Background: Hallux valgus (HV) is often accompanied by metatarsalgia. The purpose of this study was to compare the radiological and clinical outcomes of the new triplanar Chevron osteotomy (TCO) and Chevron osteotomy (CO) in the treatment of hallux valgus (HV), especially on plantar callosities and metatarsalgia. Methods: In this retrospective analysis, 90 patients (45 patients per group) with mild to moderate HV and plantar callosities were treated with TCO and CO from July 2020 to January 2022. In both procedures, the apex was located in the centre of the head of the first metatarsal bone, and the CO was oriented towards the fourth MTPJ at a 60° angle. Plantar-oblique Chevron osteotomy (POCO) was defined as Chevron osteotomy and a 20° plantar tilt; TCO was defined as POCO-based metatarsal osteotomy with a 10° tilt towards the metatarsal head. Primary outcome measures included X-ray measurements of the preoperative and postoperative HVA, IMA, DMAA, FML, SMHH and clinical measurements including VAS and AOFAS scores and changes in callosity grade and area and in the number of people with metatarsalgia. Secondary outcomes included complications, recurrence rates, and cosmetic appearance. Results: The HVA, IMA, and DMAA measurements were significantly decreased after surgery (P <0.001) in all patients. In the TCO group, the mean FML and SMHH increased significantly postoperatively (P<0.001). The AOFAS and VAS scores improved postoperatively in both groups (P < 0.001). All patients experienced satisfactory pain relief and acceptable cosmesis. The plantar callosity areas were smaller postoperatively in both the TCO and CO groups, but the change in the area (Δarea) of the TCO group was significantly different from that of the CO group (P < 0.001). The number of postoperative metatarsalgia patients and the plantar callosity grades in the TCO group were both significantly lower than those in the CO group after osteotomy (P<0.05 for both). Conclusions: TCO prevents dorsal shift of the metatarsal head and preserves and even increases the FML, thereby preventing future metatarsalgia in patients. Therefore, compared with CO, TCO has better orthopaedic outcomes and is an effective method for treating mild to moderate HV and preventing transfer metatarsalgia.
Background The aim of this study is to report our institution’s experience regarding the application of allogeneic tendons for the reconstruction of malunited lateral malleolar avulsion fractures with chronic lateral ankle instability. Methods This retrospective study included 34 (34 ankles) patients surgically treated for malunited lateral malleolar avulsion fractures with chronic lateral ankle instability from January 2016 to December 2019. All patients underwent allogeneic tendon reconstruction. The pre- and postoperative American Orthopaedic Foot and Ankle Society (AOFAS) scores、Karlsson Ankle Functional Scores (KAFS) and visual analogue scale (VAS) scores were used to evaluate the functional recovery of the ankle joint. The final follow-up, based on radiographic assessment, including talar tilt and anterior talar translation, was performed to evaluate the stability of the postoperative ankle joints. Results Thirty-two patients (32 ankles) returned for final clinical and radiologic follow-up at an average of 29 (range 24–35) months and 2 patients (2 ankles) were lost to follow-up. The preoperative talus inclination angle (13.6 ± 1.9°) and anterior displacement (9.6 ± 2.8 mm) were re-examined under X-ray and found to be reduced to 3.4 ± 1.2° and 3.8 ± 1.1 mm, respectively (p<0.01). The AOFAS scores increased from 58.5 ± 4.0 to 90.9 ± 3.8 and the Karlsson scores improved from 52.2 ± 3.6 to 89.8 ± 4.5, which was obviously better and the difference was statistically significant (P < 0.01). The VAS scores were significantly reduced from a preoperative mean of 6.8 ± 1.0 to 2.8 ± 0.9 postoperatively (p<0.01). Conclusion In this population and with this follow-up, the application of allogeneic tendons to treat malunited lateral malleolar avulsion fractures combined with chronic lateral ankle instability appeared safe and effective.
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