Chevron Osteotomy with Herbert Screw Fixation for Treatment of Hallux Valgus Deformity Results

Year 2017, Volume: 24 Issue: 3, 75 - 83, 01.09.2017

Tuluhan Yunus Emre

https://doi.org/10.17343/sdutfd.266020

Abstract

Giriş

Halluks
valgus 1.parmağın abduktor ve adduktor kaslarında gelişen
dengesizlik sonucu meydana gelen ağrılı bir deformitedir. Chevron
osteotomisi hafif ve ortaşiddette seyreden halluks valgus
deformitelerin cerrahi tedavisinde etkili bir yöntemdir.

Gereç
ve Yöntem

Ortopedi
ve Travmatoloji kiliniğine başvuran, hafif ve orta şiddetli ağrılı
halluks valgus deformitesi olan 33 genç hasta çalışmaya dahil
edildi. Herbert vidası kullanılarak distal chevron osteotomy
uygulanan hastalar ortalama 18 ay (6-30 ay) takip edildi. Hastaların
değerlendirilmesinde preoperative ve postoperative 12. ayda The
American Orthopedic Foot and Ankle Society’s (AOFAS)
hallux-metatarsophalangeal-interphalangeal skalası kullanıldı.

Sonuçlar

Preoperatif
ve postoperatif ortalama halluks valgus açıları (HVA) sırasıyla
28.93 ° ± 6.66º ve 9.48 ° ± 3.21 ° olarak ölçüldü. HVA
arasındaki fark istatistiksel olarak anlamlı bulundu (p=0.0001).
İntermetatarsal açı (İMA) ise preoperative dönemde ortalama
11.51 ° ± 2.41 ‘den postoperatif dönemde ortalama 7.53°
± 2.10°
‘ye
düştüğü saptanmıştır (p = 0.0001). Metatarsofalanjial
dorsifleksiyon derecesinde 52.48 ° ± 9.71 °’den 61.90 ° ±
10.47 °’ye yükselme gözlenmiştir (p = 0.0001). Plantar
fleksiyon skorlarında ise anlamlı yükselme saptanmıştır (p
= 0.0001)
. Preoperatif AOFAS skoru ortalaması 43,77 ± 14.14 iken
postoperatif dönemde ortalama 85.38 ± 14.34 olarak saptanmıştır
(p = 0.0001).

Tartışma

Halluks
valgus cerrahisinde Herbert vidası ile yapılan Chevron osteotomisi
ile kalıcı rotasyonel ve translasyonel stabilite
sağlanabilmektedir.

Keywords

Halluks valgus, Chevron osteotomy

References

• 1. Singh SK, Jayasekera N, Nazir S, Sharif K, Kashif F. Use of a simple suture to stabilize the chevron osteotomy: a prospective study. J Foot Ankle Surg. 2004; 43 (5):307-311, .
• 2. Trnka HJ, Zembsch A, Easley ME, Salzer M. The Chevron osteotomy for correction of hallux valgus: Comparison of findings after two and five years of follow-up. Bone Joint Surg Am. 2000; 82 A(10):1373-1378, .
• 3. Caminear DS, Pavlovich R Jr, Pietrzak WS. Fixation of the chevron osteotomy with an absorbable copolymer pin for treatment of hallux valgus deformity. J Foot Ankle Surg. 2005; 44 (3):203-210.
• 4. Jacobson K, Gough A, Mendicino SS, Rockett MS. Mechanical comparison of fixation techniques for the offset V osteotomy: a saw bone study. J Foot Ankle Surg. 2003; 42 (6):339-43, .
• 5. Schneider W, Aigner N, Pinggera O, Knahr K. Chevron osteotomy in hallux valgus: ten-year results of 112 cases. J Bone Joint Surg Br. 2004; 86 (7):1016-1020, .
• 6. Winemaker MJ, Amendola A. Comparison of bioabsorbable pins and Kirschner wires in the fixation of Chevron osteotomies for hallux valgus. Foot Ankle Int. 1996; 17 (10):623-628.
• 7. Hanft JR, Kashuk KB, Bonner AC, Toney M, Schabler J. Rigid internal fixation of the Austin/chevron osteotomy with Herbert screw fixation: a retrospective study. J Foot Surg.1992; 31 (5):512-518.
• 8. Yearian PR, Brown T, Goldman F. Chevron bunionectomy with mi- croplate and screw fixation: a retrospective follow-up of 26 feet. J Foot Ankle Surg. 1996; 35 (6):532-536.
• 9. Small HN, Braly WG, Tullos HS. Fixation of the Chevron osteotomy utilizing absorbable polydioxanon pins. Foot Ankle Int.1995; 16 (6):346-350.
• 10. Barca F, Busa RA. Chevron osteotomy fixed with bioabsorbable poly-L-lactic acid single screw. J Foot Ankle Surg. 1997; 36 (1):15-20.
• 21. Baykal B, Kirdemir V, Ateşalp AS, Bek D, Tercan V. Modified crescentic proximal metatarsal osteotomy and distal soft tissue procedures in hallux valgus. Mil Med Dec.2006; 171 (12):1247-1250, .
• 22. Duke HF. Buried Kirschner wire fixation of the Austin osteotomy-bunionectomy: a preliminary report. J Foot Surg. 1986; 25 (3):197-203.
• 13. Ibrahim T, Beiri A, Azzabi M, Best AJ, Taylor GJ, Menon DK. Reliability and validity of the subjective component of the American Orthopedic Foot and Ankle Society clinical rating scales. J Foot Ankle Surg. 2007; 46 (2):65-74.
• 14. Quinn MR, DiStazio JJ, Kruljac SJ. Herbert bone screw fixation of the Austin bunionectomy. J Foot Surg. 1987; 26 (6):516-519.
• 15.Johnson JE, Clanton TO, Baxter DE, Gottlieb MS. Comparison of Chevron osteotomy and modified McBride bunionectomy for correction of mild to moderate hallux valgus deformity. Foot Ankle Int. 1991 12 (2):61-68.
• 16. Austin DW, Leventen EO. A new osteotomy for hallux valgus: a horizontally directed “V” displacement osteotomy of the metetarsal head for hallux valgus and primus varus. Clin Orthop Jun. 1981; 157:25-30.
• 17. Meier PJ, Kenzora JE. The risks and benefits of distal first metatarsal osteotomies. Foot Ankle Int. 1985; 6 (1):7-17.
• 18. Pochatko DJ, Schlehr FJ, Murphey MD, Hamilton JJ. Distal chevron osteotomy with lateral release for treatment of hallux valgus deformity. Foot Ankle Int. 1994; 15 (9):457-461.
• 19. Courtman NH, Weighill FJ. Distal first metatarsal osteotomy and adductor release as a treatment of hallux valgus. J R Coll Surg Edinb. 1995; 40 (2):133-5.
• 20. Peterson DA, Zilberfarb JL, Greene MA, Colgrove RC. Avascular necrosis of the first metatarsal head: incidence in distal osteotomy combined with lateral soft tissue release. Foot Ankle Int Feb 15;(2):59-63, 1994.
• 23. Park CH, Ahn JY, Kim YM, Lee WC. Plate fixation for proximal chevron osteotomy has greater risk for hallux valgus recurrence than Kirschner wire fixation. Int Orthop. 2013; 37 (6):1085-1092.
• 24. Mühlbauer M, Zembsch A, Trnka HJ. Short-term results of modified chevron osteotomy with soft tissue technique and guide wire fixation: a prospective study. Z Orthop Ihre Grenzgeb. 2001; 139 (5):435-9.
• 25. Kürklü M, Demiralp B, Yurttaş Y, Ciçek EI, Ateşalp AS. Modified chevron osteotomy fixed with stofella pin for hallux valgus. Foot Ankle Int. 2008; 29 (5):478-82.
• 26. Windhagen H, Radtke K, Weizbauer A, Diekmann J, Noll Y, Kreimeyer U, Schavan R, Stukenborg-Colsman C, Waizy H. Biodegradable magnesium-based screw clinically equivalent to titanium screw in hallux valgus surgery: short term results of the first prospective, randomized, controlled clinical pilot study. Biomed Eng Online 2013; 12:62-72.
• 27. Rossi WR, Ferreira JC. Chevron osteotomy for hallux valgus. Foot Ankle. 1992; 13 (7):378-81.
• 28. Klosok JK, Pring DJ, Jessop JH, Maffulli N. Chevron or Wilson metatarsal osteotomy for hallux valgus. A prospective randomized trial. J Bone Joint Surg.1993; 75 (5):825-829.