Journal of Korean Foot and Ankle Society (대한족부족관절학회지)

Korean Foot & Ankle Society (대한족부족관절학회)
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The Distal Metatarsal Dorsal-Wedge Osteotomy Using Bio-Compression Screw for Advanced Hallux Rigidus

진행된 무지 강직증에서 생체흡수성 압박나사를 이용한 원위 중족골의 배측 쐐기 절골술

  • Kim, Yong-Min (Department of Orthopaedic Surgery, College of Medicine, Chungbuk National University) ;
  • Cho, Byung-Ki (Department of Orthopaedic Surgery, College of Medicine, Chungbuk National University) ;
  • Kim, Dong-Soo (Department of Orthopaedic Surgery, College of Medicine, Chungbuk National University) ;
  • Choi, Eui-Sung (Department of Orthopaedic Surgery, College of Medicine, Chungbuk National University) ;
  • Shon, Hyun-Chul (Department of Orthopaedic Surgery, College of Medicine, Chungbuk National University) ;
  • Park, Kyoung-Jin (Department of Orthopaedic Surgery, College of Medicine, Chungbuk National University) ;
  • Park, Ji-Kang (Department of Orthopaedic Surgery, College of Medicine, Chungbuk National University) ;
  • Choi, Seung-Myung (Department of Orthopaedic Surgery, College of Medicine, Chungbuk National University)
  • 김용민 (충북대학교 의과대학 정형외과학교실) ;
  • 조병기 (충북대학교 의과대학 정형외과학교실) ;
  • 김동수 (충북대학교 의과대학 정형외과학교실) ;
  • 최의성 (충북대학교 의과대학 정형외과학교실) ;
  • 손현철 (충북대학교 의과대학 정형외과학교실) ;
  • 박경진 (충북대학교 의과대학 정형외과학교실) ;
  • 박지강 (충북대학교 의과대학 정형외과학교실) ;
  • 최승명 (충북대학교 의과대학 정형외과학교실)
  • Received : 2012.01.15
  • Accepted : 2012.02.14
  • Published : 2012.03.15
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Abstract

Purpose: This study was performed retrospectively to evaluate clinical outcomes of distal metatarsal osteotomy using bio-compression screw as the joint preservation method for advanced hallux rigidus. Materials and Methods: Eleven cases were followed up for more than 1 year after distal metatarsal dorsal wedge osteotomy for advanced hallux rigidus. The clinical evaluation was performed according to the American Orthopaedic Foot and Ankle Society (AOFAS) score and patient's satisfaction score. The range of motion, and the period to return to running exercise, tip-toeing gait, squatting, walking down the stairs were evaluated. As the radiographic evaluation, the interval of $1^{st}$ MTP (metatarsophalangeal) joint space and the period to union were measured. Results: The AOFAS hallux score had improved significantly from preoperative average 50.7 points to 87.6 points at the last follow-up (p=0.005). The subjective satisfaction score was average 90.6 points. There were no case of subsequent fusion or additional operation, and no complication associated with bio-compression screw. The period to return to running exercise, tip-toeing gait, squatting, walking down the stairs were average of 24.8 weeks, 20.4 weeks, 16.8 weeks, 18.5 weeks respectively. Dorsiflexion of $1^{st}$ MTP joint had improved significantly from preoperative average $17.5^{\circ}$ to $44^{\circ}$ (p<0.001). All cases achieved union of osteotomy site, and the period to union was average 10.4 weeks. The interval of $1^{st}$ MTP joint space had improved significantly from preoperative average 1.2 mm to 3.5 mm (p=0.014). Conclusion: Distal metatarsal osteotomy using bio-compression screw seems to be one of effective treatment methods for advanced hallux rigidus, because of restoration of the first MTP joint motion, and reliable pain relief, and needlessness of hardware removal.

Keywords

References

  1. Coughlin MJ, Shurnas PS. Hallux rigidus. Demographics, etiology and radiographic assessment. Foot Ankle Int. 2003;24:731-43. https://doi.org/10.1177/107110070302401002
  2. Yee G, Lau J. Current concepts review: hallux rigidus. Foot Ankle Int. 2008;29:637-46. https://doi.org/10.3113/FAI.2008.0637
  3. Lundeen RO, Rose JM. Sliding oblique osteotomy for the treatment of hallux abducto valgus associated with functional hallux limitus. J Foot Ankle Surg. 2000;39:161-7. https://doi.org/10.1016/S1067-2516(00)80017-4
  4. Ronconi P, Monachino P, Baleanu PM, Favilli G. Distal oblique osteotomy of the first metatarsal for the correction of hallux limitus and rigidus deformity. J Foot Ankle Surg. 2000;39:154-60. https://doi.org/10.1016/S1067-2516(00)80016-2
  5. Youngswick FD. Modifications of the Austin bunionectomy for treatment of metatarsus primus elevates associated with hallux limitus. J Foot Surg. 1982;21:114-6.
  6. Coughlin MJ, Shurnas PS. Hallux rigidus. Grading and long-term results of operative treatment. J Bone Joint Surg Am. 2003;85:2072-88. https://doi.org/10.2106/00004623-200311000-00003
  7. Easley ME, Davis WH, Anderson RB. Intermediate to long-term follow-up of medial-approach dorsal cheilectomy for hallux rigidus. Foot Ankle Int. 1999;20:147-52. https://doi.org/10.1177/107110079902000302
  8. Feltham GT, Hanks SE, Marcus RE. Age-based outcomes of cheilectomy for the treatment of hallux rigidus. Foot Ankle Int. 2001;22:192-7. https://doi.org/10.1177/107110070102200304
  9. Mackay DC, Blyth M, Rymaszewski LA. The role of cheilectomy in the treatment of hallux rigidus. J Foot Ankle Surg. 1997;36:337-40. https://doi.org/10.1016/S1067-2516(97)80032-4
  10. Viegas GV. Reconstruction of hallux limitus deformity using a first metatarsal sagittal-Z osteotomy. J Foot Ankle Surg. 1998;37:204-11. https://doi.org/10.1016/S1067-2516(98)80112-9
  11. Gonzalez JV, Garrett PP, Jordan MJ, Reilly CH. The modified Hohmann osteotomy: an alternative joint salvage procedure for hallux rigidus. J Foot Ankle Surg. 2004;43:380-8. https://doi.org/10.1053/j.jfas.2004.09.007
  12. Derner R, Goss K, Postowski HN, Parsley N. A plantar- flexory-shortening osteotomy for hallux rigidus: a retrospective analysis. J Foot Ankle Surg. 2005;44:377-89. https://doi.org/10.1053/j.jfas.2005.07.010
  13. Citron N, Neil M. Dorsal wedge osteotomy of the proximal phalanx for hallux rigidus. Long-term results. J Bone Joint Surg Br. 1987;69:835-7.
  14. Thomas PJ, Smith RW. Proximal phalanx osteotomy for the surgical treatment of hallux rigidus. Foot Ankle Int. 1999; 20:3-12. https://doi.org/10.1177/107110079902000102
  15. Lombardi CM, Silhanek AD, Connolly FG, Dennis LN, Keslonsky AJ. First metatarsophalangeal arthrodesis for treatment of hallux rigidus: a retrospective study. J Foot Ankle Surg. 2001;40:137-43. https://doi.org/10.1016/S1067-2516(01)80079-X
  16. Coughlin MJ, Abdo RV. Arthrodesis of the first metatarsophalangeal joint with Vitallium plate fixation. Foot Ankle Int. 1994;15:18-28. https://doi.org/10.1177/107110079401500105
  17. Sanhudo JA, Gomes JE, Rodrigo MK. Surgical treatment of advanced hallux rigidus by interpositional arthroplasty. Foot Ankle Int. 2011;32:400-6. https://doi.org/10.3113/FAI.2011.0400
  18. Cosentino GL. The Cosentino modification for tendon interpositional arthroplasty. J Foot Ankle Surg. 1995;34:501-8. https://doi.org/10.1016/S1067-2516(09)80028-8
  19. Hamilton WG, O'Malley MJ, Thompson FM, Kovatis PE. Roger Mann Award 1995. Capsular interposition arthroplasty for severe hallux rigidus. Foot Ankle Int. 1997;18:68-70. https://doi.org/10.1177/107110079701800204
  20. Blair MP, Brown LA. Hallux limitus/rigidus deformity: a new great toe implant. J Foot Ankle Surg. 1993;32:257-62.
  21. Townley C, Taranow W. A metallic hemiarthroplasty resurfacing prosthesis for the hallux metatarsophalangeal joint. Foot Ankle Int. 1994;15:575-80. https://doi.org/10.1177/107110079401501101
  22. Tagoe M, Brown HA, Rees SM. Total sesamoidectomy for painful hallux rigidus: a medium-term outcome study. Foot Ankle Int. 2009;30:640-6. https://doi.org/10.3113/FAI.2009.0640
  23. Giannini S, Ceccarelli F, Faldini C, Bevoni R, Grandi G, Vannini F. What's new in surgical options for hallux rigidus? J Bone Joint Surg Am. 2004;86-A Suppl 2:72-83.
  24. Coughlin MJ, Shurnas PS. Hallux rigidus. J Bone Joint Surg Am. 2004; 86-A Suppl 1(Pt 2):119-30.
  25. Blyth MJ, Mackay DC, Kinninmonth AW. Distal wedge osteotomy in the treatment of hallux rigidus. J Foot Ankle Surg. 1998;37:8-10. https://doi.org/10.1016/S1067-2516(98)80004-5
  26. Haddad SL. The use of osteotomies in the treatment of hallux limitus and hallux rigidus. Foot Ankle Clin. 2000;5:629-61.
  27. Gong HS, Baek GH, Kim JH, Chung MS. Dorsal wedge osteotomy using bioabsorbable pins for the treatment of Freiberg's disease. J Korean Foot Ankle Soc. 2005;9:59-63.
  28. Lee HS, Kwon SY, Kim DW, Chung JW. Weil osteotomy for Freiberg's disease. J Korean Foot Ankle Soc. 2011;15:217-22.
  29. Ashammakhi N, Rokkanen P. Absorbable polyglycolide devices in trauma and bone surgery. Biomaterials. 1977;18:3-9.
  30. Lavery LA, Higgins KR, Ashry HR, Athanasiou KA. Mechanical characteristics of poly-L-lactic acid absorbable screws and stainless steel screws in basilar osteotomies of the first metatarsal. J Foot Ankle Surg. 1994;33:249-54.
  31. Small HN, Braly WG, Tullos HS. Fixation of the Chevron osteotomy utilizing absorbable polydioxanon pins. Foot Ankle Int. 1995;16:346-50. https://doi.org/10.1177/107110079501600606
  32. Winemaker MJ, Amendola A. Comparison of bioabsorbable pins and Kirschner wires in the fixation of chevron osteotomy for hallux valgus. Foot Ankle Int. 1996;17:623-8. https://doi.org/10.1177/107110079601701007
  33. Bostman OM. Osteolytic changes accompanying degradation of absorbable fracture fixation implants. J Bone Joint Surg Br. 1991;73:679-82.
  34. Bostman OM. Osteoarthritis of the ankle after foreign-body reaction to absorbable pins and screws: a three- to nine- year follow-up. J Bone Joint Surg Br. 1998;80:333-8. https://doi.org/10.1302/0301-620X.80B2.8302
  35. Burns AE, Varin J. Poly-L-lactic and rod fixation results in foot surgery. J Foot Ankle Surg. 1998;37:37-41. https://doi.org/10.1016/S1067-2516(98)80009-4