Murat TONBUL, Emre BACA, MÜJDAT ADAŞ, Mehmet Uğur ÖZBAYDAR, H.Cihangir YURDOĞLU

Halluks valgus tedavisinde kresentik distal metatarsal osteotomi: İki farklı tespit yöntemiyle ileriye dönük, randomize, kontrollü bir çalışma

Amaç: Bu çalışmada, halluks valgus tedavisinde yeterince kullanımda olmayan bir distal metatarsal osteotomi yönteminin tekrar gündeme getirilmesi ve farklı iki tespit yönteminin klinik ve radyograﬁk sonuçlarının karşılaştırılması amaçlandı. Çalışma planı: Haﬁf-orta dereceli halluks valgus (

Anahtar Kelimeler:

Ağrı ölçümü, Halluks valgus, Metatarsus, Osteotomi, İleriye dönük çalışma, Rastgele kontrollü çalışmalar

Crescentic distal metatarsal osteotomy for the treatment of hallux valgus: A prospective, randomized, controlled study of two different ﬁxation methods

Objectives: This study was designed to draw attention to a distal metatarsal osteotomy technique, which has been somewhat overlooked for the treatment of hallux valgus, and to compare the clinical and radiographic results of two different ﬁxation methods. Methods: The study included 16 feet of 13 patients (11 women, 2 men) who wertreated with crescentic distal metatar- sal osteotomy for mild-to-moderate hallux valgus (<35°). The patients were randomized to two ﬁxation methods with two cross K-wires (group 1; 7 patients, 8 feet) and a compressive screw (group 2; 6 patients, 8 feet). The results were evaluated using the AOFAS (American Orthopaedic Foot and Ankle Society) clinical rating scale for hallux, and a visual analog scale for pain. Radiographic measurements included the hallux valgus angle (HVA), ﬁrst/second intermetatarsal angle (IMA), and distal metatarsal articular angle (DMAA), before and 12 months after surgery. Results: There were no signiﬁcant differences between the two groups with regard to pre- and postoperative AOFAS scores and pain scores, which showed signiﬁcant improvements in both groups at the end of one-year follow-up (p<0.001). The HVA and IMA signiﬁcantly decreased from 32° to 19° and from 12° to 6° in group 1, and from 30° to 17° and from 12° to 8° in group 2, respectively (p<0.001). A similar improvement was also seen in the DMAA (p<0.001). Postoperative radiographic improvements were similar in both groups. One patient in group 1 underwent revision surgery with the same technique due to recurrence, and one patient in group 2 had delayed union. Conclusion: Crescentic distal metatarsal osteotomy may be an appropriate technique in the treatment of mild-to-moderate hallux valgus.

Keywords:

Pain Measurement, Hallux Valgus, Metatarsus, Osteotomy, Prospective Studies, Randomized Controlled Trial,

___

1. Rossi WR, Ferreira JC. Chevron osteotomy for hallux valgus. Foot Ankle 1992;13:378-81.
2. Deorio JK, Ware AW. Single absorbable polydioxanone pin fixation for distal chevron bunion osteotomies. Foot Ankle Int 2001;22:832-5.
3.Öznur A. A new technique for fixation of distal Chevron osteotomy. Foot Ankle Int 2002;23:954-5.
4. Small HN, Braly WG, Tullos HS. Fixation of the Chevron osteotomy utilizing absorbable polydioxanon pins. Foot Ankle Int 1995;16:346-50.
5. Hattrup SJ, Johnson KA. Chevron osteotomy: analysis of fac- tors in patients’ dissatisfaction. Foot Ankle 1985;5:327-32.
6. Jahss MH, Troy AI, Kummer F. Roentgenographic and mathematical analysis of first metatarsal osteotomies for metatarsus primus varus: a comparative study. Foot Ankle 1985;5:280-321.
7. Haber JH, Kraft J. Crescentic osteotomy for fifth metatarsal head lesions. J Foot Surg 1980;19:66-7.
8. Rosenthal DC, Callahan DF. Distal transverse crescentic osteotomy for correction of hallux abducto valgus. J Am Podiatry Assoc 1984;74:411-4.
9. Kitaoka HB, Alexander IJ, Adelaar RS, Nunley JA, Myerson MS, Sanders M. Clinical rating systems for the anklehindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int 1994;15:349-53.
10. Cedell CA, Aström M. Proximal metatarsal osteotomy in hallux valgus. Acta Orthop Scand 1982;53:1013-8.
11. Miller JW. Distal first metatarsal displacement osteotomy. Its place in the schema of bunion surgery. J Bone Joint Surg [Am] 1974;56:923-31.
12. Schneider W, Csepan R, Knahr K. Reproducibility of the radiographic metatarsophalangeal angle in hallux surgery. J Bone Joint Surg [Am] 2003;85:494-9.
13. Piggott H. The natural history of hallux valgus in adolescence and early adult life. J Bone Joint Surg [Br] 1960;42:749-60.
14. Coughlin MJ, Mann RA. Adult hallux valgus. In: Coughlin MJ, Mann RA, editors. Surgery of the foot and ankle. 7th ed. Philadelphia Mosby Year-Book; 1999. p. 150-269.
15. Richardson EG, Graves SC, McClure JT, Boone RT. First metatarsal head-shaft angle: a method of determination. Foot Ankle 1993;14:181-5.
16. Klosok JK, Pring DJ, Jessop JH, Maffulli N. Chevron or Wilson metatarsal osteotomy for hallux valgus. A prospective randomised trial. J Bone Joint Surg [Br] 1993;75:825-9.
17.Tonbul M, Adaş M, Keris I, Zengin S. Distal first metatarsal dome (crescentic) osteotomy for repair of mild to moderate hallux valgus deformity. J Foot Ankle Surg 2008;47: 259-62.
18. Trnka HJ, Zembsch A, Easley ME, Salzer M, Ritschl P, Myerson MS. The Chevron osteotomy for correction of hallux valgus. Comparison of findings after two and five years of follow-up. J Bone Joint Surg [Am] 2000;82:1373-8.
19. Saro C, Andrén B, Wildemyr Z, Felländer-Tsai L. Outcome after distal metatarsal osteotomy for hallux valgus: a prospective randomized controlled trial of two methods. Foot Ankle Int 2007;28:778-87.