Rigid Internal Fixation of Proximal Crescentic Metatarsal Osteotomy in Hallux Valgus Correction.

Authors:
Debbie Dang
Debbie Dang
University of California San Francisco
San Francisco | United States
Matthew Griffin
Matthew Griffin
Regenerative Medicine Institute (REMEDI)
Ireland
Wesley Flint
Wesley Flint
Coughlin Foot & Ankle Clinic
Christopher Hirose
Christopher Hirose
Saint Alphonsus Coughlin Foot & Ankle Clinic
United States
Michael Coughlin
Michael Coughlin
Idaho Foot and Ankle Fellowship Program

Foot Ankle Int 2019 Apr 17:1071100719842800. Epub 2019 Apr 17.

1 Saint Alphonsus Medical Group, Coughlin Foot & Ankle Clinic, Boise, ID, USA.

Background: The purpose of this study was to evaluate outcomes utilizing a low-profile titanium plate and screw construct for rigid fixation of first ray proximal crescentic osteotomies in the treatment of hallux valgus.

Methods: Forty-eight patients (53 feet) with mild to severe hallux valgus were prospectively enrolled and completed 12-month follow-up. All were treated with a proximal crescentic osteotomy, fixed with a low-profile titanium plate, distal soft tissue correction, with or without an Akin osteotomy. Recorded outcomes included change in first ray dorsiflexion angles, need for hardware removal, radiographic and clinical evaluation, pain, and American Orthopaedic Foot & Ankle Society (AOFAS) scores.

Results: All patients achieved radiographic union of their osteotomy. An Akin osteotomy was performed in 83% of patients. Seventeen feet (32%) had hardware removed. First ray dorsiflexion angles increased from a mean of 1.6 degrees preoperatively to 5.0 degrees postoperatively ( P < .001). Dorsal malunion, defined as change in dorsiflexion angle greater than 1 standard deviation above the mean, occurred in 7 feet. The mean hallux valgus angle improved from 29 to 9 degrees ( P < .001). The mean 1-2 intermetatarsal angle decreased from 14 to 6 degrees ( P < .001). The first metatarsophalangeal joint range of motion decreased from 77 to 59 degrees ( P < .001). The mean visual analog scale score improved from 4 to 0.7 ( P < .0001). The mean AOFAS score improved from 55 to 89 points ( P < .001).

Conclusion: Proximal crescentic metatarsal osteotomy, fixed with a low-profile titanium plate and screw construct, with distal soft tissue repair, and Akin osteotomy as indicated, was a safe and reliable method for operative treatment of hallux valgus.

Level Of Evidence: Level IV, retrospective case series.

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http://dx.doi.org/10.1177/1071100719842800DOI Listing
April 2019
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References

(Supplied by CrossRef)
Article in Med Sentinel
Akin O. et al.
Med Sentinel 1925
Article in Clin Orthop Relat Res
Colloff B et al.
Clin Orthop Relat Res 1967
Article in Orthopedics
Coughlin MJ. et al.
Orthopedics 1990

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