy (DMO) constructs. The purpose of this study was to evaluate the biomechanical strength of these techniques. METHODS Eighteen cadaveric specimens (9 matched pairs) were randomized to transverse or chevron DMO. Each technique was performed by a separate fellowship-trained orthopedic foot and ankle surgeon. Radiographic images were analyzed. Biomechanical testing was performed using Instron Mechanical System. Ultimate load to failure, yield load, and stiffness were assessed. A 10-N preload was applied to the sesamoid bones for stability. A coaxial compression rate (10 mm/min) was applied until failure was observed. Mean and standard deviations were compared. All cadaveric specimens were male. RESULTS There was no significant difference in percent metadiaphyseal shift between osteotomies (P = .453). The most common mode of failure was fracture at screw insertion site (55.6%), followed by failure at osteotomy site (44.4%). A trend toward increased ultimate load to failure (P = .480), yield load (P = .054), and stiffness (P = .438) among transverse compared to chevron osteotomy was observed, but this difference was not statistically significant. CONCLUSION Biomechanical testing demonstrated no significant difference in ultimate load, yield load, and stiffness between MIS transverse and chevron osteotomy constructs; a trend toward increased strength in the transverse osteotomy cohort was observed. Chevron osteotomies may result in early failure by relative ease of cutout through cancellous bone compared to transverse osteotomies in which failure requires cortical cutout. CLINICAL RELEVANCE Use of MIS techniques for hallux valgus correction is gaining clinical traction. Although various clinical studies have evaluated outcomes of these MIS techniques, biomechanical studies have been minimal. Specifically, the potential biomechanical benefits of various MIS hallux valgus osteotomy techniques have not been delineated to date. The content of this manuscript is quite timely, given the rise in use of these MIS techniques.
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Affiliation(s)
- Amiethab Aiyer
- Department of Orthopaedics, University of Miami, Miami, FL, USA
| | - Dustin H Massel
- Department of Orthopaedics, University of Miami, Miami, FL, USA
| | - Noman Siddiqui
- International Center for Limb Lengthening, Baltimore, MD, USA
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Seo JH, Lee HS, Choi YR, Park SH. Distal chevron osteotomy with lateral release for moderate to severe hallux valgus patients aged sixty years and over. INTERNATIONAL ORTHOPAEDICS 2020; 44:1099-1105. [PMID: 32322942 DOI: 10.1007/s00264-020-04562-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Accepted: 04/01/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE To analyze the outcome of distal chevron metatarsal osteotomy (DCMO) with lateral release for moderate to severe hallux valgus patients aged 60 years or more. METHODS Consecutive 77 DCMOs in 54 patients were evaluated. Average age at operation was 65.1 ± 4.3 (range 60~79) years; the mean follow-up period was 20.5 ± 14.2 (range 12~93) months. Hallux valgus angle (HVA), first to second inter-metatarsal angle (IMA), and lateral sesamoid grades were measured. Considering the weak bone quality of the patients, fixation failures such as pin migration, callus formation, delayed union, and first metatarsal bone shortening were reviewed. Osteoarthritis (OA) of the first metatarsophalangeal joint (MTPJ), limitation of 1st MTPJ motion (LOM), and transfer metatarsalgia were also reviewed. RESULTS HVA, IMA, and sesamoid grades were improved at three months and final follow-up. The mean HVA was 36.9° ± 7.0° preoperatively and 6.8° ± 7.1° at final follow-up. The mean correction angle of HVA was 31.3° ± 8.5° at three months and 30.1° ± 8.9° at final follow-up. The mean IMA was 16.3° ± 3.0° pre-operatively and 7.7° ± 2.7° at final follow-up. Hallux varus deformity was observed in three feet. Instability of osteotomy site was observed in one foot. Mean metatarsal shortening length was 1.26 ± 2.1 mm at three month follow-up. There were no cases of transfer metatarsalgia after operation. OA was observed in four feet post-operatively. LOM was observed in ten feet (13.0%). There were no instances of re-fracture or avascular necrosis (AVN). CONCLUSION Despite concerns about aggravation of OA and fixation failure, distal chevron osteotomy with lateral release was safe on patients aged 60 years and over.
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Affiliation(s)
- Jae Hyeon Seo
- Department of Orthopaedic Surgery, Asan Medical Center, Seoul, South Korea
| | - Ho Seong Lee
- Department of Orthopaedic Surgery, Asan Medical Center, Seoul, South Korea.
| | - Young Rak Choi
- Department of Orthopaedic Surgery, Asan Medical Center, Seoul, South Korea
| | - Seung Hwan Park
- Department of Orthopaedic Surgery, Asan Medical Center, Seoul, South Korea
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McKenzie JC, Rogero RG, Khawam S, McDonald EL, Nicholson K, Shakked RJ, Fuchs D, Raikin SM. Incidence and Risk Factors for Pin Site Infection of Exposed Kirschner Wires Following Elective Forefoot Surgery. Foot Ankle Int 2019; 40:1154-1159. [PMID: 31189337 DOI: 10.1177/1071100719855339] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Kirschner wires (K-wires) are commonly utilized for temporary metatarsal and phalangeal fixation following forefoot procedures. K-wires can remain in place for up to 6 weeks postoperatively and are at risk for complications. This study investigated the incidence of infectious complications of exposed K-wires after forefoot surgery and identifies risk factors for these complications. METHODS A single-surgeon retrospective chart review of forefoot surgeries from 2007 to 2017 was undertaken. Inclusion criteria were adult patients (≥18 years) undergoing elective forefoot surgery with the use of exposed K-wires. Incidence of pin site infectious complication, defined as cellulitis, or pin site drainage and/or migration/loosening of the pin was noted. Patient demographic and perioperative data were analyzed, along with the number of K-wires placed per procedure. Mann-Whitney U and chi-square tests were performed to determine predictive factors related to pin site infection rates, with a multivariable model with significant factors subsequently performed. Two-thousand seventeen K-wires in 1237 patients were analyzed. RESULTS There were 35 pin site infections for a rate of 1.74%. Combined forefoot procedures (507 pins in 229 patients) had a pin site infection rate of 4.93% (N = 25), followed by lesser metatarsal osteotomies (667 pins in 446 patients) at 1.05% (N = 7), then hammertoe corrections (694 pins in 421 patients) at 0.43% (N = 3), and no pin site infections with chevron osteotomies (149 pins in 141 patients). Male sex, body mass index (BMI), current smoker, and number of pins were significant risk factors (P ≤ .05). Additionally, there were 23 non-infection-related K-wire complications. No long-term sequelae were encountered based on any complications. CONCLUSION K-wires are commonly used for temporary immobilization of the smaller bones of the forefoot following deformity correction. Male sex, BMI, current smoker, and number of pins were significant risk factors for pin site infection, with a higher rate of infection with 2 or more pins placed. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
| | - Ryan G Rogero
- Rothman Orthopaedic Institute, Philadelphia, PA, USA.,Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Sultan Khawam
- Rowan University School of Osteopathic Medicine, Stratford, NJ, USA
| | - Elizabeth L McDonald
- Rothman Orthopaedic Institute, Philadelphia, PA, USA.,Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | | | | | - Daniel Fuchs
- Rothman Orthopaedic Institute, Philadelphia, PA, USA
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Biomechanical comparison of conventional versus modified technique in distal chevron osteotomies of the first metatarsal: A cadaver study. Foot Ankle Surg 2019; 25:665-669. [PMID: 30321928 DOI: 10.1016/j.fas.2018.07.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Revised: 07/27/2018] [Accepted: 07/31/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND Distal chevron osteotomy can be performed using a conventional or a modified technique. The aim of this biomechanical study was to compare the stability of the two techniques. METHODS Eighteen first metatarsals from nine pairs of fresh frozen human cadaver feet were used. A distal chevron osteotomy was performed using the conventional technique in group 1 (n=9) and using the modified technique in group 2 (n=9). The head of the first metatarsals was loaded in two different configurations (cantilever and physiological), using a materials testing machine. RESULTS In the cantilever configuration, the relative stiffness of the osteosynthesis in comparison with intact bone was 60% (±21%) in group 1 and 65% (±25%) in group 2 (p=0.61). In the physiological configuration, it was 47% (±29%) in group 1 and 47% (±21%) in group 2 (p=0.98). The failure strength in the cantilever configuration was 235N (±128N) in group 1 and 210N (±107N) in group 2 (p=0.47). CONCLUSIONS The conventional and the modified technique for distal chevron osteotomy in the treatment of hallux valgus show a comparable biomechanical loading capacity in this cadaver study.
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