Hallux valgus deformity correction without fusion in children with cerebral palsy

Bayhan, Avni İlhan; Kadhim, Muayad; Sees, Julieanne P.; Nishnianidze, Tristan; Rogers, Kenneth; Er, Mehmet Serhan; Miller, Freeman

doi:10.1097/bpb.0000000000000419

Cited by 6 publications

(5 citation statements)

References 17 publications

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“…Some studies support non-fusion surgery in ambulatory adolescents. 5 – 7 , 19 However, others have supported the use of arthrodesis as primary surgery for severe HV deformities, quoting superior clinical outcomes, higher corrective capacity, and lower rates of revision in comparison to reconstructive osteotomies. 8 , 9 The severity of pre-existing pes valgus and the severity of the HV deformities in this cohort, in our view indicated arthrodesis.…”

Section: Discussionmentioning

confidence: 99%

“…Joint sparing surgery, such as combinations of soft tissue balancing and corrective osteotomies, can be successful in the short term, in high-functioning adolescents with mild CP, Gross Motor Function Classification System (GMFCS) I and II. 5 – 7 Non-fusion surgery, especially soft tissue procedures or isolated bunionectomy, can be associated with high recurrence rates and lower patient satisfaction in this patient population. 5 – 7 Metatarsophalangeal joint (MTPJ) arthrodesis is an accepted method for the primary treatment of HV in adolescents and young adults with CP and severe, symptomatic deformities.…”

Section: Introductionmentioning

confidence: 99%

“… 5 – 7 Non-fusion surgery, especially soft tissue procedures or isolated bunionectomy, can be associated with high recurrence rates and lower patient satisfaction in this patient population. 5 – 7 Metatarsophalangeal joint (MTPJ) arthrodesis is an accepted method for the primary treatment of HV in adolescents and young adults with CP and severe, symptomatic deformities. 8 Prior studies have reported good outcomes in terms of pain relief, deformity correction, and patient satisfaction.…”

Section: Introductionmentioning

confidence: 99%

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Arthrodesis of the first metatarsophalangeal joint for severe hallux valgus in adolescents with cerebral palsy: A retrospective comparison study of three surgical techniques

Ye,

Cashin,

Van de Velde

et al. 2023

Journal of Children's Orthopaedics

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Purpose: We compared the outcomes of arthrodesis of the first metatarsophalangeal joint for severe hallux valgus in 31 adolescents with cerebral palsy, using three different methods of fixation: K-wires, non-locking plates, and locking plates. Methods: Clinical outcomes included time to weight-bearing, fusion rates and surgical complications. Radiographic assessment included comparing pre- and post-operative hallux valgus angles, intermetatarsal angles, interphalangeal angles, and lateral metatarsophalangeal angles. Patient-reported outcomes included pre- and post-operative visual analogue scales addressing bunion pain and concerns, difficulties with wearing shoes and braces, and difficulties with foot hygiene. Results: Of the 31 adolescents (16 male), 10 patients had K-wire fixation, 11 had a non-locking dorsal plate, and 10 had fixation with a dorsal locking plate. Mean age at surgery was 16 years (12–18 years) and mean follow-up was 4 years (2.7–6.5 years). Patients with K-wire fixation had delayed weight-bearing and had more complications than those managed by dorsal plating. There were significant improvements in radiographic parameters (except interphalangeal angle) and in patient-reported outcomes, in all groups ( p < 0.001). However, radiographic and clinical outcomes were better in the dorsal plating groups compared to the K-wire group. Conclusion: Arthrodesis of the first metatarsophalangeal joint gave good correction of deformity with improvements in symptoms and radiographic parameters in adolescents with cerebral palsy. We recommend dorsal plating that allowed early weight-bearing and had fewer complications with better clinical and radiographic outcomes, than K-wire fixation. Level of evidence: IV: Retrospective case series.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Arthrodesis of the first metatarsophalangeal joint for severe hallux valgus in adolescents with cerebral palsy: A retrospective comparison study of three surgical techniques

Ye,

Cashin,

Van de Velde

et al. 2023

Journal of Children's Orthopaedics

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“…1 While much has been published on the management of hallux valgus in CP, the literature on management of hallux flexus in adolescents with CP is limited. [1][2][3][4][5][6] We describe a technique for arthrodesis of the 1 st MTPJ for the management of hallux valgus and hallux flexus, which we have found to be reliable and reproducible.…”

Section: Introductionmentioning

confidence: 99%

Arthrodesis of the First Metatarsophalangeal Joint in Adolescents with Cerebral Palsy

Tang

Velde

et al. 2021

Journal of the Pediatric Orthopaedic Society of North America

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Symptomatic hallux valgus (HV) and hallux flexus (HF) affect 2% of adolescents with cerebral palsy.1 Management of bunions is largely divided into arthrodesis and non-fusion surgery, with the latter including soft tissue balancing and corrective osteotomies.2,3 However, due to the high recurrence rate and lower patient satisfaction it is generally accepted that fusion of the first metatarsophalangeal joint (1st MTPJ fusion) is the primary treatment of choice in symptomatic bunions.3 This aligns with our experience where the long-term outcome of non-fusion operations have been unpredictable. Approximately 50% of patients in our center have required a revision fusion for salvage with an additional 25% experiencing ongoing symptoms but declining further surgery. In our center, only 25% of patients had a successful outcome with non-fusion surgery (unpublished data). Although the literature supports the role of arthrodesis, there is less agreement about the method of achieving fusion. 7 Fixation with Kirschner wires, screws, and dorsal plates have has been reported with variable success rates. 2,4,5,6 Historically, at our institution, we performed 1st MTPJ arthrodesis by inserting K-wires in a longitudinal fashion, sometimes combined with an oblique screw, followed by 6 weeks when we recommended non-weight-bearing. We frequently noted wear and tear of the casts, loosening of the K-wires and a high prevalence of pin site infections because of inability to comply with long periods of restricted weight-bearing and activities. In this paper, we describe our surgical technique which we adapted from the technique described by Coughlin and colleagues—preparation of the joint surfaces using cup and cone reamers and fixation with a dorsal plate. Initially, we used a 4-hole Vitallium plate, but our current preference is to use a more robust locking plate.8 The use of these plates has allowed accurate alignment of the fusion and early mobilisation after surgery.8 We have adopted plate fixation as our primary means of fixation for symptomatic bunions in adolescents and young adults with cerebral palsy.

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“…A recent study by Bayhan et al reviewed joint sparing procedures for hallux valgus in 25 children (39 feet) with CP and had good results at a mean of 14.6 months follow‐up with two revisions. Interestingly, the children in this cohort were also in GMFCS level II or III.…”

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confidence: 99%

Treatment of hallux deformities in adolescents with cerebral palsy

Bouchard¹

2018

Develop Med Child Neuro

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Hallux valgus deformity correction without fusion in children with cerebral palsy

Abstract: Level IV Therapeutic Studies.

Cited by 6 publications

References 17 publications

Arthrodesis of the first metatarsophalangeal joint for severe hallux valgus in adolescents with cerebral palsy: A retrospective comparison study of three surgical techniques

Arthrodesis of the first metatarsophalangeal joint for severe hallux valgus in adolescents with cerebral palsy: A retrospective comparison study of three surgical techniques

Arthrodesis of the First Metatarsophalangeal Joint in Adolescents with Cerebral Palsy

Treatment of hallux deformities in adolescents with cerebral palsy

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