This article is more than 5 years old. Information may no longer be current.
Opening wedge and chevron metatarsal osteotomies successful for hallux valgus
Both procedures showed similar clinical outcomes in patients with hallux valgus.
SAN FRANCISCO — Although researchers found that proximal medial-opening wedge and chevron metatarsal osteotomies provided similar pain relief, satisfaction and functional outcomes in patients with hallux valgus at 1-year follow-up, surgeons participating in the level 1 study preferred the opening wedge approach.
“Proximal medial-opening wedge osteotomy is equivalent, statistically speaking, to proximal chevron osteotomy with respect to operative time, all of our medical scores [and] hallux valgus correction. In fact, it is statistically better in terms of the intermetatarsal correction than the proximal chevron,” Michael Hickey, MD, FRCS(C), said during his presentation at the American Academy of Orthopaedic Surgeons 2012 Annual Meeting. “It also lengthens the metatarsal as opposed to proximal chevron osteotomy, [which] shortens it.”
Hickey and his colleagues, including primary author Mark Glazebrook, PhD, MD, FRCS(C), performed a prospective, randomized, multicenter study of 75 patients with hallux valgus. One group of patients underwent proximal medial-opening wedge osteotomy with plate fixation, and another was treated with proximal chevron osteotomy with screw fixation.
Surgical techniques
Surgeons performed the proximal chevron osteotomies approximately 1.5 cm distal to the tarso-metatarsal joint and directed the apex proximally. These were fixed with a screw after the distal fragment was redirected laterally, Hickey said.
The opening wedge osteotomies were performed in an oblique fashion about 1.5 cm distal to the tarso-metatarsal joint and were fixed with a low-profile wedge plate and screw construct,” he said.
Clinical outcome measurements included the AOFAS forefoot score, SF-36 and visual analog scale (VAS) for pain, activity and patient satisfaction.
Outcomes
Both groups had similar demographics and initial outcome measures, except that the opening wedge group started with a significantly larger body mass index and preoperative saggital plane deformity. The groups had similar operative times, Hickey said. At 1 year, both groups showed significant improvements in clinical outcome scores and pain relief, and investigators found no significant differences between the groups for any of the clinical outcome measures.
The opening wedge group showed more improvement in intermetatarsal angle correction than the chevron metatarsal group. The opening wedge procedure lengthened the first metatarsal, whereas the chevron procedure shortened it.– by Renee Blisard
Reference:For more information:
- Glazebrook M, Copithorne PG, Boyd G, et al. Randomized Controlled Trial: 1 year follow-up of proximal medial opening wedge vs. proximal chevron osteotomies for the treatment of hallux valgus with increased intermetatarsal angle. Paper #627. Presented at the American Academy of Orthopaedic Surgeons 2012 Annual Meeting. Feb. 7-11. San Francisco.
- Michael Hickey, MD, FRCS(C), can be reached at Dalhousie University, Halifax, Nova Scotia, Canada B3H 4R2; 902-473-7137; email: hickey.ortho@gmail.com.
- Mark Glazebrook, PhD, MD, FRCS(C), can be reached at Dalhousie University; 902-473-7137; email: markglazebr@ns.sympatico.ca.
- Disclosure: Hickey received a researched grant from Arthrex for this study.