ABSTRACT
UNLABELLED: Reconstructive osteotomies for the treatment of Hallux valgus are among the most prevalent procedures in foot and ankle surgery. The combination of biodegradable materials with an innovative method for fixation by application of ultrasonic energy facilitates a new bonding method for fractures or osteotomies. As clinical experience is still limited, the aim of this study was to assess the safety and performance of the SonicPin system for fixation of Austin/Chevron osteotomies. Chevron osteotomy was performed on 30 patients for the treatment of Hallux valgus. The used SonicPins were made from polylactide and are selectively melted into the cancellous bone structure during insertion by ultrasonic energy. Patients were followed for one year, which included X-ray and MRI examinations as well as evaluation of life quality by EQ-5D (EuroQol). The MRI after three months showed adequate bone healing in all cases and no signs of foreign body reactions, which was again confirmed by MRI 12 months postoperatively. The bony healing after 12 months was uneventful without any signs of foreign body reactions. In summary, based on the low complication rate and the significant improvement in health related quality of life (EQ-5D) reported in this study, fixation of an Austin/Chevron osteotomy with a SonicPin for treatment of Hallux valgus can be considered to be safe and efficient over the short term. LEVEL OF CLINICAL EVIDENCE: Therapeutic Level III.
ABSTRACT
OBJECTIVE: With this joint-preserving procedure impinging and damaged parts of the first metatarsal head and the proximal phalanx are removed. The attachment of the short flexor tendon is preserved. Joint motion will increase and joint function is preserved. INDICATIONS: Hallux rigidus stage 2-3 according to the Vanore classification. Salvage procedure for failed arthroplasty of the first metatarsophalangeal joint. CONTRAINDICATIONS: Hallux rigidus stage 4 according to the Vanore classification. Severe elevatus position of first ray. SURGICAL TECHNIQUE: Surgery with tourniquet is preferred. Dorsomedial skin incision. Longitudinal incision of the capsule. Removal of medial and lateral osteophytes both from the metatarsal and the proximal phalanx. Release of the sesamoids. Removal of the dorsal osteophytes from the metatarsal head and the proximal phalanx in a 45 degrees angle. Intraoperative dorsiflexion should be at least 75 degrees. Hourglass tightening of the capsule at joint level. POSTOPERATIVE MANAGEMENT: Active and passive exercises immediately after surgery. Full weight bearing is allowed. Tape in forefoot pronation if marked relieving posture. RESULTS: Follow-up study of 162 patients. Follow-up period at least 2 years (24-38 months). Increase in dorsiflexion by 27 degrees. 80% of the patients temporarily showed pain at the sesamoids. Twelve patients with progression of the osteoarthritis underwent implant arthroplasty of the first metatarsophalangeal joint (n = 10) or a fusion of the joint (n = 2) as salvage surgery. Fusion or implant arthroplasty of the first metatarsophalangeal joint could be avoided primarily. In comparison to the relevant literature the results are superior to a cheilectomy.
