Tricorrectional bunionectomy for hallux abducto valgus. A comprehensive outcome study

Abstract

A longitudinal outcome study of the tricorrectional bunionectomy with AO screw fixation for the correction of hallux abducto valgus was undertaken involving 84 consecutive patients (121 feet) with a mean age of 48.4 years who underwent the procedure over a 6-month period. Preoperative and postoperative measurements of forefoot angles were calculated, with the following mean results obtained: intermetatarsal angle of 14.46 degrees corrected to 5.72 degrees, hallux abductus angle of 26.38 degrees corrected to 11.65 degrees, proximal articular set angle of 19.85 degrees corrected to 6.06 degrees, and tibial sesamoid position of 4.75 corrected to 1.87. The average time to return to athletic shoes was 12.63 days. Postoperative complications were minor, with no delayed unions, malunions, hematomas, bone infections, or hallux varus. Long-term follow-up (mean, 21.33 months) using the American Orthopaedic Foot and Ankle Society's objective Hallux Metatarsophalangeal-Interphalangeal Scale revealed an overall mean score of 88.94 points out of a possible 100. An excellent mean result of 95 points out of a possible 100 on the subjective patient rating scale was also reported.

Extended plantar limb (modified) chevron osteotomy versus scarf osteotomy for hallux valgus correction: A randomised controlled trial

“…Several other centres have similarly modified the chevron osteotomy to include a longer plantar limb but with slight variations [19][20][21][22][23][24]. Nery et al [23] and Corte-Real et al [22] included the removal of a medially-based wedge from the capital fragment in order to correct the DMAA.…”

Treatment of Hallux Valgus with Three-dimensional Modification of Mitchell’s Osteotomy

“…A similar correction of 13.8°could be achieved with Selner's Tricorrectional method. 25 Objective plantar displacement is indirectly measured with the first metatarsal declination angle. With Mitchell's method, the angle increased 1.2°, and with the 3-D method, 4.3°.…”

The Multiplanar Effect of First Metatarsal Osteotomy on Sesamoid Position

“…The 7-point Hardy and Clapham classification system used to evaluate the sesamoids in relation to the first metatarsal in perioperative planning for hallux abductovalgus deformity takes into consideration 2 variables: (1) transverse plane tibial sesamoid position, and (2) transverse plane first metatarsal position ( Figure 1) (1). Using this classification system, a number of studies have reported substantial changes in the tibial sesamoid position following surgical intervention for the repair of hallux abductovalgus (2)(3)(4)(5)(6)(7)(8)(9)(10)(11). However, because one of these variables, the first metatarsal, is usually laterally transposed during surgical correction, this measurement may not accurately describe a change in the position of the tibial sesamoid.…”