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International Orthopaedics

, Volume 37, Issue 9, pp 1771–1780 | Cite as

Angular correction and complications of proximal first metatarsal osteotomies for hallux valgus deformity

  • Reinhard SchuhEmail author
  • Madeleine Willegger
  • Johannes Holinka
  • Robin Ristl
  • Reinhard Windhager
  • Axel H. Wanivenhaus
Original Paper

Abstract

Purpose

Proximal first metatarsal osteotomies are recommended for the surgical treatment of moderate to severe hallux valgus deformity. This study aimed to compare correction of intermetatarsal and hallux valgus angles and complications of proximal crescentic, Ludloff, proximal opening wedge, proximal closing wedge, proximal chevron and other proximal first metatarsal osteotomies.

Methods

A systematic search for the keywords “(bunion OR hallux) AND (proximal OR crescentic OR basilar OR opening OR closing OR shelf OR Ludloff) AND osteotomy” in the online databases MEDLINE, Embase, CINAHL, Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews was performed.

Results

There was a mean correction of hallux valgus angle of 20.1° [confidence interval (CI) 18.7–21.4] and of intermetatarsal angle of 8.1° (CI 7.7–8.9). The overall complication rate reached 18.7 %.

Conclusions

The results of this study reveal higher corrective power of proximal osteotomies compared to meta-analysis data on diaphyseal osteotomies.

Keywords

Corrective Power Wedge Osteotomy Hallux Valgus Angle Lock Plate Fixation Angular Correction 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Smith SE et al (2012) Scarf versus chevron osteotomy for the correction of 1–2 intermetatarsal angle in hallux valgus: a systematic review and meta-analysis. J Foot Ankle Surg 51:437–444PubMedCrossRefGoogle Scholar
  2. 2.
    Easley ME, Trnka HJ (2007) Current concepts review: hallux valgus part 1: pathomechanics, clinical assessment, and nonoperative management. Foot Ankle Int 28:654–659PubMedCrossRefGoogle Scholar
  3. 3.
    Trnka HJ (2005) Osteotomies for hallux valgus correction. Foot Ankle Clin 10:15–33PubMedCrossRefGoogle Scholar
  4. 4.
    Sammarco VJ, Acevedo J (2001) Stability and fixation techniques in first metatarsal osteotomies. Foot Ankle Clin 6:409–432PubMedCrossRefGoogle Scholar
  5. 5.
    Robinson AH, Limbers JP (2005) Modern concepts in the treatment of hallux valgus. J Bone Joint Surg Br 87:1038–1045PubMedCrossRefGoogle Scholar
  6. 6.
    Nyska M et al (2002) Proximal metatarsal osteotomies: a comparative geometric analysis conducted on sawbone models. Foot Ankle Int 23:938–945PubMedGoogle Scholar
  7. 7.
    Wagner E, Ortiz C (2012) Osteotomy considerations in hallux valgus treatment: improving the correction power. Foot Ankle Clin 17:481–498PubMedCrossRefGoogle Scholar
  8. 8.
    Easley ME, Trnka HJ (2007) Current concepts review: hallux valgus part II: operative treatment. Foot Ankle Int 28:748–758PubMedCrossRefGoogle Scholar
  9. 9.
    Wright JG. Levels of evidence and grades of recommendations: an evaluation of literature. American Academy of Orthopaedic Surgeons (AAOS)Google Scholar
  10. 10.
    Viechtbauer W (2010) Learning from the past: refining the way we study treatments. J Clin Epidemiol 63:980–982PubMedCrossRefGoogle Scholar
  11. 11.
    Bar-David T, Trepal MJ (1991) A retrospective analysis of distal Chevron and Basilar osteotomies of the first metatarsal for correction of intermetatarsal angles in the range of 13 to 16 degrees. J Foot Surg 30:450–456PubMedGoogle Scholar
  12. 12.
    Cedell CA, Aström M (1982) Proximal metatarsal osteotomy in hallux valgus. Acta Orthop Scand 53:1013–1018PubMedCrossRefGoogle Scholar
  13. 13.
    Chiang CC et al (2012) Distal linear osteotomy compared to oblique diaphyseal osteotomy in moderate to severe hallux valgus. Foot Ankle Int 33:479–486PubMedCrossRefGoogle Scholar
  14. 14.
    Chiodo CP, Schon LC, Myerson MS (2004) Clinical results with the Ludloff osteotomy for correction of adult hallux valgus. Foot Ankle Int 25:532–536PubMedGoogle Scholar
  15. 15.
    Choi WJ et al (2009) Comparison of the proximal chevron and Ludloff osteotomies for the correction of hallux valgus. Foot Ankle Int 30:1154–1160PubMedCrossRefGoogle Scholar
  16. 16.
    Chow FY et al (2008) Plate fixation for crescentic metatarsal osteotomy in the treatment of hallux valgus: an eight-year followup study. Foot Ankle Int 29:29–33PubMedCrossRefGoogle Scholar
  17. 17.
    Cooper MT et al (2007) Proximal opening-wedge osteotomy of the first metatarsal for correction of hallux valgus. Surg Technol Int 16:215–219PubMedGoogle Scholar
  18. 18.
    Coughlin MJ, Grimes S (2005) Proximal metatarsal osteotomy and distal soft tissue reconstruction as treatment for hallux valgus deformity. Keio J Med 54:60–65PubMedCrossRefGoogle Scholar
  19. 19.
    Coughlin MJ, Jones CP (2007) Hallux valgus and first ray mobility. A prospective study. J Bone Joint Surg Am 89:1887–1898PubMedCrossRefGoogle Scholar
  20. 20.
    Day T, Charlton TP, Thordarson DB (2011) First metatarsal length change after basilar closing wedge osteotomy for hallux valgus. Foot Ankle Int 32:S513–S518PubMedCrossRefGoogle Scholar
  21. 21.
    Dreeben S, Mann RA (1996) Advanced hallux valgus deformity: long-term results utilizing the distal soft tissue procedure and proximal metatarsal osteotomy. Foot Ankle Int 17:142–144PubMedCrossRefGoogle Scholar
  22. 22.
    Easley ME et al (1996) Prospective, randomized comparison of proximal crescentic and proximal chevron osteotomies for correction of hallux valgus deformity. Foot Ankle Int 17:307–316PubMedCrossRefGoogle Scholar
  23. 23.
    Fadel GE et al (2008) Fixation of first metatarsal basal osteotomy using Acutrak screw. Foot Ankle Surg 14:21–25PubMedCrossRefGoogle Scholar
  24. 24.
    Fox IM, Caffiero L, Pappas E (1999) The crescentic first metatarsal basilar osteotomy for correction of metatarsus primus varus. J Foot Ankle Surg 38:203–207PubMedCrossRefGoogle Scholar
  25. 25.
    Gallentine JW, Deorio JK, Deorio MJ (2007) Bunion surgery using locking-plate fixation of proximal metatarsal chevron osteotomies. Foot Ankle Int 28:361–368PubMedCrossRefGoogle Scholar
  26. 26.
    Glover JP et al (2008) Early results of the Mau osteotomy for correction of moderate to severe hallux valgus: a review of 24 cases. J Foot Ankle Surg 47:237–242PubMedCrossRefGoogle Scholar
  27. 27.
    Granberry WM, Hickey CH (1995) Hallux valgus correction with metatarsal osteotomy: effect of a lateral distal soft tissue procedure. Foot Ankle Int 16:132–138PubMedCrossRefGoogle Scholar
  28. 28.
    Haas Z et al (2007) Maintenance of correction of first metatarsal closing base wedge osteotomies versus modified Lapidus arthrodesis for moderate to severe hallux valgus deformity. J Foot Ankle Surg 46:358–365PubMedCrossRefGoogle Scholar
  29. 29.
    Hofstaetter SG et al (2006) The modified ludloff osteotomy for correction of severe metatarsus primus varus with hallux valgus deformity. Z Orthop Ihre Grenzgeb 144(2):141–147PubMedCrossRefGoogle Scholar
  30. 30.
    Hyer CF et al (2008) A comparison of the crescentic and Mau osteotomies for correction of hallux valgus. J Foot Ankle Surg 47:103–111PubMedCrossRefGoogle Scholar
  31. 31.
    Jensen NC, Søballe K, Christiansen SE (1989) Correction of hallux valgus and metatarsus primus varus. Using the Cedell technique. Orthopedics 12:421–424PubMedGoogle Scholar
  32. 32.
    Lee KB et al (2009) Outcome of unilateral versus simultaneous correction for hallux valgus. Foot Ankle Int 30:120–123PubMedCrossRefGoogle Scholar
  33. 33.
    Lee KB et al (2008) Outcome of proximal chevron osteotomy for hallux valgus with and without transverse Kirschner wire fixation. Foot Ankle Int 29:1101–1106PubMedCrossRefGoogle Scholar
  34. 34.
    Lee WC, Kim YM (2007) Correction of hallux valgus using lateral soft-tissue release and proximal Chevron osteotomy through a medial incision. J Bone Joint Surg Am 89:82–89PubMedCrossRefGoogle Scholar
  35. 35.
    Limbird TJ, DaSilva RM, Green NE (1989) Osteotomy of the first metatarsal base for metatarsus primus varus. Foot Ankle 9:158–162PubMedCrossRefGoogle Scholar
  36. 36.
    Lüthje P (1990) Long-term results of proximal metatarsal osteotomy in hallux valgus. J Am Podiatr Med Assoc 80:304–306PubMedGoogle Scholar
  37. 37.
    Mann RA, Rudicel S, Graves SC (1992) Repair of hallux valgus with a distal soft-tissue procedure and proximal metatarsal osteotomy. A long-term follow-up. J Bone Joint Surg Am 74:124–129PubMedGoogle Scholar
  38. 38.
    Markbreiter LA, Thompson FM (1997) Proximal metatarsal osteotomy in hallux valgus correction: a comparison of crescentic and chevron procedures. Foot Ankle Int 18:71–76PubMedCrossRefGoogle Scholar
  39. 39.
    Nedopil A et al (2010) Closed wedge osteotomy in 66 patients for the treatment of moderate to severe hallux valgus. Foot Ankle Surg 16:9–14PubMedCrossRefGoogle Scholar
  40. 40.
    Okuda R et al (2000) Distal soft tissue procedure and proximal metatarsal osteotomy in hallux valgus. Clin Orthop Relat Res 379:209–217PubMedCrossRefGoogle Scholar
  41. 41.
    Okuda R et al (2005) Proximal metatarsal osteotomy: relation between 1- to greater than 3-years results. Clin Orthop Relat Res 435:191–196PubMedCrossRefGoogle Scholar
  42. 42.
    Okuda R et al (2008) Proximal metatarsal osteotomy for hallux valgus: comparison of outcome for moderate and severe deformities. Foot Ankle Int 29:664–670PubMedCrossRefGoogle Scholar
  43. 43.
    Paczesny L, Kruczyński J, Adamski R (2009) Scarf versus proximal closing wedge osteotomy in hallux valgus treatment. Arch Orthop Trauma Surg 129:1347–1352PubMedCrossRefGoogle Scholar
  44. 44.
    Pearson SW et al (1991) Results and complications following a proximal curved osteotomy of the hallux metatarsal. Contemp Orthop 23:127–132PubMedGoogle Scholar
  45. 45.
    Pehlivan O et al (2004) Proximal oblique crescentic osteotomy in hallux valgus. J Am Podiatr Med Assoc 94:43–46PubMedGoogle Scholar
  46. 46.
    Petratos DV et al (2008) Correction of adolescent hallux valgus by proximal crescentic osteotomy of the first metatarsal. Acta Orthop Belg 74:496–502PubMedGoogle Scholar
  47. 47.
    Randhawa S, Pepper D (2009) Radiographic evaluation of hallux valgus treated with opening wedge osteotomy. Foot Ankle Int 30:427–431PubMedCrossRefGoogle Scholar
  48. 48.
    Resch S, Stenström A, Egund N (1989) Proximal closing wedge osteotomy and adductor tenotomy for treatment of hallux valgus. Foot Ankle 9:272–280PubMedCrossRefGoogle Scholar
  49. 49.
    Ritschl P et al (1999) Hallux valgus: a therapy concept and its outcome from 1993 to 1996. Z Orthop Ihre Grenzgeb 137:521–527PubMedCrossRefGoogle Scholar
  50. 50.
    Robinson AH et al (2009) Prospective comparative study of the scarf and Ludloff osteotomies in the treatment of hallux valgus. Foot Ankle Int 30:955–963PubMedCrossRefGoogle Scholar
  51. 51.
    Sammarco GJ, Brainard BJ, Sammarco VJ (1993) Bunion correction using proximal Chevron osteotomy. Foot Ankle 14:8–14PubMedCrossRefGoogle Scholar
  52. 52.
    Sammarco GJ, Russo-Alesi FG (1998) Bunion correction using proximal chevron osteotomy: a single-incision technique. Foot Ankle Int 19:430–437PubMedCrossRefGoogle Scholar
  53. 53.
    Saragas NP (2009) Proximal opening-wedge osteotomy of the first metatarsal for hallux valgus using a low profile plate. Foot Ankle Int 30:976–980PubMedCrossRefGoogle Scholar
  54. 54.
    Seiberg M, et al (1994) 1994 William J. Stickel Silver Award. Closing base wedge versus Austin bunionectomies for metatarsus primus adductus. J Am Podiatr Med Assoc 84:548–563PubMedGoogle Scholar
  55. 55.
    Señarís-Rodríguez J et al (1998) Surgical treatment for bunions in adolescents. J Pediatr Orthop B 7:210–216PubMedCrossRefGoogle Scholar
  56. 56.
    Shurnas PS, Watson TS, Crislip TW (2009) Proximal first metatarsal opening wedge osteotomy with a low profile plate. Foot Ankle Int 30:865–872PubMedCrossRefGoogle Scholar
  57. 57.
    Smith WB et al (2009) Opening wedge osteotomies for correction of hallux valgus: a review of wedge plate fixation. Foot Ankle Spec 2:277–282PubMedCrossRefGoogle Scholar
  58. 58.
    Takao M et al (2007) Proximal oblique-domed osteotomy of the first metatarsal for the treatment of hallux valgus associate with flat foot: effect to the correction of the longitudinal arch of the foot. Arch Orthop Trauma Surg 127:685–690PubMedCrossRefGoogle Scholar
  59. 59.
    Tanaka Y et al (2008) Proximal spherical metatarsal osteotomy for the foot with severe hallux valgus. Foot Ankle Int 29:1025–1030PubMedCrossRefGoogle Scholar
  60. 60.
    Thordarson DB, Leventen EO (1992) Hallux valgus correction with proximal metatarsal osteotomy: two-year follow-up. Foot Ankle 13:321–326PubMedCrossRefGoogle Scholar
  61. 61.
    Treadwell JR (2005) Rail external fixation for stabilization of closing base wedge osteotomies and lapidus procedures: a retrospective analysis of sixteen cases. J Foot Ankle Surg 44:429–436PubMedCrossRefGoogle Scholar
  62. 62.
    Trnka HJ et al (2008) Intermediate-term results of the Ludloff osteotomy in one hundred and eleven feet. J Bone Joint Surg Am 90:531–539PubMedCrossRefGoogle Scholar
  63. 63.
    Trnka HJ et al (1999) Basal closing wedge osteotomy for correction of hallux valgus and metatarsus primus varus: 10- to 22-year follow-up. Foot Ankle Int 20:171–177PubMedCrossRefGoogle Scholar
  64. 64.
    Veri JP, Pirani SP, Claridge R (2001) Crescentic proximal metatarsal osteotomy for moderate to severe hallux valgus: a mean 12.2 year follow-up study. Foot Ankle Int 22:817–822PubMedGoogle Scholar
  65. 65.
    Walther M et al (2008) The proximal open-wedge osteotomy with interlocking plate for correction of splayfoot deformities with hallux valgus. Oper Orthop Traumatol 20:452–462PubMedCrossRefGoogle Scholar
  66. 66.
    Wukich DK, Roussel AJ, Dial DM (2009) Correction of metatarsus primus varus with an opening wedge plate: a review of 18 procedures. J Foot Ankle Surg 48:420–426PubMedCrossRefGoogle Scholar
  67. 67.
    Zembsch A et al (1998) Long-term results of basal wedge osteotomy in metatarsus primus varus in the young patient. Z Orthop Ihre Grenzgeb 136:243–249PubMedCrossRefGoogle Scholar
  68. 68.
    Zettl R et al (2000) Moderate to severe hallux valgus deformity: correction with proximal crescentic osteotomy and distal soft-tissue release. Arch Orthop Trauma Surg 120:397–402PubMedCrossRefGoogle Scholar
  69. 69.
    Park CH et al (2013) A comparison of proximal and distal chevron osteotomy for the correction of moderate hallux valgus deformity. Bone Joint J 95:649–656PubMedCrossRefGoogle Scholar
  70. 70.
    Scott AT et al (2010) Biomechanical comparison of hallux valgus correction using the proximal chevron osteotomy fixed with a medial locking plate and the Ludloff osteotomy fixed with two screws. Clin Biomech (Bristol, Avon) 25:271–276CrossRefGoogle Scholar
  71. 71.
    Varner KE et al (2009) Screw versus plate fixation of proximal first metatarsal crescentic osteotomy. Foot Ankle Int 30:142–149PubMedCrossRefGoogle Scholar
  72. 72.
    Hofstaetter SG et al (2008) Biomechanical comparison of screws and plates for hallux valgus opening-wedge and Ludloff osteotomies. Clin Biomech (Bristol, Avon) 23:101–108CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Reinhard Schuh
    • 1
    Email author
  • Madeleine Willegger
    • 1
  • Johannes Holinka
    • 1
  • Robin Ristl
    • 2
  • Reinhard Windhager
    • 1
  • Axel H. Wanivenhaus
    • 1
  1. 1.Department of OrthopaedicsMedical University of ViennaViennaAustria
  2. 2.Section for Medical Statistics, Center for Medical Statistics, Informatics, and Intelligent SystemsMedical University of ViennaViennaAustria

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