Angular correction and complications of proximal first metatarsal osteotomies for hallux valgus deformity

Schuh, Reinhard; Willegger, Madeleine; Holinka, Johannes; Ristl, Robin; Windhager, Reinhard; Wanivenhaus, A.

doi:10.1007/s00264-013-2012-4

Cited by 53 publications

(52 citation statements)

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“…The proximal chevron osteotomy represents a proximal vshaped metatarsal osteotomy with high correctional power and a relatively low complication rate compared to other proximal first metatarsal osteotomies [6].…”

Section: Discussionmentioning

confidence: 99%

“…5 a, b Boxplots representing bending stiffness and dorsal angulation at the first load cycle of the two constructs be recommended. However, to the best of our knowledge this is the first study that directly compares locking plate fixation to conventional screw fixation for proximal chevron osteotomy [6,26,32].…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, the proximal procedures are recommended for more severe hallux valgus deformities [1,2,[6][7][8].…”

Section: Introductionmentioning

confidence: 99%

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Biomechanical analysis of two fixation methods for proximal chevron osteotomy of the first metatarsal

Schuh

Hofstaetter

Benca

et al. 2014

International Orthopaedics (SICOT)

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Purpose The proximal chevron osteotomy provides high correctional power. However, relatively high rates of dorsiflexion malunion of up to 17 % are reported for this procedure. This leads to insufficient weight bearing of the first ray and therefore to metatarsalgia. Recent biomechanical and clinical studies pointed out the importance of rigid fixation of proximal metatarsal osteotomies. Therefore, the aim of the present study was to compare biomechanical properties of fixation of proximal chevron osteotomies with variable locking plate and cancellous screw respectively. Methods Ten matched pairs of human fresh frozen cadaveric first metatarsals underwent proximal chevron osteotomy with either variable locking plate or cancellous screw fixation after obtaining bone mineral density. Biomechanical testing included repetitive plantar to dorsal loading from 0 to 31 N with the Results The variable locking plate construct reveals statistically superior results in terms of bending stiffness and dorsal angulation compared to the cancellous screw construct. There was a statistically significant correlation between bone mineral density and maximum tolerated load until construct failure occurred for the screw construct (r=0.640, p=0.406). Conclusion The results of the present study indicate that variable locking plate fixation shows superior biomechanical results to cancellous screw fixation for proximal chevron osteotomy. Additionally, screw construct failure was related to levels of low bone mineral density. Based on the results of the present study we recommend variable locking plate fixation for proximal chevron osteotomy, especially in osteoporotic bone.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Biomechanical analysis of two fixation methods for proximal chevron osteotomy of the first metatarsal

Schuh

Hofstaetter

Benca

et al. 2014

International Orthopaedics (SICOT)

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“…Se encontró un metaanálisis que realiza una comparación entre la DMO de Chevron y la osteotomía diafisaria de Scarf, para comprobar cuál de las dos técni-cas da mayor corrección al ángulo IMA 28 . Una revisión sistemática que realiza una comparación entre varias técnicas de PMO (y una que puede ser considerada como una osteotomía diafisaria), para comprobar estadísticamen-te cual de todas ellas presenta mayor corrección del ángulo IMA y del ángulo HVA, con menor tasa de complicaciones 29 . Una revisión sistemática sobre artrodesis de la AMTF, en la cual los autores afirman que se puede llegar a hacer una corrección medianamente aceptable del ángulo IMA sólo mediante el uso de la artrodesis de la primera AMTF 20 .…”

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Osteotomías en el tratamiento quirúrgico del hallux abductus valgus

Saavedra¹

2017

Rev. Int. Cienc. Podol.

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Resumen. La elección de una técnica ideal para la cirugía del hallux abductus valgus ha sido un tema que los cirujanos han intentado resolver durante muchos años sin demasiado éxito. Las osteotomías son consideradas una de las técnicas de elección para el tratamiento de la deformidad. Se pueden localizar en el aspecto proximal, diafisario o distal del primer metatarsiano. La pregunta que se ha intentado responder es si existe algún lugar del metatarsiano más indicado para realizar las osteotomías. También se ha intentado averiguar cuál de las osteotomías descritas aportaba mayor grado de corrección angular con el menor número de complicaciones. Palabras clave: hallux valgus; cirugía; osteotomía; DMO; PMO.[en] Osteotomies in the surgical treatment of hallux valgus Abstract. Choosing the perfect for abductus hallux valgus surgery technique has been an issue that surgeons have grappled for years with little success. Osteotomies are considered one of the techniques of choice for the treatment of deformity. Can be localized proximal, diaphyseal or distal of the first metatarsal. The question that has tried to answer, is whether there somewhere more appropriate to perform metatarsal osteotomies. It has also been tried to determine which of the osteotomies described brought greater angular correction with fewer complications. Key words: hallux valgus; surgery; osteotomy; DMO; PMO.El autor declara no tener ningún tipo de interés económico o comercial. Sumario

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“…To the Editor, In this meta-analysis, Schuh et al [1] compared correction of intermetatarsal and hallux valgus angles and complications of proximal crescentic, Ludloff, proximal opening wedge, proximal closing wedge, proximal chevron and other proximal first metatarsal osteotomies. They found that there was a mean correction of hallux valgus angle of 20.1°[confidence interval (CI) 18.7-21.4] and of intermetatarsal angle of 8.1°(CI 7.7-8.9).…”

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confidence: 99%

Comment on Schuh et al.: Angular correction and complications of proximal first metatarsal osteotomies for hallux valgus deformity

Peng

2013

International Orthopaedics (SICOT)

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In this meta-analysis, Schuh et al.[1] compared correction of intermetatarsal and hallux valgus angles and complications of proximal crescentic, Ludloff, proximal opening wedge, proximal closing wedge, proximal chevron and other proximal first metatarsal osteotomies. They found that there was a mean correction of hallux valgus angle of 20.1°[confidence interval (CI) 18.7-21.4] and of intermetatarsal angle of 8.1° ). The overall complication rate reached 18.7 %. It is a valuable study. Nevertheless, there are some comments we would like to raise related to this article.1. The authors included 62 primary studies eligible for metaanalysis. However, we found several repeated studies in the meta-analysis ( included all these studies in their meta-analysis. In our opinion, some repeated data might exist among their studies [2][3][4][5][6][7]. To solve these problems, we suggest that these studies [2,4,6] should be excluded from the meta-analysis. Publication language was limited to English and Germanin the meta-analysis. Therefore, the authors should mention the potential importance of language bias in the limitations of their meta-analysis. 3. The authors described that "funnel plots were drawn to check for publication bias. Inspection of the funnel plots showed no sign of publication bias." However, we cannot find the funnel plots in the paper. The author should provide us all the funnel plots.We agree with the following conclusions of the authors, i.e. the proximal crescentic osteotomy provided the highest amount of HVA correction. However, regarding angular correction as well as complications, the proximal chevron osteotomy revealed the most favourable results. Rigid fixation is mandatory in order to reduce complications, and further high-quality prospective comparative studies are required and might change the observed effects.Conflict of interest There is no conflict of interest and the paper has not been submitted elsewhere.

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Angular correction and complications of proximal first metatarsal osteotomies for hallux valgus deformity

Cited by 53 publications

References 68 publications

Biomechanical analysis of two fixation methods for proximal chevron osteotomy of the first metatarsal

Biomechanical analysis of two fixation methods for proximal chevron osteotomy of the first metatarsal

Osteotomías en el tratamiento quirúrgico del hallux abductus valgus

Comment on Schuh et al.: Angular correction and complications of proximal first metatarsal osteotomies for hallux valgus deformity

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