• Title/Summary/Keyword: Proximal crescentic osteotomy

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Additional axial K-wire Fixation for Proximal Crescentic Metatarsal Osteotomy : A Biomechanical Study (반월형 근위 중족골 절골술에 대한 보강적 축성 K-강선 고정술 : 생체역학적 연구)

  • Jung, Hong-Geun;Kim, You-Jin;Guyton, Gregory
    • Journal of Korean Foot and Ankle Society
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    • v.7 no.2
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    • pp.151-156
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    • 2003
  • Purpose: Proximal crescentic metatarsal osteotomy(PMO) is one of the most common procedures for correcting moderate to severe degree hallux valgus deformity. Although screw fixation is used for osteotomy site stability, loss of reduction can occur. The purpose of this study is to compare the sagittal plane stability of the conventional crescentic PMO fixed with a single screw with that of the crescentic PMO fixed with 1 screw and 2 supplemental K -wires. Material and Methods: Ten matched pairs of cadaveric foot specimens were used for the proximal crescentic metatarsal osteotomy. For one foot specimen of each pair, crescentic osteotomy was fixed with 4mm long threaded cannulated screw, while the matched pair was prepared by adding two axial 1.6mm K-wires to the conventionally fixed 4mm screw. The extensometer was used to measure the osteotomy gap as the metatarsal head was loaded continuously until failure using a servohydraulic MTS Mini Bionix test frame. The strength of fixation was normalized with the bone mineral density (BMD) of the paired specimen $(N{\times}cm^{2}/gm)$, Result: The average strength of the crescentic PMO with axial K-wire fixation ($458.8cm^{2}/gm$, S.D. 434.3) was significantly higher than the standard crescentic PMO ($367.5cm^{2}/gm$, S.D. 397,9) (p=0.05). Conclusion: Supplemental fixation with two axial K-wires can be added to the crescentic PMO to enhance the initial fixation stability to prevent the loss of reduction or dorsal malunion.

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Treatment of Hallux Valgus with Modified McBride Procedure and Proximal Metatarsal Crescentic Osteotomy (McBride씨 변형 술식과 근위 중족골 반월형 절골술을 이용한 무지 외반증의 치료)

  • Lee, Ju-Hong;Park, Jong-Hyuk
    • Journal of Korean Foot and Ankle Society
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    • v.9 no.1
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    • pp.81-86
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    • 2005
  • Propose: This study was retrospectively to review the surgical results for moderate to severe hallux valgus corrected with a modified McBride procedure and proximal metatarsal crescentic osteotomy. Materials and Methods: Between August 1997 and August 2001, 15 patients with 22 bunion underwent surgical correction and were followed for an average 29.3 months (range, 18 to 53 months). Clinical results were evaluated with AOFAS clinical rating system for hallux and radiological measurements were done preoperatively and at a minimum of 12 months postoperatively. Results: The average AOFAS clinical rating score improved from 47.5 to 86.0. Union of the osteotomy site occurred at 9.5 weeks except one delayed union. The hallux valgus angle improved an from $36.5^{\circ}$ to $15.7^{\circ}$ and the intermetatarsal angle improved from $17.4^{\circ}$ to $8.6^{\circ}$ on average. Dorsiflexion of the first metatarsal at the osteotomy site was present in three (13.6%) with average $4^{\circ}$. Complications were two recurred deformity, one hallux varus and one painful transfer lesion. There was a high level of satisfaction with clinical results in 11 patients (73.3%) with 17 feets and cosmesis in 18 feets (81.8%). Conclusion: Modified McBride procedure and proximal metatarsal crescentic osteotomy based on careful patient selection and meticulous technique showed satisfactory outcome for moderate to severe hallux valgus.

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Results of the Proximal Crescentic Osteotomy for Moderate to Severe Hallux Valgus Deformity (중등도 이상의 무지 외반증에서 근위 초승달형 절골술의 효과)

  • Lee, Yoon-Tae;Kim, Hyoung-Bok;Yoon, Han-Kook
    • Journal of Korean Foot and Ankle Society
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    • v.14 no.1
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    • pp.11-15
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    • 2010
  • Purpose: The purpose of this study was to retrospectively analyze the clinical and radiologic results of the proximal crescentic osteotomy for moderate to severe hallux valgus deformity. Materials and Methods: Between March 2001 and March 2008, 55 patients (71 feet) who had undergone crescentic osteotomy and distal soft tissue procedure for hallux valgus were followed up for more than one year. The average follow-up period was 15.8 months (12~28 months) and the average age at the time of surgery was 49.8 years (20~69 years). We analyzed the hallux valgus angle (HVA), the first-second intermetatarsal angle (IMA), the length of 1st metatarsal bone and the position of medial sesamoid in preoperative and the last follow-up radiographs. The American Othopeaedic Foot and Ankle Society (AOFAS) score and patient satisfaction were measured by modifying Johnson's method which were used for clinical outcome assessments. Results: The HVA and the IMA were 36.2 and 15.8 degrees preoperatively, and 10.8 and 3.9 degrees at the last follow-up, respectively. The amount of shortening of 1st metatarsal bone averaged $2.3{\pm}1.1$ rum postoperatively. The medial sesamoid position improved from a preoperative average of grade 6.6 to the last follow-up average of grade 1.9. The AOFAS score improved from a preoperative average of 45.3 points to an average 90.6 points at the last follow-up. The patient's satisfaction was completely satisfied in 61 cases (85.9%), satisfied with minor reservations in 6 cases (8.5%), satisfied with major reservations in 2 cases (2.8%), and dissatisfied in 2 cases (2.8%). Conclusion: Proximal crescentic osteotomy produced satisfactory results for moderate to severe hallux valgus deformity.

A Comparison of the Contact Area between Three Different Correcting Angles after Proximal Crescentic Osteotomy and Ludloff Osteotomy of the First Metatarsal (Preliminary Report) (제1 중족골 근위 반월형 절골술과 Ludloff 절골술 후 교정 각도에 따른 절골편간 접촉 면적 비교(예비보고))

  • Park, Yong-Wook;Jang, Keun-Jong;Park, Sang-Ho
    • Journal of Korean Foot and Ankle Society
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    • v.14 no.1
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    • pp.5-10
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    • 2010
  • Purpose: This study was performed to compare the contact area between three different correcting angles after the proximal crescentic and Ludloff osteotomies of the first metatarsal. Materials and Methods: We used the two sawbone models. Proximal crescentic (PCO) and Ludloff osteotomies (LO) were performed and secured using K-wires under the correcting intermetatarsal angle (IMA) $5^{\circ}$, $10^{\circ}$, and $15^{\circ}$. Then each 6 osteotomized model was scanned five times and measured the contact area using the calculating program. We excluded the highest and lowest values. Results: The mean area of cutting surface was 189 $mm^2$ in PCO, 863 $mm^2$ in LO. The mean contact area (contact ratio; contact area $\times$100/area of cutting surface) of PCO was 149 $mm^2$ (79%) in $5^{\circ}$, 139.5 $mm^2$ (74%) in $10^{\circ}$, 107 $mm^2$ (57%) in $15^{\circ}$ IMA. The mean contact area (contact ratio) of LO was 711 $mm^2$ (82%) in $5^{\circ}$, 535.5 $mm^2$ (62%) in $10^{\circ}$, 330 $mm^2$ (38%) in $15^{\circ}$ IMA. Conclusion: A significant decrease in the contact area and contact ratio according to increase in correcting IMA was noticed in LO. We recommend the PCO rather than LO, when the IMA is needed to correct over $15^{\circ}$.

Proximal Dome Osteotomy for Hallux Valgus (반월형 절골술을 이용한 무지 외반증의 치료)

  • Park, Yong-Wook;Kim, Do-Young;Lee, Sang-Soo;Yoon, Tae-Kyung;Noh, Kyu-Cheol;Son, Hyun-Il
    • Journal of Korean Foot and Ankle Society
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    • v.7 no.2
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    • pp.174-178
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    • 2003
  • Purpose: The purpose of this study was to evaluate the radiographic results and complications after the proximal dome osteotomy for hallux valgus. Material and Methods: 127 cases of clinically moderate to severe hallux valgus from October 1994 to September 1997 were included in this study. All had been surgically corrected with proximal dome osteotomy, bunionectomy, and distal soft tissue release. We compared the hallux valgus angle(HVA) and intermetatarsal angle(IMA) at preoperative, postoperative 3 weeks, postoperative 6 weeks, and postoperative 3 months. Also we reviewed the postoperative com plications. Result: The HVA averaged $34.1^{\circ}$ at preoperative, $4.3^{\circ}$ at 3 weeks after operation, $8.1^{\circ}$ at 6 weeks after operation, and $10.2^{\circ}$ at 3 months after operation. The lMA averaged $14.6^{\circ}$ at preoperative, $5.1^{\circ}$ at 3 weeks after operation, $5.6^{\circ}$ at 6 weeks after operation, and $7.3^{\circ}$ at 3 months after operation. We experienced 7 cases of malunion, 5 cases of limitation of motin at the first metatarso-phalangeal joint, 3 cases of hallux varus deformity, 2 cases of delayed union. Conclusion: Proximal dome osteotomy for moderate to severe hallux valgus deformity was considered as one of the effective treatment methods. And we try to avoid limitation of motion at the first metatarso-phalangeal joint after operation.

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