Closed wedge osteotomy in 66 patients for the treatment of moderate to severe hallux valgus

Nedopil, Alexander; Rudert, Maximilian; Gradinger, Reiner; Schuster, Tibor; Bracker, Wolfgang

doi:10.1016/j.fas.2009.03.003

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Volume 16, Issue 1 , Pages 9-14, March 2010

Closed wedge osteotomy in 66 patients for the treatment of moderate to severe hallux valgus

Alexander Nedopil
- Department of Orthopaedics and Traumatology, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Str. 22, 81675 München, Germany
Maximilian Rudert
- Department of Orthopaedic Surgery, University of Würzburg, Brettreichstr. 11, 97074 Würzburg, Germany
- Corresponding author. Tel: +49 931 8031102; fax: +49 931 8031109.
Reiner Gradinger
- Department of Orthopaedics and Traumatology, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Str. 22, 81675 München, Germany
Tibor Schuster
- Institute of Medical Statistics and Epidemiology (IMSE), Klinikum rechts der Isar der Technischen Universität München, Ismaninger Str. 22, 81675 München, Germany
Wolfgang Bracker
- OCM Klinik, GmbH Steinerstraße 6, 81369 München, Germany

Received 11 September 2008; received in revised form 17 March 2009; accepted 31 March 2009. published online 18 May 2009.

Abstract

Background

The intention of this study was to analyze the long-term results of the proximal closing wedge osteotomy for the correction of hallux valgus deformity, modified by adding a mini L-plate for osteosynthesis.

Methods

The outcome of a proximal first metatarsal closing wedge osteotomy was retrospectively evaluated after a mean follow-up of 52 months. A total of 66 female patients (86 feet) participated in this study. The AOFAS-score was used to evaluate the postoperative results. Pre- and postoperative weight-bearing radiographs were used to evaluate the osseous development.

Results

95.5% of the patients were satisfied, 3 patients (4.5%) were not satisfied with the overall result of the operation. Transfer metatarsalgia was registered in 7 of 50 cases. The mean improvement of the HV-angle was 22.1° (36.4° to 14.3°) and the intermetatarsal angle was reduced from a mean of 17.6° to a mean of 6.5°. The mean first metatarsal shortening was 3.2mm. The mean AOFAS-score was 78 points.

Conclusion

The results confirm, that the closing wedge osteotomy is indicated for moderate to severe hallux valgus. The shortening of the first ray is comparable with other well-established operative procedures. The risk of transfer metatarsalgia can only be lightly reduced by this procedure.

Abbreviations: MTP, Metatarso-phalangeal, HV, Hallux valgus, IM, Intermetatarsal, ROM, Range of movement, CI, Confidence interval