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A modified minimally invasive osteotomy for hallux valgus enables reduction of malpositioned sesamoid bones

Authors

  • Ezequiel Palmanovich Orthopaedic Department, Meir Hospital, Sapir Medical Center, Kfar Saba, Israel
  • Nissim Ohana Orthopaedic Department, Meir Hospital, Sapir Medical Center, Kfar Saba, Israel
  • Omer Slevin Orthopaedic Department, Meir Hospital, Sapir Medical Center, Kfar Saba, Israel
  • Viktor Feldman Orthopaedic Department, Meir Hospital, Sapir Medical Center, Kfar Saba, Israel
  • Yaron S Brin Orthopaedic Department, Meir Hospital, Sapir Medical Center, Kfar Saba, Israel
  • Meir Nyska Sackler Faculty of Medicine, Tel Aviv University
  • David Segal Orthopaedic Department, Meir Hospital, Sapir Medical Center, Kfar Saba, Israel

Abstract

Background: Current minimally invasive distal metatarsal osteotomy for hallux valgus (HV) is V-shaped, which prevents correcting the rotational metatarsal head deformity and reduction of sesamoid bones. We aimed to determine the optimal method for sesamoid bone reduction in HV surgery.

Methods: We reviewed the records of 53 patients who underwent HV surgery by a single surgeon from 2017 to 2019 according to 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). Sesamoid position was graded using the Hardy and Clapham method based on standing radiographs.

Results: Postoperative sesamoid position scores were significantly lower (better) following the modified osteotomy than following open chevron osteotomy and V-shaped osteotomy (1.44±0.81, 3.74±1.48 and 4.61±1.09, respectively, P<0.001); and the mean change in score was greater (P<0.001).

Conclusion: Modified minimally invasive osteotomy was superior to the two other techniques, in the correction of HV deformity in all planes, including sesamoid reduction.

Keywords:

hallux valgus, distal metatarsal osteotomy, minimally invasive chevron and akin

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References

De Prado M. Minimally invasive foot surgery: A paradigm shift. Minim. Invasive Surg. Foot Ankle. Springer London; 2011. p. 3–11.

Ferrari J, Higgins JPT, Prior TD. Interventions for treating hallux valgus (abductovalgus) and bunions. Cochrane database Syst. Rev. [Internet]. 2004 [cited 2020 Mar 11];CD000964. Available from: http://www.ncbi.nlm.nih.gov/pubmed/14973960

Fraissler L, Konrads C, Hoberg M, Rudert M, Walcher M. Treatment of hallux valgus deformity. EFORT Open Rev. British Editorial Society of Bone and Joint Surgery; 2016;1:295–302.

Palmanovich E, Myerson MS. Correction of moderate and severe hallux valgus deformity with a distal metatarsal osteotomy using an intramedullary plate [Internet]. Foot Ankle Clin. W.B. Saunders; 2014 [cited 2020 Mar 11]. p. 191–201. Available from: http://www.ncbi.nlm.nih.gov/pubmed/24878409

Maffulli N, Longo UG, Marinozzi A, Denaro V. Hallux valgus: effectiveness and safety of minimally invasive surgery. A systematic review. Br. Med. Bull. [Internet]. 2011 [cited 2020 Mar 11];97:149–67. Available from: http://www.ncbi.nlm.nih.gov/pubmed/20710024

Giannini S, Bevoni R, Vannini F, Cadossi M. Hallux Valgus Surgery: The Minimally Invasive Bunion Correction. Minim. Invasive Surg. Orthop. Springer New York; 2010. p. 463–71.

Magnan B, Pezzè L, Rossi N, Bartolozzi P. Percutaneous distal metatarsal osteotomy for correction of hallux valgus. J. Bone Jt. Surg. - Ser. A [Internet]. 2005 [cited 2020 Mar 11];87:1191–9. Available from: http://www.ncbi.nlm.nih.gov/pubmed/15930526

Malagelada F, Sahirad C, Dalmau-Pastor M, Vega J, Bhumbra R, Manzanares-Céspedes MC, et al. Minimally invasive surgery for hallux valgus: a systematic review of current surgical techniques. [Internet]. Int. Orthop. Springer Verlag; 2019 [cited 2020 Mar 11]. p. 625–37. Available from: http://www.ncbi.nlm.nih.gov/pubmed/30218181

Vernois J, Redfern DJ. Percutaneous Surgery for Severe Hallux Valgus [Internet]. Foot Ankle Clin. W.B. Saunders; 2016 [cited 2020 Mar 11]. p. 479–93. Available from: http://www.ncbi.nlm.nih.gov/pubmed/27524702

Deenik AR, De Visser E, Louwerens JWK, Malefijt MDW, Draijer FF, De Bie RA. Hallux valgus angle as main predictor for correction of hallux valgus. BMC Musculoskelet. Disord. 2008;9.

Okuda R, Kinoshita M, Yasuda T, Jotoku T, Shima H, Takamura M. Hallux valgus angle as a predictor of recurrence following proximal metatarsal osteotomy. J. Orthop. Sci. [Internet]. Springer Tokyo; 2011 [cited 2020 Mar 11];16:760–4. Available from: http://www.ncbi.nlm.nih.gov/pubmed/21818604

Okuda R, Kinoshita M, Yasuda T, Jotoku T, Kitano N, Shima H. Postoperative incomplete reduction of the sesamoids as a risk factor for recurrence of hallux valgus. J. Bone Jt. Surg. - Ser. A [Internet]. Journal of Bone and Joint Surgery Inc.; 2009 [cited 2020 Mar 11];91:1637–45. Available from: http://www.ncbi.nlm.nih.gov/pubmed/19571086

Katsui R, Samoto N, Taniguchi A, Akahane M, Isomoto S, Sugimoto K, et al. Relationship between Displacement and Degenerative Changes of the Sesamoids in Hallux Valgus. Foot Ankle Int. [Internet]. SAGE Publications Inc.; 2016 [cited 2020 Mar 11];37:1303–9. Available from: http://www.ncbi.nlm.nih.gov/pubmed/27530982

Suzuki J, Tanaka Y, Takaoka T, Kadono K, Takakura Y. Axial radiographic evaluation in hallux valgus: evaluation of the transverse arch in the forefoot. J. Orthop. Sci. [Internet]. Springer Japan; 2004 [cited 2020 Mar 11];9:446–51. Available from: http://www.ncbi.nlm.nih.gov/pubmed/15449119

Nyska M. Principles of first metatarsal osteotomies. Foot Ankle Clin. [Internet]. 2001 [cited 2020 Mar 11];6:399–408. Available from: http://www.ncbi.nlm.nih.gov/pubmed/11692489

Hardy RH, Clapham JCR. OBSERVATIONS ON HALLUX VALGUS. J. Bone Joint Surg. Br. [Internet]. 1951 [cited 2020 Mar 11];33-B:376–91. Available from: http://online.boneandjoint.org.uk/doi/10.1302/0301-620X.33B3.376

Wagner P, Ortiz C, Wagner E. Rotational Osteotomy for Hallux Valgus. A New Technique for Primary and Revision Cases. Tech. foot ankle Surg. [Internet]. Lippincott Williams and Wilkins; 2017 [cited 2020 Mar 11];16:3–10. Available from: http://www.ncbi.nlm.nih.gov/pubmed/28286430

Nyska M, Trnka H-J, Parks BG, Myerson MS. The Ludloff metatarsal osteotomy: guidelines for optimal correction based on a geometric analysis conducted on a sawbone model. Foot ankle Int. [Internet]. 2003 [cited 2020 Mar 11];24:34–9. Available from: http://www.ncbi.nlm.nih.gov/pubmed/12540079

Okuda R. Proximal Supination Osteotomy of the First Metatarsal for Hallux Valgus [Internet]. Foot Ankle Clin. W.B. Saunders; 2018 [cited 2020 Mar 11]. p. 257–69. Available from: http://www.ncbi.nlm.nih.gov/pubmed/29729800

Frigg A, Zaugg S, Maquieira G, Pellegrino A. Stiffness and Range of Motion After Minimally Invasive Chevron-Akin and Open Scarf-Akin Procedures. Foot Ankle Int. [Internet]. SAGE Publications Inc.; 2019 [cited 2020 Mar 11];40:515–25. Available from: http://www.ncbi.nlm.nih.gov/pubmed/30688526

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2020-11-24

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Copyright (c) 2020 Ezequiel Palmanovich, Nissim Ohana, Omer Slevin, Viktor Feldman, Yaron S Brin, Meir Nyska, David Segal

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