The clinical and radiographic results of closed wedge proximal metatarsal osteotomy for the treatment of hallux valgus
Serkan Erkan, Hüseyin S. Yercan, Güvenir Okcu
Celal Bayar Üniversitesi Tıp Fakültesi Ortopedi ve Travmatoloji Anabilim Dalı, Manisa
Keywords: Hallux valgus/surgery; metatarsal bones/surgery; osteotomy/methods.
Objectives: We evaluated the clinical and radiographic results of closed wedge proximal metatarsal osteotomy (PMO) for the treatment of hallux valgus.
Patients and methods: Fourteen patients (12 females, 2 males; mean age 42 years; range 18 to 62 years) underwent closed wedge PMO for hallux valgus in 16 feet. Bilateral cases were treated with a three-month interval. For fixation, Kirschner wires were used in 12 feet, and mini cortical screws in four feet. Radiographic measurements included hallux valgus angle, intermetatarsal angle, distal metatarsal articular angle, congruency angle, and the length of the first metatarsal bone on anteroposterior radiographs, and the angle between first metatarsal bone and diaphysis of the first proximal phalanx on lateral radiographs. Clinical results were evaluated using the AOFAS scoring system. The mean follow-up was 36 months (range 7 to 80 months).
Results: Union was obtained in a mean of seven weeks. The following decreases were seen postoperatively: hallux valgus angle by 22°, intermetatarsal angle by 7°, distal metatarsal articular angle by 7°, congruency angle by 11°, the length of the first metatarsal bone by 6 mm, and the angle between first metatarsal bone and diaphysis of the first proximal phalanx by 6°. The mean AOFAS score increased by 46 points. Postoperative changes in the congruency angle and the length of the first metatarsal bone were significant (p<0.05). Increase in the AOFAS score was significant in patients in whom the length of the first metatarsal bone decreased by less than 3 mm (9 feet) and in those in whom the congruency angle was smaller than 8° (9 feet) (p<0.05).
Conclusion: Preoperative planning is of particular importance for hallux valgus surgery. It should be considered that closed wedge PMO may result in undesirable shortness particularly in advanced cases.