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Percutaneous Distal Metatarsal Osteotomy for Correction of Hallux Valgus
Bruno Magnan, MD1; Lorenzo Pezzè, MD1; Nicola Rossi, MD1; Pietro Bartolozzi, MD1
1 Department of Orthopaedics, University of Verona, P.le L.A. Scuro 10, 37134 Verona, Italy
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Investigation performed at the Department of Orthopaedics, University of Verona, Verona, Italy

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2005 Jun 01;87(6):1191-1199. doi: 10.2106/JBJS.D.02280
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Abstract

Background: Distal osteotomy of the first metatarsal is indicated for the surgical treatment of mild-to-moderate hallux valgus deformity. The aim of this study was to evaluate the results of a subcapital distal osteotomy of the first metatarsal with use of a percutaneous technique.

Methods: From 1996 to 2001, 118 consecutive percutaneous distal osteotomies of the first metatarsal were performed for the treatment of painful mild-to-moderate hallux valgus in eighty-two patients. The patients were assessed with a clinical and radiographic protocol at a mean of 35.9 months postoperatively. The American Orthopaedic Foot and Ankle Society (AOFAS) hallux-metatarsophalangeal-interphalangeal scale was used for the clinical assessment.

Results: The patients were satisfied following 107 (91%) of the 118 procedures. The mean score on the AOFAS scale was 88.2 ± 12.9 points. The postoperative radiographic assessments showed a significant change (p < 0.05), compared with the preoperative values, in the mean hallux valgus angle, first intermetatarsal angle, distal metatarsal articular angle, and sesamoid position. The valgus deformity recurred after three procedures (2.5%), the first metatarsophalangeal joint was stiff but not painful after eight (6.8%), and a deep infection developed after one (0.8%). The infection resolved with antibiotic therapy.

Conclusions: The percutaneous technique proved to be reliable for the correct execution of a distal linear osteotomy of the first metatarsal for the correction of a painful mild-to-moderate hallux valgus deformity. The clinical results appear to be comparable with those obtainable with traditional open techniques, with the additional advantages of a minimally invasive procedure, a substantially shorter operating time, and a reduced risk of complications related to surgical exposure.

Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.

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    References

    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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    Carlos Pique-Vidal
    Posted on February 01, 2006
    Percutaneous Distal Metatarsal Osteotomy for Correction of Hallux Valgus
    Centro Medico Teknon, Barcelona, SPAIN

    To The Editor:

    I read with interest the paper entitled “Percutaneous Distal Metatarsal Osteotomy for Correction of Hallux Valgus” (2005;87:1191-1199) by Magnan, et al. The authors deserve to be complimented for a scientific study on a topic about which very little has been published.

    Additionally, I agree with the comments of Coughlin and Grimes (1) regarding the advantages of minimally invasive surgery to reduce the likelihood of necrosis of the metatarsal head. However, complications of minimally invasive procedures associated with injuries of vessels, nerves or tendons stated by Coughlin and Grimes seem to be supported by an editorial of Weil (2), although no bibliographic reference was included in this paper.

    In my experience using a careful percutaneous Reverdin-Isham-Akin technique in more than 3,000 patients undergoing hallux valgus correction, not only did none of these complications occur, but also a satisfactory clinical outcome was observed (3,4). In order to avoid lesions of vessels, nerves or tendons it is important to pay attention to the surgical approach and protect the tissues with retractors, and use fluoroscopic control to perform the osteotomy.

    References:

    1. Coughlin M. Grimes JS. Commentary and Perspective on Percutaneous Distal Metatarsal Osteotomy for Correction of Hallux Valgus. J Bone J Surg June 2005. http//www.jbjs.org/Comments/2005/cp_jun05_coughlin.shtml

    2. Weil LS. Minimal invasive surgery of the foot and ankle. J Foot Ankle Surg. 2001;40:61.

    3. Pique-Vidal C. The effect of temperature elevation during discontinuous use of rotatory burrs in the correction of hallux valgus. J Foot Ankle. Surg. 2005; 44:336-44.

    4. Pique-Vidal C. Foot thickness and swelling after hallux valgus correction with the Reverdin-Isham procedure: a 4-month follow-up study. Foot Ankle Surg. 2005;11:35-39.

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