Medica Jadertina, Vol. 41 No. 3-4, 2011.
Izvorni znanstveni članak
Simultaneous surgical correction of hallux valgus and lesser toes deformity
Ivica Lucijanić
; Opća bolnica Karlovac, Služba za ortopediju
Tatjana Cicvara-Pećina
; KB Dubrava, Zavod za dijagnostičku i interventnu radiologiju, Zagreb
Goran Bićanić
; Klinički bolnički centar Zagreb, Klinika za ortopediju
Marko Pećina
; Medicinski fakultet Sveučilišta u Zagrebu
Sažetak
The purpose of this study was to present results of simultaneous correction of hallux valgus and lesser toes deformity. In the Department of Orthopaedic Surgery, Karlovac General Hospital, between 2000 and 2009, 74 patients (87 feet) underwent new three-dimensional (3-D) osteotomy for hallux valgus (Lucijanić's method) combined with lesser toes surgery or lesser metatarsal osteotomy. Correction deformities included proximal interphalangeal resection arthroplasty, extensor tendon lengthening, resection of both bases of the second and third toes with a subtotal webbing of toes two and three (syndactylisation).The Weil osteotomy on the lesser metatarsal was performed in 11 cases with excess of the lesser metatarsal length. Clinical and radiological evaluation was performed with an average follow up of 60.5 months (range: 12-127 months).
The average patient age at the time of surgical treatment was 56.5 years (27-70), 97.3% were women. The average hallux valgus angle significantly decreased from 33.5 +- 8 to 11.4 +- 6.8 while the intermetatarsal angle significantly decreased from 14.3 +- 3.6 to 6.1 +- 3.2. The first metatarsal distal articular surface angle
was reduced in average from 16.8 +- 6.7 to -1.4 +- 7.4. The first metatarsophalangeal joint congruence of
average 1.3 +- 0.9 grade was corrected to 0.2 +- 0.5. The sesamoid position was corrected from an average preoperative grade of 2.5 +- 0.7 to a grade of 0.4 +- 1.2 at final follow-up. The first metatarsal declination angle was increased from 22.6 +- 3.7 to 28.5 -+ 4.6. The first metatarsal pronation angle was corrected from 7.2 +- 6.9 to 0.2 -+- 5.6. The relative length of the first and the second metatarsals was reduced from 2.4 +- 3.7 to -4.7 +- 3.7 millimetres. The first metatarsal shortened an average of 7.1 millimetres compensated with
plantar displacement of the metatarsal head at the osteotomy site.
The preoperative AOFAS' hallux-metatarsophalangeal-interfhalangeal score averaged 37.1 +- 11.2 which increased significantly to 87.8 +- 9.4 postoperatively (p < 0.001). The overall outcome was rated as
excellent and good in 85% of cases (10 fair, 3 poor). Complication included recurrence of deformity in six cases. Prolonged swelling was found in three cases. There were one case of superficial infection and one case of vein thrombosis two weeks after surgery. The results of this study confirmed the author's procedure as very useful surgical technique for correction of a moderate to sever hallux valgus deformity. Its combination with various procedures for lesser toes ensures complete correction of main forefoot disorders.
Ključne riječi
Hallux valgus; lesser toe deformity; surgical treatment; three-dimensional osteotomy
Hrčak ID:
77241
URI
Datum izdavanja:
1.2.2012.
Posjeta: 6.021 *