Proximal first metatarsal opening wedge osteotomy: Geometric analysis on saw bone models

Kugan, R.; Currall, V.A.; Johal, P.; Clark, Callum

doi:10.1016/j.foot.2014.09.002

Cited by 3 publications

(2 citation statements)

References 16 publications

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“…7 Saragas et al 14 also reported an average 2.3-mm increase in first metatarsal length following POWO in 46 patients (64 feet) utilizing primarily 2.0- and 2.5-mm opening wedges. Kugan et al, 8 in a saw bone model of POWO, reported increases in length of the first metatarsal of 2.6, 4.6, and 5.0 mm with 3, 5, and 7 mm opening wedge plates, respectively. Our results indicated sequential increases in first metatarsal length with opening wedge size, reaching an increase as high as 6.4% over untreated measurements (Table 1).…”

Section: Discussionmentioning

confidence: 98%

First Tarsometatarsal Joint Loading After Sequential Correction of Hallux Valgus Using a Proximal Opening Wedge Metatarsal Osteotomy and Distal Soft Tissue Procedure

Kraus

Ziegele

Wang

et al. 2021

Foot & Ankle Orthopaedics

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Background: The proximal opening wedge osteotomy (POWO) of the first metatarsal (TMT-1) is commonly performed in the operative treatment of hallux valgus. Limited work has been dedicated to study POWO’s effect on the TMT-1 joint, however. The purpose of this study is to evaluate the changes in TMT-1 joint contact stress following POWO of the first metatarsal. Methods: Five fresh-frozen cadaveric below-knee specimens (mean age: 73 years) with hallux valgus deformities (mean hallux valgus angle [HVA]: 37.4 ± 8.5 degrees) were studied. The specimens were loaded to 400 N on an MTS servohydraulic load frame. Joint contact characteristics at TMT-1 joint were measured with a Tekscan pressure sensor (Model 6900, 1100 psi; Tekscan Inc, Boston, MA) with various opening wedge sizes of 3, 5, and 7 mm both without and with a distal soft tissue release (DSTR). The contact force, area, and peak contact stress were compared among groups using analysis of variance and post hoc multiple comparisons over the untreated (Dunnett test, P < .05). Results: The mean contact force was 47.7 ± 33.5 N for untreated specimens. This increased sequentially with opening wedge size and reached statistical significance for 7-mm opening wedge (129.7 ± 62.3 N, P = .01) and 7-mm wedge + DSTR (134.8 ± 60.5 N, P = .008). The mean peak contact stress was 2.8 ± 1.3 MPa for the untreated specimens and increased incrementally with wedge size to 5.7 ± 3.0 MPa for 7-mm wedge only ( P = .03) and 5.6 ± 2.5 MPa for 7-mm wedge + DSTR ( P = .05). The contact area increased with corrections, but none reached significance. Conclusion: With increasing opening wedge size, loading of the TMT-1 joint increases. Joint stresses higher than 4.7 MPa have been shown to be chondrotoxic, potentially predisposing patients to arthritic joint changes following POWO. Level of Evidence: XXXXXX

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Section: Discussionmentioning

confidence: 98%

First Tarsometatarsal Joint Loading After Sequential Correction of Hallux Valgus Using a Proximal Opening Wedge Metatarsal Osteotomy and Distal Soft Tissue Procedure

Kraus

Ziegele

Wang

et al. 2021

Foot & Ankle Orthopaedics

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“…10,49 Therefore, the rotational angular change of the distal metatarsal end on the frontal plane had never been clarified quantitatively. On the other hand, the previous 3-dimensional analyses of correctional osteotomies reported geometric research to simulate osteotomies using synthetic bone, 23 a mathematical model, 30 and a computer model. 3,31 Those studies clarified that each metatarsal osteotomy makes it possible to achieve frontal rotational correction of the first metatarsal.…”

Section: Discussionmentioning

confidence: 99%

Three-Dimensional Analysis of the First Metatarsal Bone in Minimally Invasive Distal Linear Metatarsal Osteotomy for Hallux Valgus

et al. 2019

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Background: Modified Bösch osteotomy (distal linear metatarsal osteotomy [DLMO]) is one of the minimally invasive correctional surgeries for hallux valgus. The 3-dimensional correctional angles and distances of the first metatarsal bone in DLMO have not been clarified. The purpose of this study was to analyze the 3-dimensional postoperative morphological changes of the first metatarsal bone in DLMO. Methods: Twenty patients (30 feet) who underwent DLMO were enrolled. Preoperative plain radiographs and computed tomography (CT) scans of the feet were examined. Postoperative radiographs and CT scans were also obtained after bone union. The surface data of the pre- and postoperative first metatarsals were reconstructed from the CT data. The positions of the distal ends of the first metatarsals described with respect to the proximal ends were calculated using CT surface-matching technique. Results: The distal end of the first metatarsal after DLMO was significantly supinated (10.2 ± 6.0 degrees, P < .001), adducted (6.0 ± 11.8 degrees, P = .004), dorsiflexed (11.1 ± 10.9, P < .001), shortened (7.4 ± 2.5 mm, P < .001), elevated (2.3 ± 3.1 mm, P = .001), and laterally shifted (8.2 ± 3.0 mm, P < .001) compared to the preoperative metatarsal distal end. Supination correction demonstrated a significant correlation with adduction correction ( r = 0.659, P < .001) on correlation analyses between these parameters. Conclusion: The 3-dimensional corrections of the first metatarsal bone after DLMO were evaluated. Pronation and abduction were successfully corrected. Furthermore, adduction correction might be an important factor affecting correction of pronation. Level of Evidence: Level IV, retrospective case series.

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Fixation Principles in Minimal Incision Hallux Valgus Surgery

Kay

2020

Foot and Ankle Clinics

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Proximal first metatarsal opening wedge osteotomy: Geometric analysis on saw bone models

Cited by 3 publications

References 16 publications

First Tarsometatarsal Joint Loading After Sequential Correction of Hallux Valgus Using a Proximal Opening Wedge Metatarsal Osteotomy and Distal Soft Tissue Procedure

First Tarsometatarsal Joint Loading After Sequential Correction of Hallux Valgus Using a Proximal Opening Wedge Metatarsal Osteotomy and Distal Soft Tissue Procedure

Three-Dimensional Analysis of the First Metatarsal Bone in Minimally Invasive Distal Linear Metatarsal Osteotomy for Hallux Valgus

Fixation Principles in Minimal Incision Hallux Valgus Surgery

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