Screw Versus Plate Fixation of Proximal First Metatarsal Crescentic Osteotomy

Varner, Kevin E.; Matt, Victoria; Alexander, Jerry W.; Johnston, James D.; Younas, Shiraz; Marymont, John V.; Noble, Philip C.

doi:10.3113/fai-2009-0142

Cited by 11 publications

(11 citation statements)

References 30 publications

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“…To our knowledge, K-wire fixation has shown some complications such as dorsal malunion, pin irritation, and recurrence of deformity due to loss of correction caused by insufficient stability. 13 14) Hence, we decided to investigate a new fixation technique and its biomechanical property to prove the effectiveness of PCMO.…”

Section: Discussionmentioning

confidence: 99%

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Biomechanical Comparison Study of Three Fixation Methods for Proximal Chevron Osteotomy of the First Metatarsal in Hallux Valgus

et al. 2017

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BackgroundFixation of proximal chevron metatarsal osteotomy has been accomplished using K-wires traditionally and with a locking plate recently. However, both methods have many disadvantages. Hence, we developed an intramedullary fixation technique using headless cannulated screws and conducted a biomechanical study to evaluate the superiority of the technique to K-wire and locking plate fixations.MethodsProximal chevron metatarsal osteotomy was performed on 30 synthetic metatarsal models using three fixation techniques. Specimens in group I were fixated with K-wires (1.6 mm × 2) and in group II with headless cannulated screws (3.0 mm × 2) distally through the intramedullary canal. Specimens in group III were fixated with a locking X-shaped plate (1.3-mm thick) and screws (2.5 mm × 4). Eight metatarsal specimens were selected from each group for walking fatigue test. Bending stiffness and dorsal angulation were measured by 1,000 repetitions of a cantilever bending protocol in a plantar to dorsal direction. The remaining two samples from each group were subjected to 5 mm per minute axial loading to assess the maximal loading tolerance.ResultsAll samples in group I failed walking fatigue test while group II and group III tolerated the walking fatigue test. Group II showed greater resistance to bending force and smaller dorsal angulation than group III (p = 0.001). On the axial loading test, group I and group II demonstrated superior maximum tolerance to group III (54.8 N vs. 47.2 N vs. 28.3 N).ConclusionsAuthors have demonstrated proximal chevron metatarsal osteotomy with intramedullary screw fixation provides superior biomechanical stability to locking plate and K-wire fixations. The new technique using intramedullary screw fixation can offer robust fixation and may lead to better outcomes in surgical treatment of hallux valgus.

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Section: Discussionmentioning

confidence: 99%

“… 15) Because of this, complications including clinical recurrence, shortening, and dorsiflexion malunion are found in 18.7%. 13 14) Recently, biomechanical and clinical studies have emphasized the importance of robust fixation and described the results of new devices and techniques.…”

Section: Discussionmentioning

confidence: 99%

Biomechanical Comparison Study of Three Fixation Methods for Proximal Chevron Osteotomy of the First Metatarsal in Hallux Valgus

et al. 2017

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“…Various studies have shown that plate fixation is biomechanically superior to screw fixation after proximal metatarsal osteotomy [ 21 , 32 ]. However, while acknowledging the biomechanical superiority of plate fixation, Park et al [ 33 ] reported that radiologic outcomes were worse after plate fixation than after K-wire fixation since loss of correction occurred at the osteotomy sites during the plate fixation process conducted after proximal metatarsal osteotomy.…”

Section: Discussionmentioning

confidence: 99%

Comparison of outcomes according to fixation technique following the modified Ludloff osteotomy for hallux valgus in patients with rheumatoid arthritis

Park

Song

et al. 2017

BMC Musculoskelet Disord

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BackgroundClinical and radiological outcomes including fixation stability of osteotomy site were compared in rheumatoid arthritis (RA) patients who underwent modified Ludloff osteotomy to correct hallux valgus with osteotomy site fixation using two screws versus those who underwent additional fixation using a plate.MethodsThe fixation technique performed with two screws was used to fix the osteotomy sites following modified Ludloff osteotomy in 15 patients (15 feet, Group S), while the augmented plate fixation technique was used in 14 patients (16 feet, Group P). Surgical outcomes were analysed using the American Orthopedic Foot and Ankle Society (AOFAS) scores, and radiologic parameters measured before surgery and during follow-up examinations. To evaluate the stability of each osteotomy site fixation technique, the 1–2 inter-metatarsal angle (IMA) and angle of the altered margin of the lateral cortex (AMLC) were measured immediately and 6 weeks after surgery, and variations in the angles were compared. In addition, bone mineral density (BMD) values were compared between patients with correction loss at the osteotomy site and those with no loss of correction.ResultsNo significant differences between groups were found for total AOFAS scores before surgery and at the final follow-up. However, significant differences were observed in the 1–2 IMA, beginning at 6 weeks postoperatively and continuing through the final follow-up. The 1–2 IMA and angle of AMLC measured immediately after and 6 weeks after surgery showed significantly greater variation in Group S than in Group P. In Group S, patients with correction loss (5 feet) at osteotomy site showed significantly lower BMD values than those with no loss of correction (10 feet). Despite the lower BMD values of patients in Group P than in Group S, a loss of correction did not occur in these patients.ConclusionsCorrection loss occurred at the osteotomy site within 6 weeks postoperatively in patients who underwent fixation using only the two-screw fixation technique following modified Ludloff osteotomy; such loss could be reduced using the augmented plate fixation technique even in patients with osteoporosis.

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“…Fillinger et al demonstrated a double screw fixation to be more stable compared to single screw fixation [17]. Varner et al reported greater stability of plate fixation compared to single screw fixation for metatarsal crescentic osteotomy [18]. …”

Section: Discussionmentioning

confidence: 99%

Proximal metatarsal osteotomy for hallux valgus: an audit of radiologic outcome after single screw fixation and full postoperative weightbearing

Mittag¹,

Leichtle²,

Meisner

et al. 2013

Journal of Foot and Ankle Research

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BackgroundProximal metatarsal osteotomy combined with a distal soft-tissue procedure is a common treatment for moderate to severe hallux valgus. Secure stabilisation of the metatarsal osteotomy is necessary to avoid complications such as delayed union, nonunion or malunion as well as loss of correction. The aim of this study was to report our results using a single screw for stabilisation of the osteotomy.MethodsWe retrospectively reviewed 151 patients with severe hallux valgus who were treated by the above mentioned way with full postoperative weightbearing in a stiff soled shoe. Mean age of patients at time of surgery was 54 years, 19 patients were male and 132 female. Assessment of clinical and radiographic results was performed after 2 days and 6 weeks. Results were also correlated to the experience of the performing surgeon.ResultsMean preoperative HVA (hallux valgus angle) was 36.4 degrees, and then 3.5 degrees 2 days and 13.4 degrees 6 weeks after the procedure (p < 0.001). Mean preoperative IMA (intermetarsal angle) was 16.8 degrees, and then 6.4 degrees after 2 days and 9.8 degrees after 6 weeks (p < 0.001). Mean preoperative first metatarsal length of 56.4 mm decreased to 53.6 mm after 6 weeks. Possible non-union of the osteotomy was observed in 4 patients (2.6%) after 6 weeks. Performing residents (n = 40) operated in 65 minutes and attending surgeons (n = 111) in 45 minutes, with no significant differences in radiographic measurements between both groups.ConclusionsSingle screw stabilisation of proximal chevron osteotomy is a reliable method for treating severe hallux valgus deformities with satisfactory results.

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Screw Versus Plate Fixation of Proximal First Metatarsal Crescentic Osteotomy

Abstract: The greater stability of the plate construct may be helpful in selecting the fixation device for these osteotomies.

Cited by 11 publications

References 30 publications

Biomechanical Comparison Study of Three Fixation Methods for Proximal Chevron Osteotomy of the First Metatarsal in Hallux Valgus

Biomechanical Comparison Study of Three Fixation Methods for Proximal Chevron Osteotomy of the First Metatarsal in Hallux Valgus

Comparison of outcomes according to fixation technique following the modified Ludloff osteotomy for hallux valgus in patients with rheumatoid arthritis

Proximal metatarsal osteotomy for hallux valgus: an audit of radiologic outcome after single screw fixation and full postoperative weightbearing

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