Halluks valgus cerrahisinde Herbert vidası ile yapılan Chevron osteotomisi sonuçlarının değerlendirilmesi

Giriş: Halluks valgus 1.parmağın abduktor ve adduktor kaslarında gelişen dengesizlik sonucu meydana gelen ağrılı bir deformitedir. Chevron osteotomisi hafif ve orta şiddette seyreden halluks valgus deformitelerinin cerrahi tedavisinde etkili bir yöntemdir. Gereç ve Yöntem: Ortopedi ve Travmatoloji kliniğine başvuran, hafif ve orta şiddetli ağrılı halluks valgus deformitesi olan 33 genç hasta çalışmaya dahil edildi. Herbert vidası kullanılarak distal chevron osteotomi uygulanan hastalar ortalama 18 ay (6-30 ay) takip edildi. Hastaların değerlendirilmesinde preoperatif ve postoperatif 12. ayda American Orthopedic Foot and Ankle Society's (AOFAS) halluks-metatarsofalangeal-interfalangeal skalası kullanıldı. Sonuçlar:Preoperatif ve postoperatif ortalama halluks valgus açıları (HVA) sırasıyla 28.93 ° ± 6.66º ve 9.48 ° ± 3.21 ° olarak ölçüldü. HVA arasındaki fark istatistiksel olarak anlamlı bulundu (p=0.0001). İntermetatarsal açının (İMA) ise preoperatif dönemde ortalama 11.51 ° ± 2.41 'den postoperatif dönemde ortalama 7.53° ± 2.10° 'ye düştüğü saptanmıştır (p = 0.0001). Metatarsofalanjial dorsifleksiyon derecesinde 52.48 ° ± 9.71 °'den 61.90 ° ± 10.47 °'ye yükselme gözlenmiştir (p = 0.0001). Plantar fleksiyon skorlarında ise anlamlı yükselme saptanmıştır (p = 0.0001) . Preoperatif AOFAS skoru ortalaması 43,77 ± 14.14 iken postoperatif dönemde ortalama 85.38 ± 14.34 olarak saptanmıştır (p = 0.0001). Tartışma: Halluks valgus cerrahisinde Herbert vidası ile yapılan Chevron osteotomisi ile kalıcı rotasyonel ve translasyonel stabilite sağlanabilmektedir.

Chevron Osteotomy with Herbert Screw Fixation for Treatment of Hallux Valgus Deformity Results

Objective: Hallux valgus is a painful deformity caused by an imbalance in the abductor and adductor muscle mechanism of the big toe. Chevron osteotomy is one of the effective surgical treatment methods for mild and moderate hallux valgus deformity. Materials and Methods: Thirty-three young patients who had mild to moderate hallux valgus deformity were admitted to Orthopedics and Traumatology inpatient clinic. Distal chevron osteotomy with Herbert screw fixation was applied with a mean follow-up of 18 (6-30 months). The American Orthopedic Foot and Ankle Society's (AOFAS) hallux-metatarsophalangeal-interphalangeal scale was used in preoperative physical assessment and at the 12 month postoperative assessment.Results: This results showed a significant decrease in the hallux valgus angle (HVA) from 28.93° ± 6.66º preoperatively to 9.48° ± 3.21° postoperatively (p = 0.0001). The intermetatarsal angle (IMA) also decreased from 11.51° ± 2.41° preoperatively to 7.53° ± 2.10° postoperatively (p = 0.0001). The degree of dorsiflexion of the first metatarsophalangeal joint significantly increased from 52.48° ± 9.71° preoperatively to 61.90° ± 10.47° postoperatively (p = 0.0001). Plantar flexion scores significantly increased from 20.36° ± 4.57° preoperatively to 24.71° ± 5.18° postoperatively (p = 0.0001). The AOFAS score was 43.77° ± 14.14° preoperatively, climbing to 85.38° ± 14.34° in the postoperative period (p = 0.0001). Conclusion: Although the chevron osteotomy has inherent stability, displacement can occur if the toe is traumatized in the early postoperative period. Herbert screw fixation in hallux valgus surgery provides strong and permanent rotational and translational stability which is correlated with satisfactory surgical outcomes.

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1. Singh SK, Jayasekera N, Nazir S, Sharif K, Kashif F. Use of a simple suture to stabilize the chevron osteotomy: a prospective study. J Foot Ankle Surg. 2004; 43 (5):307- 311, .
2. Trnka HJ, Zembsch A, Easley ME, Salzer M. The Chevron osteotomy for correction of hallux valgus: Comparison of findings after two and five years of follow-up. Bone Joint Surg Am. 2000; 82 A(10):1373-1378 , . 3. Caminear DS, Pavlovich R Jr, Pietrzak WS. Fixation of the chevron osteotomy with an absorbable copolymer pin for treatment of hallux valgus deformity. J Foot Ankle Surg. 2005; 44 (3):203-210.
4. Jacobson K, Gough A, Mendicino SS, Rockett MS. Mechanical comparison of fixation techniques for the offset V osteotomy: a saw bone study. J Foot Ankle Surg. 2003; 42 (6):339-43, .
5. Schneider W, Aigner N, Pinggera O, Knahr K. Chevron osteotomy in hallux valgus: ten-year results of 112 cases. J Bone Joint Surg Br. 2004; 86 (7):1016-1020, .
6. Winemaker MJ, Amendola A. Comparison of bioabsorbable pins and Kirschner wires in the fixation of Chevron osteotomies for hallux valgus. Foot Ankle Int. 1996; 17 (10):623-628.
7. Hanft JR, Kashuk KB, Bonner AC, Toney M, Schabler J. Rigid internal fixation of the Austin/chevron osteotomy with Herbert screw fixation: a retrospective study. J Foot Surg.1992; 31 (5):512-518.
8. Yearian PR, Brown T, Goldman F. Chevron bunionectomy with mi- croplate and screw fixation: a retrospective followup of 26 feet. J Foot Ankle Surg. 1996; 35 (6):532-536.
9. Small HN, Braly WG, Tullos HS. Fixation of the Chevron osteotomy utilizing absorbable polydioxanon pins. Foot Ankle Int.1995; 16 (6):346-350.
10. Barca F, Busa RA. Chevron osteotomy fixed with bioabsorbable poly-L-lactic acid single screw. J Foot Ankle Surg. 1997; 36 (1):15-20.
11. Ozkurt B, Altay M, Aktekin CN, Toprak A, Tabak Y. Capsuloperiosteal flap application for the stabilization of chevron osteotomy. Acta Orthop Traumatol Turc. 2006; 40 (2):151-157.
12. Kitaoka HB, Alexander IJ, Adelaar RS, Nunley JA, Myerson MS, Sanders M. Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int. 1994; 15 (7):349-53.
13. Ibrahim T, Beiri A, Azzabi M, Best AJ, Taylor GJ, Menon DK. Reliability and validity of the subjective component of the American Orthopedic Foot and Ankle Society clinical rating scales. J Foot Ankle Surg. 2007; 46 (2):65-74.
14. Quinn MR, DiStazio JJ, Kruljac SJ. Herbert bone screw fixation of the Austin bunionectomy. J Foot Surg. 1987; 26 (6):516-519.
15.Johnson JE, Clanton TO, Baxter DE, Gottlieb MS. Comparison of Chevron osteotomy and modified McBride bunionectomy for correction of mild to moderate hallux valgus deformity. Foot Ankle Int. 1991 12 (2):61-68.
16. Austin DW, Leventen EO. A new osteotomy for hallux valgus: a horizontally directed "V" displacement osteotomy of the metetarsal head for hallux valgus and primus varus. Clin Orthop Jun. 1981; 157:25-30.
17. Meier PJ, Kenzora JE. The risks and benefits of distal first metatarsal osteotomies. Foot Ankle Int. 1985; 6 (1):7-17.
18. Pochatko DJ, Schlehr FJ, Murphey MD, Hamilton JJ. Distal chevron osteotomy with lateral release for treatment of hallux valgus deformity. Foot Ankle Int. 1994; 15 (9):457- 461.
19. Courtman NH, Weighill FJ. Distal first metatarsal osteotomy and adductor release as a treatment of hallux valgus. J R Coll Surg Edinb. 1995; 40 (2):133-5.
20. Peterson DA, Zilberfarb JL, Greene MA, Colgrove RC. Avascular necrosis of the first metatarsal head: incidence in distal osteotomy combined with lateral soft tissue release. Foot Ankle Int Feb 15;(2):59-63, 1994.
21. Baykal B, Kirdemir V, Ateşalp AS, Bek D, Tercan V. Modified crescentic proximal metatarsal osteotomy and distal soft tissue procedures in hallux valgus. Mil Med Dec.2006; 171 (12):1247-1250, .
22. Duke HF. Buried Kirschner wire fixation of the Austin osteotomy-bunionectomy: a preliminary report. J Foot Surg. 1986; 25 (3):197-203.
23. Park CH, Ahn JY, Kim YM, Lee WC. Plate fixation for proximal chevron osteotomy has greater risk for hallux valgus recurrence than Kirschner wire fixation. Int Orthop. 2013; 37 (6):1085-1092.
24. Mühlbauer M, Zembsch A, Trnka HJ. Short-term results of modified chevron osteotomy with soft tissue technique and guide wire fixation: a prospective study. Z Orthop Ihre Grenzgeb. 2001; 139 (5):435-9.
25. Kürklü M, Demiralp B, Yurttaş Y, Ciçek EI, Ateşalp AS. Modified chevron osteotomy fixed with stofella pin for hallux valgus. Foot Ankle Int. 2008; 29 (5):478-82.
26. Windhagen H, Radtke K, Weizbauer A, Diekmann J, Noll Y, Kreimeyer U, Schavan R, Stukenborg-Colsman C, Waizy H. Biodegradable magnesium-based screw clinically equivalent to titanium screw in hallux valgus surgery: short term results of the first prospective, randomized, controlled clinical pilot study. Biomed Eng Online 2013; 12:62-72.
27. Rossi WR, Ferreira JC. Chevron osteotomy for hallux valgus. Foot Ankle. 1992; 13 (7):378-81.
28. Klosok JK, Pring DJ, Jessop JH, Maffulli N. Chevron or Wilson metatarsal osteotomy for hallux valgus. A prospective randomized trial. J Bone Joint Surg.1993; 75 (5):825-829.