Long-term Follow-up of Dorsal Wedge Osteotomy for Pediatric Freiberg Disease

Pereira, Bruno; Frada, Tiago; Freitas, Daniel Salvatore de; Varanda, Pedro; Vieira-Silva, Manuel; Oliva, Xavier Martín; Duarte, Rui M.

doi:10.1177/1071100715598602

Cited by 18 publications

(9 citation statements)

References 25 publications

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“…The osteotomy site was fixed with two small K-wires (cross-pinning).Some osteotomies which were rotationally stable were fixed with single thick K-wire. Young patients had greater improvement in score in Kitaoka et al 11 scoring system in our study as was seen by Bruno S Pereira et al 13 Gauther and Elbaz 7 in their study on 53 patients treated by dorsiflexion osteotomy found only one patient with persistent pain. Chao and co-workers 12 reported two poor results from thirteen patients with all stages of Freiberg's disease who were treated with dorsal closing wedge osteotomy.…”

Section: Discussionsupporting

confidence: 81%

Results of Dorsal Closing Wedge Osteotomy in Freiberg’s Disease

Gani¹,

Ganai²,

Baba³

et al. 2019

IJCMR

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Introduction: Freiberg's disease, the osteochondrosis of the metatarsal seen in our part of the world, usually at late stages, are refractory to the conservative treatment. Objective:The purpose of this study was to evaluate the results of dorsal closing wedge osteotomy and pin fixation besides debridement and synovectomy. Material and Methods: Twenty patients (14 females, 6 Males), mean age 19.3 years; range 14 to 26 years were evaluated and teated by dorsal closing wedge osteotomy and pin fixation besides debridement and synovectomy, between september 2016 to 2018 at our institution. The presenting symptoms were pain on walking or sports, limitation of daily routine activities, footwear problems, cosmetic deformities of forefoot and failed conservative treatment. Three patients had a history of trauma. According to Smillies's classification twelve patients were type IV and eight were Type V.Mean follow-up period was 14.85 months(range 6 months to 24 months). Results: Patients were assessed by the lesser metatarsophalangeal interphalangeal (LMPI) scale by kitaokaetal. At the final follow-up, scoring had changed from (44-66) with an average 54.65 to (76-100) with an average 85.3. There was no case of infection, avascular necrosis, arthritis or pseudoarthrosis. Conclusion: Treatment of freiberg's disease with dorsal closing-wedge osteotomy shows satisfactory pain relief and improvement in quality of life.

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Section: Discussionsupporting

confidence: 81%

Results of Dorsal Closing Wedge Osteotomy in Freiberg’s Disease

Gani¹,

Ganai²,

Baba³

et al. 2019

IJCMR

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show abstract

“…While long-term follow-up studies have recently begun to demonstrate the efficacy of dorsal wedge closing osteotomies for the treatment of Freiberg’s disease, the best approach for failed operative management of the disease remains in question. 14 Five out of 13 patients in our cohort failed not only conservative management but also previous operative management for Freiberg’s. Therefore, it is important to note that a common use of PVA implant in our study cohort was in the setting of a previously failed operative treatment.…”

Section: Discussionmentioning

confidence: 86%

“…8 Despite good long-term results for operative treatment of most stages of Freiberg's disease, late-stage disease and failed primary procedures present a challenge. 5,7,8,12,14 Salvage options for failed osteotomies and advanced second MT head arthritis include resection arthroplasty, joint debridement, osteotomy, and osteochondral transplant. 4 More recently, synthetic cartilage implants have been demonstrated in clinical trial to be safe and efficacious in treating advanced stage hallux rigidus, offering pain relief while preserving motion at the MTP joint.…”

Section: Introductionmentioning

confidence: 99%

Outcomes of Polyvinyl Alcohol Hydrogel Implant of the Lesser Metatarsals

et al. 2020

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Background: Lesser toe metatarsophalangeal (MTP) joint pathology presents a challenge for surgical treatment. At our institution, arthroplasty using a polyvinyl alcohol (PVA) hydrogel implant has been utilized in the second and third MTP joints for advanced arthritis, failed management of Freiberg’s infraction, and osteochondral defects. We present a case series describing the clinical outcomes of 13 patients following PVA implantation of the second or third MTP. Methods: We retrospectively identified 13 patients (14 joints) who underwent PVA hydrogel implantation of the second ( n = 12) or third ( n = 2) metatarsal between 2017 and 2019. The average age was 49 (range, 20-67) years, with 100% females. Patient-Reported Outcomes Measurement Information System (PROMIS) scores were collected preoperatively and at an average of 21.1 (range, 8.3-29.2) months postoperatively. Clinical outcomes were also evaluated. The average time to clinical follow-up was 24.7 (range, 7-35.8) months. Results: On average, patients demonstrated pre- to postoperative improvement in all PROMIS domains, with significant improvements in Pain Intensity ( P = .01) and Pain Interference ( P = .01). Five postoperative complications were observed: 1 case of persistent avascular necrosis, 1 revision with implant removal and bone grafting, 1 periprosthetic fracture, and 2 recurrences of pain requiring ultrasound-guided injection. Conclusion: This study represents the largest case series to date evaluating the use of PVA implant in the surgical correction of lesser toe MTP joint pathology. While the PVA implant presents a viable option in the setting of advanced arthritis, Freiberg’s infraction, and certain osteochondral defects, it is not without complications. The specific indications for use of the PVA implant should be carefully considered. Level of Evidence: Level IV, case series.

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“…Only 1 study could be found that reported the long-term results of osteotomy. Pereira et al 27 reported that after a mean follow-up period of 23.4 years of 20 patients in the pediatric age group, the mean AOFAS score was 96.8, and all the patients had good to excellent results. However, 85% of the patients in that study were grades 2 and 3, there were no cases of grade 5, and there was a negative correlation between the AOFAS score at the final follow-up and disease grade.…”

Section: Discussionmentioning

confidence: 99%

Interpositional Arthroplasty With Extensor Digitorum Brevis Tendon in Freiberg Disease

et al. 2020

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Background: No consensus has been reached in the treatment of Frieberg disease. Our aim was to evaluate medium- to long-term results of patients with advanced Freiberg disease managed with extensor digitorum brevis tendon interpositional arthroplasty. Methods: There were 24 patients (19 females, 5 males) managed with interpositional arthroplasty for advanced Freiberg disease between 2003 and 2015. The mean follow-up was 133.8 (range, 60-198) months. According to Smillie classification, there were 4 grade 3, 13 grade 4, and 7 grade 5 patients. Patients were evaluated preoperatively and at the final follow-up with the American Orthopaedic Foot & Ankle Society (AOFAS) score and metatarsophalangeal joint range of motion and postoperatively with visual analog scale (VAS) and subjective satisfaction evaluation. Joint space was evaluated on x-rays. Results: Mean AOFAS score increased (53.9 to 80.3, P = .001). Eight patients had excellent, 14 had good, and 2 had fair scores. A significant increase was found in dorsiflexion (38.1° [24°-52°] vs 55.3° [34°-65°]; P = .001) and plantarflexion (19.0° [10°-28°] vs 28.6° [19°-39°]; P = .001). Narrowing of the joint space was not seen in any patient, but expansion was determined in all patients (0.39 [0.35-0.47] vs 0.44 [0.41-0.47] cm; P = .002). Of the patients, 9 were very satisfied, 12 were satisfied, 2 were moderately satisfied, and 1 was dissatisfied. The mean postoperative VAS pain score was 1.7 ± 0.9 (0-4). Conclusion: After a minimum 5-year follow-up, most patients with Freiberg disease managed with interpositional arthroplasty using the extensor digitorum brevis tendon had excellent to good functional results with a widening of the joint space. Level of Evidence: Level IV, retrospective case series.

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Long-term Follow-up of Dorsal Wedge Osteotomy for Pediatric Freiberg Disease

Abstract: Level IV, retrospective case series.

Cited by 18 publications

References 25 publications

Results of Dorsal Closing Wedge Osteotomy in Freiberg’s Disease

Results of Dorsal Closing Wedge Osteotomy in Freiberg’s Disease

Outcomes of Polyvinyl Alcohol Hydrogel Implant of the Lesser Metatarsals

Interpositional Arthroplasty With Extensor Digitorum Brevis Tendon in Freiberg Disease

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