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Clinical and biomechanics effects of modified Helal osteotomy with screw fixation in forefoot reconstruction

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Abstract

Purpose

The object of this study was to assess the efficacy of Helal metatarsal osteotomy with screw fixation in patients with hammertoe deformities.

Methods

Thirty-five patients (66 feet, 66 metatarsals) with hammertoe deformity underwent Helal osteotomy with screw fixation after first ray reconstruction. Pre- and postoperative AOFAS scale results, podobarometry (in-shoe plantar pressure), and X-ray (angular) parameters were analyzed. The patients were examined before the operation and two, six, and 24 months postoperatively.

Results

The average AOFAS score was 59 (± 2.4) preoperatively and 96 (± 1.2) in 12 months after the operations. Pressure under the second and third metatarsal heads was decreased from 396 (± 52.3) kPa preoperatively to 240 (± 22.3) kPa 12 months postoperatively. Lateral subluxation of the second and third toes before the operation was observed in 62 (94%) feet, average metatarsophalangeal angle was 28.1 (± 3.3) degrees. While it was not found in any case 12 months after operation, in four (6.1%) feet, it became recurrent 24 months postoperatively; the average metatarsophalangeal angle was 5° (± 0.6).

Conclusion

Helal osteotomy with screw fixation demonstrated good-to-excellent results in 24 months postoperatively. It allows for a three-dimension lesser rays reconstruction: shortening, elevating, and lateral or medial displacement of the metatarsal head.

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Author information

Authors and Affiliations

  1. Microsurgical Department of University Clinic, Privolzhsky Research Medical University, Nizhny Novgorod, Russia

    Anton V. Kachesov & Oleg B. Nosov

  2. Department of Traumatology, Orthopedics and Disaster Surgery, Sechenov University, Moscow, Russia

    Dmitry S. Bobrov & Kirill D. Artemov

  3. Department of Traumatology, Military Medical Academy, Belgrade, Serbia

    Goran Lekic

Authors
  1. Anton V. Kachesov
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  2. Oleg B. Nosov
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  3. Dmitry S. Bobrov
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  4. Kirill D. Artemov
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  5. Goran Lekic
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Anton V. Kachesov, Oleg B. Nosov, Goran Lekic, Dmitry S. Bobrov, and Kirill D. Artemov. The first draft of the manuscript was written by Anton V. Kachesov, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Kirill D. Artemov.

Ethics declarations

Ethics approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of Sechenov University (17.05.2017 /no. 04-17).

Consent to publish

The authors affirm that human research participants provided informed consent for publication of the images in Figs. 2a, 2b, 2c, 2e, 2f, 2g, 2h, 3a, 3b, 3c, 3e, and 3f.

Competing interests

The authors declare no competing interests.

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Kachesov, A.V., Nosov, O.B., Bobrov, D.S. et al. Clinical and biomechanics effects of modified Helal osteotomy with screw fixation in forefoot reconstruction. International Orthopaedics (SICOT) 47, 2579–2583 (2023). https://doi.org/10.1007/s00264-023-05874-y

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  • DOI: https://doi.org/10.1007/s00264-023-05874-y

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