Abstract:ObjectiveThis study aimed to present a treatment algorithm for the correction of the hallux valgus deformity in Cerebral Palsy (CP) patients and to discuss the outcomes based on our clinical and radiological results.Methods29 patients (45 feet) were included in the study. The mean age of the patients at the time of the surgery was 14 (range 6–22) years. The mean follow-up was 33 (range 22–59) months. A reconstructive procedure was performed on 19 patients (27 feet); a soft tissue surgery and exostectomy of the… Show more
“…One study scored a CMS of 70 ( 32 ), indicating high methodological quality. All other studies had CMS scores between 40 and 70 ( 9 , 12 , 16 , 18 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 ), suggesting medium methodological quality. The lowest CMS score was 43 ( 35 ) and the average CMS score was 55 points.…”
Section: Resultsmentioning
confidence: 99%
“…The other articles were therefore excluded. Ultimately 16 articles were included in the data extraction phase ( 9 , 12 , 16 , 18 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 ). Figure 1 PRISMA flow diagram illustrating search strategy and number of records screened and one included.…”
Section: Resultsmentioning
confidence: 99%
“…There were six prospective cohort studies ( 9 , 18 , 30 , 31 , 32 , 33 ) and ten retrospective articles ( 12 , 16 , 29 , 34 , 35 , 36 , 37 , 38 , 39 , 40 ). Follow-up periods ranged from 6 to 29 months.…”
Section: Resultsmentioning
confidence: 99%
“…( 38 ) Retrospective 77 60 (39–83) 12 43 Rippstein et al ( 39 ) Retrospective 8 - - - Sarikaya et al . ( 40 ) Retrospective 4 - - - *Percentage of females of the total participants. …”
Purpose
A systematic review to determine the effect of different types of joint preparation, joint fixation, and postoperative weight-bearing protocols on non-union frequency in first metatarsophalangeal joint (MTPJ) arthrodesis in patients with moderate-to-severe hallux valgus.
Material and methods
A systematic literature search (PubMed and EMBASE), adhering to PRISMA guidelines. Data on MTPJ preparation, fixation, weight-bearing, and non-union in patients with moderate-to-severe hallux valgus were collected. Quality assessment was performed using the Coleman Methodology Score.
Results
Sixteen studies (934 feet) were included, generally of medium quality. Overall non-union rate was 7.7%. At 6.3%, convex/concave joint preparation had the lowest non-union rate vs 12.2% for hand instruments and 22.2% for planar cuts. Non-union of 2.8% was found for joint fixation with a plate combined with a lag screw vs 6.5% for plate fixation, 11.1% for crossed screw fixation, and 12.5% for a plate with a cross plate compression screw. A 5.1% non-union frequency was found following postoperative full weight-bearing on a flat shoe vs 9.3% for full weight-bearing on a heel weight-bearing shoe and 0% for a partial weight-bearing regimen.
Conclusion
Based on medium-quality papers, joint preparation with convex/concave reamers and joint fixation with a plate using a lag screw show the lowest non-union rate. Full postoperative weight-bearing in a stiff-soled postoperative shoe is safe and not associated with non-union vs a more protective load-bearing regimen. Further research should focus on larger sample sizes, longer follow-ups, and stronger study designs.
“…One study scored a CMS of 70 ( 32 ), indicating high methodological quality. All other studies had CMS scores between 40 and 70 ( 9 , 12 , 16 , 18 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 ), suggesting medium methodological quality. The lowest CMS score was 43 ( 35 ) and the average CMS score was 55 points.…”
Section: Resultsmentioning
confidence: 99%
“…The other articles were therefore excluded. Ultimately 16 articles were included in the data extraction phase ( 9 , 12 , 16 , 18 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 ). Figure 1 PRISMA flow diagram illustrating search strategy and number of records screened and one included.…”
Section: Resultsmentioning
confidence: 99%
“…There were six prospective cohort studies ( 9 , 18 , 30 , 31 , 32 , 33 ) and ten retrospective articles ( 12 , 16 , 29 , 34 , 35 , 36 , 37 , 38 , 39 , 40 ). Follow-up periods ranged from 6 to 29 months.…”
Section: Resultsmentioning
confidence: 99%
“…( 38 ) Retrospective 77 60 (39–83) 12 43 Rippstein et al ( 39 ) Retrospective 8 - - - Sarikaya et al . ( 40 ) Retrospective 4 - - - *Percentage of females of the total participants. …”
Purpose
A systematic review to determine the effect of different types of joint preparation, joint fixation, and postoperative weight-bearing protocols on non-union frequency in first metatarsophalangeal joint (MTPJ) arthrodesis in patients with moderate-to-severe hallux valgus.
Material and methods
A systematic literature search (PubMed and EMBASE), adhering to PRISMA guidelines. Data on MTPJ preparation, fixation, weight-bearing, and non-union in patients with moderate-to-severe hallux valgus were collected. Quality assessment was performed using the Coleman Methodology Score.
Results
Sixteen studies (934 feet) were included, generally of medium quality. Overall non-union rate was 7.7%. At 6.3%, convex/concave joint preparation had the lowest non-union rate vs 12.2% for hand instruments and 22.2% for planar cuts. Non-union of 2.8% was found for joint fixation with a plate combined with a lag screw vs 6.5% for plate fixation, 11.1% for crossed screw fixation, and 12.5% for a plate with a cross plate compression screw. A 5.1% non-union frequency was found following postoperative full weight-bearing on a flat shoe vs 9.3% for full weight-bearing on a heel weight-bearing shoe and 0% for a partial weight-bearing regimen.
Conclusion
Based on medium-quality papers, joint preparation with convex/concave reamers and joint fixation with a plate using a lag screw show the lowest non-union rate. Full postoperative weight-bearing in a stiff-soled postoperative shoe is safe and not associated with non-union vs a more protective load-bearing regimen. Further research should focus on larger sample sizes, longer follow-ups, and stronger study designs.
“…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.…”
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.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
