TITLE:
Can a Subcapital Osteotomy Fixed with an Intramedullary Locking Plate Correct all Possible Deformities of a Mild to Moderate Hallux Valgus?
AUTHORS:
Michael Vitek, Hannes Kugler, Felix Fink, Ornella Vitek
KEYWORDS:
Hallux Valgus, Mild, Moderate, Toe Deformity, Lateralization, Plantarization, Derotation, Improvement of DMAA, Full Weightbearing, Hallux Valgus Surgery, New Access, Lazy-L Osteotomy, Soft Tissue Correction, IM-Angle, Angle-Stable Locking Screws, Intramedullary Locking Plate
JOURNAL NAME:
Open Journal of Orthopedics,
Vol.7 No.9,
September
4,
2017
ABSTRACT: Background: There are at least 5 very popular methods described for the correction of mild to moderate hallux valgus deformities. Despite of reported and self experienced good results in favorable fitting preoperative anatomical conditions of some of these methods; it seems that no one is really satisfying under “difficult” or non favorable preoperative anatomic conditions. How could an optimum operation method for a satisfying correction of a mild to moderate hallux valgus look like? The well known criteria for an optimally satisfying method to achieve full normalization of important forefoot parameters under all conditions should be a lateralization, plantarization and derotation of the Ist metatarsal head and also a normalization of the distal metatarsal articular angle (DMAA) in combination with a soft tissue correction. Methods: In order to achieve this outcome without the disadvantages of shortening or the need for unloading, we developed a new operation technique and new fixation devices. We performed a simple transverse lazy-L subcapital osteotomy and after an additional soft tissue release the Ist metatarsal head was restored to its preplaned optimum position in terms of narrowing the IM angle, plantarization, correction of the hallux valgus angle, derotation of a pronation l malrotation and improvement of the DMAA. Fixation was achieved with an intramedullary angel-stable transfixed 30 mm titanium plate. The rigidity of the implant rendered interfragmental compression or solid bone contact unnecessary. The goal was only an optimal correction. All patients were allowed to ambulate with full weightbearing immediately after the operation. Results: We retrospectively reviewed 346 patients (433 feet) who underwent subcapital osteotomy between May 2007 and December 2011; 308 were women and 38 men; their mean age was 65 years. The follow-up investigation was performed on average after 6.5 years (78 months); range 5.5 to 10 years (66 to 120 months). The AOFAS Score improved from 61.18 to 96.82 (t = 55.13, p ° to 4.21° (t = 89.70, p ° to 7.75° (t = 51.68, p ° to 6.61° (t = 29.34, p