Outcome of Minimally Invasive Distal Metatarsal Metaphyseal Osteotomy (DMMO) for Lesser Toe Metatarsalgia.

BACKGROUND: As in all fields of surgery, advances in orthopaedic surgery develop toward less invasive surgical techniques. The advantages of smaller incisions include minimal soft tissue dissection allowing procedures to be performed as outpatient surgery. There is the assumption that this leads to a quicker recovery time permitting an earlier return to work. As with any new surgical technique, there is an associated learning curve. This study looked into the outcome of minimally invasive distal metatarsal metaphyseal osteotomy (DMMO) performed at a University Hospital. METHODS: Thirty patients underwent minimally invasive surgery for DMMO. There were 13 males and 17 females with an average age of 60 years. More than one metatarsal osteotomy was done in all cases to facilitate the moulding of the metatarsal head to the correct alignment with full weight bearing. The outcome was measured with the Manchester-Oxford Foot Questionnaire (MOXFQ), patient-reported outcome (PRO), and visual analog scale (VAS) pain score. Minimum follow up was 1 year. RESULTS: At the final review, the average MOXFQ score was an excellent 31. Average improvement in VAS score was 3.5, which ranged from 10 to -7. The VAS was affected by 2 patients whose pain worsened after the operation. There were 4 complications, one each of nonunion, malunion, transfer metatarsalgia, and soft tissue ossification. CONCLUSION: The 3 most common complications of foot and ankle surgery are infection, wound dehiscence, and skin ulcer or blister. Intra-articular metatarsal osteotomies are commonly associated with stiffness due to scarring and consequently hammertoes. By reducing the soft tissue injury in minimally invasive surgery, these risks can be potentially minimized. Minimally invasive DMMO produced good patient satisfaction, functional improvement, and low complication rates in most cases. LEVEL OF EVIDENCE: Level IV, retrospective case series.

Complications of suture button ankle syndesmosis stabilization with modifications of surgical technique.

BACKGROUND: The TightRope® is a relatively new device designed to stabilize ankle syndesmotic injuries. There are no studies evaluating the clinical effectiveness of this technique and few reports addressing complications and potential modifications to the surgical technique reported in this article. MATERIALS AND METHODS: A retrospective review of 102 cases of traumatic ankle syndesmotic stabilization using the TightRope device is presented. Patients were followed up for a median of 85 days after surgery. RESULTS: Eight patients subsequently had the TightRope removed. This was performed for four reasons: osteomyelitis surrounding the implant, painful aseptic osteolysis surrounding the implant, failed stabilization of the syndesmosis, and unexplained pain. CONCLUSIONS: On the basis of experience, the authors recommend meticulous attention during the surgical technique. To prevent skin irritation and stitch abscess formation leading to osteomyelitis, the FiberWire loop is best cut with a knife at least 1 cm beyond the knot, allowing the sharp end of the FiberWire to lay flat adjacent to the fibula. Painful aseptic osteolytic reaction to the TightRope necessitates removal. To prevent rediastasis, a small medial incision is recommended for endobutton positioning directly abutting the tibial cortex without soft tissue interposition. Inserting the TightRope through a fibula plate prevents lateral button pull-through and rediastasis.

Three-dimensional analysis of different first metatarsal osteotomies in a hallux valgus model.

BACKGROUND: This study evaluates and compares three-dimensional (3-D) changes in geometry of the first metatarsal (MT1) independent of soft tissue corrections of 5 common osteotomies: three distal (Chevron, Mitchell, and Wilson), one proximal (Stephens basal), and one combined proximal/distal (Scarf), using standardized synthetic bone models. MATERIALS AND METHODS: A digitizing system was used to measure and record points on the synthetic bone models in 3-D space. Computer vector analysis calculated 3-D rotations and translations of the MT1 head plus the conventional intermetatarsal angle (IMA) and distal metatarsal articular angle (DMAA). RESULTS: The Wilson and Mitchell's osteotomies produced significant shortening (p < 0.001) in contrast to the three other osteotomies. All the osteotomies produced a reduction in the 3-D IMA. The Scarf and Stephens basal osteotomies reduced the DMAA. All of the osteotomies resulted in lateral translations and depression of the MT1 head. While there were no significant (p > 0.05) translational differences between the Scarf and Stephens basal osteotomies, there were rotational differences, with the Stephens basal producing significantly more plantar flexion (p = 0.000) and pronation (p < 0.001) than the Scarf. CONCLUSION: This geometric study indicated many of the MT1 head changes following metatarsal osteotomy to be out-of-plane translational and multiplanar rotations which cannot be determined using AP radiographs alone. CLINICAL RELEVANCE: We advocate judicious choice of osteotomy to achieve the desired correction of hallux valgus in each individual.