Bunion Correction Using Proximal Chevron Osteotomy

Abstract

Fifty-one cases of moderate to severe bunion deformity with hallux valgus and metatarsus primus varus in 43 patients were treated by bunionectomy, proximal Chevron metatarsal osteotomy, lateral capsulotomy, adductor tenotomy, and lashing of first and second metatarsals together. The hallux valgus angle improved an average of 19 degrees from 33 degrees (mean) preoperatively to 14 degrees (mean) postoperatively. The intermetatarsal angle improved an average of 7.3 degrees from an average of 14 degrees preoperatively to an average of 6 degrees postoperatively. The position of the sesamoids was realigned to beneath the first metatarsal head and the metatarsal length remained essentially unchanged. Union occurred in 9 weeks (mean). No malunions occurred. Foot score profiles revealed a significant improvement in subjective evaluation from 69/100 preoperatively to 83/100 postoperatively with respect to pain, deformity, motion, disability, and cosmesis. Seventy-eight percent of patients had a good to excellent result. Improved subjective evaluations indicated that proximal Chevron osteotomy combined with bunionectomy, capsulotomy, tenotomy, and metatarsal lashing provides a reliable method with respect to stability, technical ease, low complication, and satisfactory surgical outcome for correction of moderate and severe bunion deformity, both as a primary and revision procedure.

Plate fixation for proximal chevron osteotomy has greater risk for hallux valgus recurrence than Kirschner wire fixation

“…The main advantage of proximal chevron osteotomy is the versatility of correction, thus every deformed component of the first metatarsal can be corrected [4,12,13]. Widened intermetatarsal angle is corrected by lateral angulation and translation of the distal fragment [4], and supination can be added at the time of correction.…”

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

“…The large contact area is relatively stable, and for fixation a combination of a screw and a Kirschner wire, two screws, or a plate are recommended [2,[9][10][11][12][13][14][15][16][17]. Nevertheless, relatively high rates of dorsiflexion malunion of up to 17 % are reported for this procedure.…”

“…The proximal chevron osteotomy, first reported by Sammarco et al, does not simply rely on a lateral translation of the distal fragment, as with the distal chevron procedure [9] but concomitantly incorporates an opening wedge principle [9][10][11]. The large contact area is relatively stable, and for fixation a combination of a screw and a Kirschner wire, two screws, or a plate are recommended [2,[9][10][11][12][13][14][15][16][17].…”

Proximal opening wedge metatarsal osteotomy for correction of moderate to severe hallux valgus deformity using a locking plate

“…Different types of proximal metatarsal osteotomies have been used over the last decades including proximal crescentic osteotomy [7], proximal chevron osteotomy [8,9], scarf osteotomy [10,11], Ludloff osteotomy [12], Mau osteotomy [13], modified Mau [14], lateral closing wedge basal osteotomy [15] and medial opening wedge basal osteotomy [16].…”