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Waizy H, Polzer H, Schikora N, Forth A, Becker F, Stukenborg-Colsman C, Yao D. One-Stage Metatarsal Interposition Lengthening With an Autologous Fibula Graft for Treatment of Brachymetatarsia. Foot Ankle Spec 2019; 12:330-335. [PMID: 30280593 DOI: 10.1177/1938640018803731] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: Brachymetatarsia is defined as the pathological shortening of a metatarsal bone, which can cause cosmetic problems and pain in the forefoot. The main surgical treatment options are: extension osteotomy, interposition of a bone graft, and callus distraction. Usually, a bone graft from the iliac crest is used for the interposition osteotomy. The operative technique of graft extraction from the fibula has not been described in the literature yet. Methods: Eight feet with brachymetatarsia in 5 patients were evaluated retrospectively. The minimum follow-up period was 2 years. Via a dorsal V/Y skin incision, a central osteotomy on the metatarsal bone was done. A graft was obtained from the anterior fibula. The graft was inserted and fixed by a locking plate. Additional soft tissue procedures were done. Results: We had bony consolidation in all cases. The mean extension was 9.01 mm (5.49 to 12.54 mm). This corresponded to a mean 20.3% extension of the entire metatarsal. High patient satisfaction as well as high satisfaction regarding the cosmetic results were achieved. There were no postoperative complications. The range of motion of the metatarsal-phalangeal joint IV was 20% less preoperative in terms of plantar flexion. Standing up on tiptoes was possible in all patients postoperatively. One patient reported mild symptoms after sports activities. Conclusions: Because of its anatomy the graft adapts to the metatarsal IV bone. As our study showed, harvesting from the distal fibula causes no functional restriction. In terms of wound and bone healing as well as pain symptoms, this method should be considered as an alternative to the standard iliac graft.
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Affiliation(s)
- Hazibullah Waizy
- Hessing Stiftung, Augsburg, Germany.,Laboratory for Biomechanics and Biomaterials, Hannover Medical School, Hannover, Germany
| | - Hans Polzer
- Department of General, Trauma and Reconstructive Surgery, Munich University Hospital LMU, Munich, Germany
| | | | | | - Felix Becker
- Department of General, Visceral and Transplant Surgery, University Hospital Muenster, Muenster, Germany
| | | | - Daiwei Yao
- Department of Orthopaedic Surgery, Hannover Medical School, Hannover, Germany
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Abstract
UNLABELLED Avascular necrosis of the second metatarsal head was first described by Freiberg in 1913. Conservative treatment includes nonsteroidal anti-inflammatory medication, reduced activity, padding, orthotics, and immobilization. Should conservative treatment fail, a wide variety of surgical procedures exist; however, the optimal procedure is unknown. This systematic review was undertaken to determine which surgical procedure allows for the best resolution of symptoms and return to activity. Included studies were restricted to articles published in English language peer-reviewed journals that consecutively enrolled patients of all ages, with Freiberg's infraction of any stage, who underwent operative treatment, and had a mean follow-up of greater than or equal to 12 months duration. Eighty-five publications were identified, of which 38 (44.7%) met all the inclusion criteria. Surgical techniques and outcomes were grouped into joint sparing and joint destructive procedures. A total of 70 joint destructive procedures were performed with a combined mean follow-up time of 15.0 months. A greater than 70% resolution of pain and full return to activity was reported. A total of 257 joint sparing procedures were performed with a combined mean follow-up of 30.4 months. A greater than 90% resolution of pain and full return to activity was reported. Results of this systematic review reveal that the results of joint sparing procedures are reported more often and appear to have a better prognosis for symptom resolution and return to activity. Smillie stage was not consistently reported, making it difficult to determine its effect on procedure selection. LEVEL OF EVIDENCE Therapeutic, Level IV: Systematic review of Level IV studies.
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Averous C, Leider F, Rocher H, Determe P, Guillo S, Cermolacce C, Diebold P. Interphalangeal Arthrodesis of the Toe With a New Radiolucent Intramedullary Implant (Toegrip). Foot Ankle Spec 2015; 8:520-4. [PMID: 26264635 DOI: 10.1177/1938640015599031] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Interphalangeal arthrodesis is a very common surgical treatment of rigid hammertoe and claw toe deformities. The K-wires habitually used in this procedure are sometimes complicated by pin tract infection, migration, discomfort, and breakage. The aim of this study is to evaluate the results of an interphalangeal arthrodesis with a new radiolucent angulated intramedullary implant. METHODS A total of 377 implants were placed in 297 patients between October 1, 2011, and October 1, 2012. In this study, 157 patients had more than 1 year follow-up and 142 patients were reviewed. The operation technique is explained in detail. RESULTS This intramedullary device offers a good immediate mechanical stability, adequate deformity correction, and a high rate of consolidation (83%). The satisfaction rate of patients in this series was 94%. CONCLUSIONS This study demonstrates good results with a new generation of radiolucent implants. LEVEL OF EVIDENCE Therapeutic, Level IV: Case series.
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Affiliation(s)
- Christophe Averous
- Clinique del Orangerie, Strasbourg, France (CA, FL)Institut Aquitain du Pied Bordeaux, Pessac, France (HR)Medipole Garonne, Toulouse, France (P Determe)Clinique du Sport, Bordeaux, Merignac, France (SG)Clinique Juge, Marseille, France (CC)Nancy, France (P Diebold)
| | - Frederic Leider
- Clinique del Orangerie, Strasbourg, France (CA, FL)Institut Aquitain du Pied Bordeaux, Pessac, France (HR)Medipole Garonne, Toulouse, France (P Determe)Clinique du Sport, Bordeaux, Merignac, France (SG)Clinique Juge, Marseille, France (CC)Nancy, France (P Diebold)
| | - Hubert Rocher
- Clinique del Orangerie, Strasbourg, France (CA, FL)Institut Aquitain du Pied Bordeaux, Pessac, France (HR)Medipole Garonne, Toulouse, France (P Determe)Clinique du Sport, Bordeaux, Merignac, France (SG)Clinique Juge, Marseille, France (CC)Nancy, France (P Diebold)
| | - Patrice Determe
- Clinique del Orangerie, Strasbourg, France (CA, FL)Institut Aquitain du Pied Bordeaux, Pessac, France (HR)Medipole Garonne, Toulouse, France (P Determe)Clinique du Sport, Bordeaux, Merignac, France (SG)Clinique Juge, Marseille, France (CC)Nancy, France (P Diebold)
| | - Stephane Guillo
- Clinique del Orangerie, Strasbourg, France (CA, FL)Institut Aquitain du Pied Bordeaux, Pessac, France (HR)Medipole Garonne, Toulouse, France (P Determe)Clinique du Sport, Bordeaux, Merignac, France (SG)Clinique Juge, Marseille, France (CC)Nancy, France (P Diebold)
| | - Christophe Cermolacce
- Clinique del Orangerie, Strasbourg, France (CA, FL)Institut Aquitain du Pied Bordeaux, Pessac, France (HR)Medipole Garonne, Toulouse, France (P Determe)Clinique du Sport, Bordeaux, Merignac, France (SG)Clinique Juge, Marseille, France (CC)Nancy, France (P Diebold)
| | - Patrice Diebold
- Clinique del Orangerie, Strasbourg, France (CA, FL)Institut Aquitain du Pied Bordeaux, Pessac, France (HR)Medipole Garonne, Toulouse, France (P Determe)Clinique du Sport, Bordeaux, Merignac, France (SG)Clinique Juge, Marseille, France (CC)Nancy, France (P Diebold)
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