Evaluación radiológica pre y posoperatoria de la osteotomía de Austin y uso de AutoCAD® / Preoperative and Postoperative Radiological Evaluation of Austin Osteotomy and Use of Autocad®

Introducción: Se han descrito más de 300 técnicas quirúrgicas para la corrección del hallux valgus. Una de ellas es la técnica de Austin, la cual constituye una osteotomía capital en V con una angulación de 60º utilizada en el tratamiento quirúrgico del hallux valgus leve-moderado. Objetivos: Analizar el grado de corrección que tiene la osteotomía de Austin sobre diferentes parámetros radiológicos y describir la frecuencia con la que se utilizan técnicas complementarias sobre la falange proximal. Métodos: Se realizó un estudio descriptivo, transversal, observacional y retrospectivo. Se seleccionó una muestra de 29 pies intervenidos mediante la técnica de Austin, a los que se les realizaron varias mediciones sobre sus radiografías pre y posoperatorias con AutoCAD®. Resultados: Se obtuvieron diferencias estadísticamente significativas en todos los parámetros evaluados. Conclusiones: Esta técnica corrige significativamente todos los parámetros analizados. Se demuestra que el uso de técnicas quirúrgicas complementarias sobre la falange proximal es bastante frecuente al realizar esta osteotomía(AU)

Introduction: More than 300 surgical techniques have been described for the correction of hallux valgus. One of them is the Austin technique, which constitutes a capital V osteotomy with an angulation of 60º used in the surgical treatment of mild-moderate hallux valgus. Objectives: To analyze the degree of correction that Austin osteotomy has on different radiological parameters and to describe the frequency with which complementary techniques are used on the proximal phalanx. Methods: A descriptive, cross-sectional, observational and retrospective study was carried out in a sample of 29 feet operated on using the Austin technique. Several measurements were made on their pre- and postoperative radiographs with AutoCAD®. Results: Statistically significant differences were obtained in all the parameters evaluated. Conclusions: This technique significantly corrects all the parameters analyzed. It is shown that the use of complementary surgical techniques on the proximal phalanx is quite frequent when performing this osteotomy(AU)

Sex-Related Differences in Outcomes after Hallux Valgus Surgery

PURPOSE: With differences between the sexes in foot bone anatomy and ligamentous laxity, there is the possibility that the results of hallux valgus surgery may also differ between the sexes. We aimed to compare the results of hallux valgus surgery between the sexes. MATERIALS AND METHODS: The authors retrospectively reviewed 60 males (66 feet) and 70 females (82 feet) who underwent distal or proximal chevron osteotomy for the treatment of hallux valgus deformity between June 2005 and December 2011. We compared the clinical and radiologic outcomes between the sexes. RESULTS: There were no statistically significant differences in demographics between the sexes. The mean American Orthopedic Foot and Ankle Society score, visual analogue scale for pain, and patient satisfaction at the last follow-up did not differ significantly between the sexes. The mean preoperative hallux valgus angle (HVA) and inter-metatarsal angle (IMA) were not significantly different between the sexes. At the last follow-up, the mean HVA was significantly greater in females (p=0.003) than in males; mean IMA was not significantly different between the sexes. The mean correction of HVA in males was significantly greater than that in females (p=0.014). CONCLUSION: There were no significant differences between the sexes regarding clinical outcomes after distal and proximal chevron osteotomy. However, male patients achieved greater correction of HVA than female patients. There is a possibility that sexual dimorphism of the foot may affect postoperative HVA.

Sex-Related Differences in Outcomes after Hallux Valgus Surgery

PURPOSE: With differences between the sexes in foot bone anatomy and ligamentous laxity, there is the possibility that the results of hallux valgus surgery may also differ between the sexes. We aimed to compare the results of hallux valgus surgery between the sexes. MATERIALS AND METHODS: The authors retrospectively reviewed 60 males (66 feet) and 70 females (82 feet) who underwent distal or proximal chevron osteotomy for the treatment of hallux valgus deformity between June 2005 and December 2011. We compared the clinical and radiologic outcomes between the sexes. RESULTS: There were no statistically significant differences in demographics between the sexes. The mean American Orthopedic Foot and Ankle Society score, visual analogue scale for pain, and patient satisfaction at the last follow-up did not differ significantly between the sexes. The mean preoperative hallux valgus angle (HVA) and inter-metatarsal angle (IMA) were not significantly different between the sexes. At the last follow-up, the mean HVA was significantly greater in females (p=0.003) than in males; mean IMA was not significantly different between the sexes. The mean correction of HVA in males was significantly greater than that in females (p=0.014). CONCLUSION: There were no significant differences between the sexes regarding clinical outcomes after distal and proximal chevron osteotomy. However, male patients achieved greater correction of HVA than female patients. There is a possibility that sexual dimorphism of the foot may affect postoperative HVA.

Comparison of Proximal and Modified Distal Chevron Osteotomy for the Treatment of Moderate to Severe Hallux Valgus Deformity / 대한족부족관절학회지

PURPOSE: The purpose of our study is the comparison of radiological and clinical outcomes between modified distal chevron osteotomy and proximal metatarsal osteotomy for the patients who had moderate to severe hallux valgus deformity. MATERIALS AND METHODS: In this retrospective study, we included 54 patients (65 feets) who underwent the operation of moderate to severe hallux valgus in our hospital from May 2007 to August 2010. Our study compares two groups. For Group 1, a modified distal chevron osteotmy and a distal soft tissue procedure were done and for Group 2, a proximal metatarsal osteotmy and a distal soft tissue procedure were done. The group 1 were 29 feets; the group 2 were 36 feets, and the average follow up was 9 months. RESULTS: The radiological results show that the hallux valgus angle and the first-second intermetatarsal angle were significantly decreased in two groups. In each parameter, the correction of the hallux valgus angle was 19.1degrees (Group 1) and 24.3degrees (Group 2), the correction of the first-second intermetatarsal angle was 9.6degrees (Group 1) and 10.3degrees (Group 2). Shortening of the first metatarsal length was 0.87 mm (Group 1) and 0.77 mm (Group 2). There are no significant clinical results (American Orthopaedic Foot and Ankle Society score, AOFAS score) in two groups. CONCLUSION: It is thought that a modified distal chevron osteotomy and a distal soft tissue procedure are a considerable operative treatment of moderate to severe hallux valgus deformity because of the similar cilinical results, more simple operative techniques, and less complications than a proximal metatarsal osteotomy.

Comparison of Proximal Metatarsal Osteotomy andDistal Chevron Osteotomy for Correction of Hallux Valgus / 대한족부족관절학회지

PURPOSE: The purpose of this study is comparison of radiological and clinical outcomes between proximal metatarsal osteotomy and distal chevron osteotomy for the correction of hallux valgus. MATERIALS AND METHODS: In this retrospective study, we included subjects who underwent the correction of hallux valgus in our institution between March 2001 and August 2006, with a minimum follow-up of 12 months. The group of proximal metatarsal osteotomy was 23 patients (34 feet); the group of distal chevron osteotomy was 20 patients (26 feet). The group of proximal metatarsal osteotomy was composed of 26 severe cases (76.5%) and 8 moderate cases (23.5%); the group of distal chevron osteotomy was composed of 13 severe cases (50.0%) and 13 moderate cases (50.0%). RESULTS: Compared to preoperative values, the hallux valgus angle, the first-second intermetatarsal angle and the distance of first-fifth metatarsal head were significantly decreased in two groups (p<0.05). In each parameter, the hallux valgus angle was decreased 66.3% (proximal metatarsal osteotomy) versus 49.6% (distal chevron osteotomy), which were significant (p=0.037). The first-second intermetatarsal angle and the distance of first-fifth metatarsal head were not significant. Mayo clinic forefoot scoring system (FFSS) score was significantly improved in two groups (p<0.05). The ratio of improvement was not significant (p=0.762). In severe group, hallux valgus angle and the first-second intermetatarsal angle was significantly decreased in proximal metatarsal osteotomy group compared to distal chevron osteotomy group (p<0.05), but the difference of the distance of first-fifth metatarsal head and FFSS score was not significant in both groups. In moderate group, the difference of all parameters was not significant in both groups. CONCLUSION: Although both proximal metatarsal osteotomy and distal chevron osteotomy showed satisfactory result in FFSS, proximal metatarsal osteotomy was more proper operative technique than distal chevron osteotomy in severe group, because of superiority of correction in radiological parameters.

Comparison of the Results between Distal Chevron Osteotomy and Proximal Metatarsal Osteotomy for the Treatment of Moderate Hallux Valgus / 대한족부족관절학회지

PURPOSE: The purpose of this study is to compare the treatment outcomes of distal chevron osteotomy with those of proximal metatarsal closing wedge osteotomy in patients with moderate severity hallux valgus. MATERIALS AND METHODS: Forty-two patients (51 feet) who were underwent either distal chevron osteotomy (Group I, 22 patients, 27 feet) or proximal metatarsal closing wedge osteotomy (Group II, 20 patients, 24 feet) for the correction of moderate hallux valgus deformity were evaluated retrospectively. We assessed the radiographic results with several parameters including hallux valgus angle (HVA), intermetatarsal angle (IMA) and distal metatarsal articular angle (DMAA). And clinical results with modified AOFAS score at last follow-up. RESULTS: There were no significant differences in IMA, HVA and DMAA between two groups preoperatively. We can achieve the good results with both procedures, but mean HVA and IMA of group II was significantly lower than those of group I. There was some loss of correction in group I at the last follow-up. There was no significant difference in clinical results according to modified AOFAS scoring between two groups at the last follow-up. CONCLUSION: The proximal metatarsal closing wedge osteotomy for the hallux valgus with moderate severity is better treatment option to achieve better radiographic correction and to prevent loss of correction or recurrence than distal chevron osteotomy.

Distal Chevron Osteotomy for Moderate to Severe Hallux Valgus Deformity in Patients Aged 50 or Older / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to analyze the clinical and radiological results of distal chevron osteotomy in patients aged 50 and older with moderate-to-severe hallux valgus. MATERIALS AND METHODS: The authors reviewed the medical records and radiographs of 19 patients (26 feet). Average age at time of surgery was 58 years and the mean follow-up period was 3 years and 1 month. For radiological evaluation, we analyzed changes in hallux valgus angles and 1st-2nd intermetatarsal angles after index operations. Clinical results were assessed with respect to pain, activities of daily living, and shoe-wear. RESULTS: Hallux valgus angles and 1st-2nd intermetatarsal angles improved, but considerable correction loss occurred with time. This correction loss was found to be significantly correlated with preoperative subluxation of the 1st metatarsophalangeal joint and the 1st-2nd intermetatarsal angle. Clinically, remarkable improvements were achieved in terms of pain and level of activity, but most patients (except 4) still wore comfortable shoes rather than hard shoes at latest follow-ups. CONCLUSION: Distal chevron osteotomy is beneficial for patients aged 50 and older with moderate-to- severe hallux valgus deformity, but correction loss may occur in patients with marked subluxation of the 1st metatarsophalangeal joint or a severe 1st-2nd intermetatarsal angle.

Avascular Necrosis of the First Metatarsal Head after Distal Chevron Osteotomy for Hallux Valgus: A Case Report / 대한족부족관절학회지

Avascular necrosis of the first metatarsal head is uncommon. It is most often seen following a distal metatarsal osteotomy for hallux valgus. Although many cases may be subclinical, it is a powerful cause of failure of bunion surgery. Avascular necrosis of the first metatarsal head results in a series of events that begins with phases of avascularity; revascularization, with or without collapse; and reossification. Collapse may result in degenerative change of the metatarsophalangeal joint. We have recently experienced a case of avascular necrosis of the first metatarsal head.

The Results of Distal Chevron Osteotomy with Lateral Soft Tissue Release for Hallux Valgus Deformity / 대한족부족관절학회지

PURPOSE: To evaluate the results and effectiveness of distal chevron osteotomy combined with lateral soft tissue release for the correction of hallux valgus deformity. MATERIALS AND METHODS: 31 patients who underwent distal chevron osteotomy with lateral soft tissue release between July 2002 and June 2003, were analyzed in terms of hallux valgus angle, intermetatarsal angle, subluxation of sesamoid, AOFAS score and the occurrence of avascular necrosis of the first metatarsal head. RESULTS: The mean amount of the correction of hallux valgus angle was 26.3 degrees . The mean amount of the correction of intermetatarsal angle was 6.6 degrees. The mean amount of the correction of sesamoid subluxation was 1.2 points. The mean improvement of AOFAS score was 25.8 points. Avascular necrosis of the first metatarsal head was not found in any cases. CONCLUSION: For correction of hallux valgus deformity, distal chevron osteotomy with lateral soft tissue release showed improvement of hallux valgus angle, sesamoid subluxation and AOFAS score with no evidence of avascular necrosis of the first metatarsal head.

Treatment of Bunionette Deformity with Distal Chevron Osteotomy / 대한정형외과학회잡지

PURPOSE: To evaluate a symptomatic bunionette managed by a distal chevron osteotomy. MATERIALS AND METHODS: From 1997, among eighty-three patients who had been treated for a bunionette deformity with a distal chevron osteotomy, 17 patients, who had no other associated diseases, were reviewed retrospectively. The VAS pain score and AOFAS score, the patient satisfaction level, shoe selectability and disappearance of the callus on the foot were examined. The 5th metatarso-phalangeal angle and 4th and 5th intermetatarsal angle were measured using AP plain radiography. The bunionette was classified as types 1, 2, and 3 and the treatment results were analyzed. RESULTS: 8 male and 9 female patients were enrolled in this study. The mean age of the patients was 33.6 years (21-49 years). The mean follow-up period was 37.6 months (20-62 months). The pain VAS scores were 7.9 preoperatively and 1.2 postoperatively. The last follow-up AOFAS score was 94.7, and all patients were ranked at the very satisfied or satisfied level. All patients had also good shoe selectability and the callus on the lateral sole had disappeared. The preoperative 4th and 5th intermetatarsal angle (mean 10.2 degrees) and the 5th metatarso-phalangeal angle (mean 21.4 degrees) improved to 2.7 degrees and 7.2 degrees after surgery, respectively. There was a type 1, 2 and 3 deformity in 2 (12%), 1 (6%) and 14 patients (82%), respectively. The results among the types were satisfactory. CONCLUSION: A distal chevron osteotomy for the treatment of a symptomatic bunionette is safe, easy and can reduce the signs and symptoms. Regardless of the types of deformity, a distal chevron osteotomy can obtain satisfactory results.

A Comparison of with and without in the Fixation of Distal Chevron Osteotomies for Hallux Valgus / 대한족부족관절학회지

PURPOSE: The distal chevron osteotomy has gained popularity for the mild to moderate hallux valgus, but necessity of fixation is controversy. No fixation of distal chevron osteotomy cause instability, but fixation has problem which has pin site infection and irritability, extension of operation time, discomfort of rehabilitation. So, the author was going to analyse and compare with and without in the fixation of distal chevron osteotomy. MATERIALS AND METHODS: Between 2004 and 2005, a total 18 patients (20 feet) following with and without in fixation of distal chevron osteotomies. The fixation group (A) was performed for the treatment of 10 patients (10 feet) and no fixation group (B) was done to 8 patients (10 feet). RESULTS: On group A, the mean first MTP (metatarsophalangeal) angle corrected 17 degrees pre-operatively to average 29 degrees (range; 20-37 degrees) and the mean first IM (intermetatarsal) angle corrected 10 degrees pre-operatively to average 15 degrees (range; 9-18 degrees). On Group B, the mean first MTP angle corrected 16 degrees pre-operatively to average 29 degrees (range; 18-33 degrees) and the mean first IM angle corrected 7 degrees pre-operatively to average 13 degrees (range; 9-16 degrees) (P>0.05). Clinical results, based on AOFAS score showed an improvement in the overall results. CONCLUSIONS: Comparing the clinical and radiographic results of the distal chevron osteotomies no difference in with and without fixation of distal chevron osteotomies.

Distal Chevron Osteotomy with One BOLD Screw(R) Fixation in Hallux Valgus / 대한족부족관절학회지

PURPOSE: To present our experience of distal chevron osteotomy utilizing one BOLD screw(R) as an alternative fixation method which has advantages over the Kirschner (K)-wire fixation. MATERIALS AND METHODS: Between January 2001 and June 2003, 19 patients with a symptomatic hallux valgus deformity underwent 20 distal metatarsal chevron osteotomies with one BOLD screw(R) fixation. The mean age was 55.6 years with a minimum follow up period 12 months. For radiographical evaluation, hallux valgus angle (HVA) and intermetatarsal angle (IMA) were used. For clinical evaluation, we used AOFAS hallux metatarsophalangeal interphalangeal scale and overall satisfaction of the patients. RESULTS: The AOFAS scores improved from mean 47.5 points to mean 68.1 points at postoperative 3 months and mean 86.0 points at last follow-up. The average HVA corrected from 25.3 degrees to 12.7 degrees. The IMA was corrected from 11.6 degrees to 7.6 degrees. The overall satisfaction of the patients was 85%. There was no major complication. CONCLUSION: We demonstrated that distal chevron osteotomy with one BOLD screw(R) fixation has advantages such as no additional procedure, no loss of correction, early rehabilitation, no prominent hardware and skin irritation. This method also showed excellent bone union, correction and patient satisfaction.

The Results of Distal Chevron Osteotomy for Hallux Valgus in Young Adult / 대한족부족관절학회지

PURPOSE: To analyze the risk factors and the treatment results of the distal chevron osteotomy for the hallux valgus in young adult. MATERIALS AND METHODS: Eleven cases of hallux valgus in 9 patients who underwent the distal chevron osteotomy between February 2000 and January 2004 were included for the study. For the clinical evaluation, we used hallux-metatarsophalangeal interphalangeal scale of American Orthopaedic Foot and Ankle Society (AOFAS). For radiological evaluation, we measured hallux valgus angle (HVA) and intermetatarsal angle (IMA). RESULTS: Five patients had family history of hallux valgus. Symptoms were aggravated by military drill and sports activity. The average AOFAS scale was 62.5 preoperatively, and 88.4 at final follow-up. The HVA and IMA were 34.9 degrees, and 15.8 degrees preoperatively, 16.3 degrees and 8.2 degrees at postoperative 6 weeks, and 19.9 degrees and 9.8 degrees at final follow-up. CONCLUSION: The symptoms of hallux valgus in young adults were aggravated by military drill and sports activity. Distal chevron osteotomy was useful for the treatment of the moderate to severe hallux valgus in young patients.

Distal Chevron Osteotomy with One BOLD Screw(R) Fixation in Hallux Valgus / 대한족부족관절학회지

PURPOSE: To present our experience of distal chevron osteotomy utilizing one BOLD screw(R) as an alternative fixation method which has advantages over the Kirschner (K)-wire fixation. MATERIALS AND METHODS: Between January 2001 and June 2003, 19 patients with a symptomatic hallux valgus deformity underwent 20 distal metatarsal chevron osteotomies with one BOLD screw(R) fixation. The mean age was 55.6 years with a minimum follow up period 12 months. For radiographical evaluation, hallux valgus angle (HVA) and intermetatarsal angle (IMA) were used. For clinical evaluation, we used AOFAS hallux metatarsophalangeal interphalangeal scale and overall satisfaction of the patients. RESULTS: The AOFAS scores improved from mean 47.5 points to mean 68.1 points at postoperative 3 months and mean 86.0 points at last follow-up. The average HVA corrected from 25.3 degrees to 12.7 degrees. The IMA was corrected from 11.6 degrees to 7.6 degrees. The overall satisfaction of the patients was 85%. There was no major complication. CONCLUSION: We demonstrated that distal chevron osteotomy with one BOLD screw(R) fixation has advantages such as no additional procedure, no loss of correction, early rehabilitation, no prominent hardware and skin irritation. This method also showed excellent bone union, correction and patient satisfaction.

The Results of Distal Chevron Osteotomy for Hallux Valgus in Young Adult / 대한족부족관절학회지

PURPOSE: To analyze the risk factors and the treatment results of the distal chevron osteotomy for the hallux valgus in young adult. MATERIALS AND METHODS: Eleven cases of hallux valgus in 9 patients who underwent the distal chevron osteotomy between February 2000 and January 2004 were included for the study. For the clinical evaluation, we used hallux-metatarsophalangeal interphalangeal scale of American Orthopaedic Foot and Ankle Society (AOFAS). For radiological evaluation, we measured hallux valgus angle (HVA) and intermetatarsal angle (IMA). RESULTS: Five patients had family history of hallux valgus. Symptoms were aggravated by military drill and sports activity. The average AOFAS scale was 62.5 preoperatively, and 88.4 at final follow-up. The HVA and IMA were 34.9 degrees, and 15.8 degrees preoperatively, 16.3 degrees and 8.2 degrees at postoperative 6 weeks, and 19.9 degrees and 9.8 degrees at final follow-up. CONCLUSION: The symptoms of hallux valgus in young adults were aggravated by military drill and sports activity. Distal chevron osteotomy was useful for the treatment of the moderate to severe hallux valgus in young patients.