Nonunion After Chevron Osteotomy: Incidence, Treatment, Follow-up, and Outcomes
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Published:
Apr 24, 2023
Keywords:
Hallux valgus, Chevron osteotomy, nonunion
Main Article Content
Abstract
Introduction: Hallux valgus is the most common disorder of the first toe. It causes pain, functional impairment, and alters gait patterns. Mild to moderate deformities are tipically corrected with distal osteotomies of the first metatarsal, such as the chevron osteotomy, a safe procedure, but not without complications. The objectives of this study were to determine the incidence of pseudarthrosis following this osteotomy and report our therapeutic method, follow-up, and outcomes.
Materials and Methods: A retrospective multicenter study was carried out, which included patients operated on between 2009 and 2018. A total of 1156 chevron osteotomies were evaluated as a treatment for mild to moderate hallux valgus in 1017 patients (age range 16 -83 years; average57.5 years) performed by 4 experienced surgeons. The inclusion criterion was that the patient had imaging studies compatible with pseudarthrosis six months after surgery.
Results: We evaluated five patients who met our criterion. The average AOFAS (American Orthopedic Foot and Ankle Society) scores were 51 before hallux valgus treatment and 87.8 after pseudarthrosis treatment.
Conclusion: The incidence of pseudarthrosis was 0.4% in the distant postoperative period. Our approach and treatment of pseudarthrosis achieved excellent clinical and functional improvements in all operated patients.
Materials and Methods: A retrospective multicenter study was carried out, which included patients operated on between 2009 and 2018. A total of 1156 chevron osteotomies were evaluated as a treatment for mild to moderate hallux valgus in 1017 patients (age range 16 -83 years; average57.5 years) performed by 4 experienced surgeons. The inclusion criterion was that the patient had imaging studies compatible with pseudarthrosis six months after surgery.
Results: We evaluated five patients who met our criterion. The average AOFAS (American Orthopedic Foot and Ankle Society) scores were 51 before hallux valgus treatment and 87.8 after pseudarthrosis treatment.
Conclusion: The incidence of pseudarthrosis was 0.4% in the distant postoperative period. Our approach and treatment of pseudarthrosis achieved excellent clinical and functional improvements in all operated patients.
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How to Cite
Córdoba, M. A., Mendoza Puello, C., Costanza, E., Devoto, M., Iglesias, A., & Rodríguez Castells, F. (2023). Nonunion After Chevron Osteotomy: Incidence, Treatment, Follow-up, and Outcomes. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 88(2), 177-186. https://doi.org/10.15417/issn.1852-7434.2023.88.2.1664
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Clinical Research
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References
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3. Coughlin MJ, Roger A. Mann Award. Juvenile hallux valgus: Etiology and treatment. Foot Ankle Int
1995;16(11):682-97. https://doi.org/10.1177/107110079501601104
4. Bai LB, Lee KB, Seo CY, Song EK, Yoon TR. Distal chevron osteotomy with distal soft tissue procedure for moderate to severe hallux valgus deformity. Foot Ankle Int 2010;31(8):683-8. https://doi.org/10.3113/FAI.2010.0683
5. Chuckpaiwong B. Comparing proximal and distal metatarsal osteotomy for moderate to severe hallux valgus. Int Orthop 2012;36(11):2275-8. https.//doi.org/10.1007/s00264-012-1656-9
6. Yee G, Lau J. Current concepts review: hallux rigidus. Foot Ankle Int 2008;29(6):637-46.
https://doi.org/10.3113/FAI.2008.0637
7. Deenik A, van Mameren H, de Visser E, de Waal Malefijt M, Draijer F, et al. Equivalent correction in scarf and chevron osteotomy in moderate and severe hallux valgus: a randomized controlled trial. Foot Ankle Int 2008;29(12):1209-15. https://doi.org/10.3113/FAI.2008.1209
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PMID: 7249456
9. Wirth CJ, Mutschler W-E, Bischoff H-P. Komplikationen in Orthopädie und Unfallchirurgie. Stuttgart: Thieme; 2010.
10. 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):1016-20. https://doi.org/10.1302/0301-620x.86b7.15108
11. Cueva-del Castillo JF, Valdés-Gutiérrez GA, Elizondo-Vázquez F, Pérez-Ortiz O, Piña BMC. Tratamiento de pérdidas óseas, pseudoartrosis, artrodesis y tumores óseos benignos con un xenoimplante mexicano (estudio clínico). Cir Ciruj 2009;77(4):287-91. Disponible en: https://www.medigraphic.com/pdfs/circir/cc-2009/cc094f.pdf
12. Rodriguez-Merchan EC, Forriol F. Nonunion: general principles and experimental data. Clin Orthop Relat Res 2004;(419):4-12. PMID: 15021125
13. Gelalis ID, Politis AN, Arnaoutoglou CM, Korompilias AV, Pakos EE, Vekris MD, et al. Diagnostic and treatment modalities in nonunions of the femoral shaft: A review. Injury 2012;43:(7):980-8.
https://doi.org/10.1016/j.injury.2011.06.030
14. Benazzo F, Mosconi M, Bove F, Quattrini F. Treatment of femoral diaphyseal non-unions: Our experience. Injury 2010;41(11):1156-60. https://doi.org/10.1016/j.injury.2010.08.010
15. W-Dahl A, Toksvig-Larsen S. Cigarette smoking delays bone healing: A prospective study of 200 patients operated on by the hemicallotasis technique. Acta Orthop Scand 2004;75(3):347-51.
https://doi.org/10.1080/00016470410001303
16. Kempf I, Grosse A, Rigaut P. The treatment of noninfected pseudarthrosis of the femur and tibia with locked intramedullary nailing. Clin Orthop Relat Res 1986;(212):142-54. PMID: 3769280
17. Salinas Gilabert JE, Lajara Marco F, Ruiz Herrera M. La osteotomía distal percutánea en el tratamiento de la metatarsalgia de los radios menores. Rev Esp Cir Ortop Traumatol 2009;53(3):192-7.
https://doi.org/10.1016/j.recot.2008.04.001
18. Mifsut D, Franco E, Turowicz M, Subías A, Cutillas B. Osteotomía de Weil percutánea en el tratamiento de las metatarsalgias: correlación clínico-radiológica. Rev Esp Cir Osteoart 2009;44(237):30-5. Disponible en: http://hdl.handle.net/10550/40727
19. Piqué-Vidal C. The effect of temperature elevation during discontinuous use of rotatory burrs in the correction of hallux valgus. J Foot Ankle Surg 2005;44(5):336-44. https://doi.org/10.1053/j.jfas.2005.07.009
20. Krause WR, Bradbury DW, Kelly JE, Lunceford EM. Temperature elevations in orthopaedic cutting operations. J Biomech 1982;15(4):267-75. https://doi.org/10.1016/0021-9290(82)90173-7
21. Richardson EG. Complications after hallux valgus surgery. Instr Course Lect 1999;48:331-42. PMID: 10098059
22. Vora AM, Myerson MS. First metatarsal osteotomy nonunion and malunion. Foot Ankle Clin 2005;10(1):117-27. https://doi.org/10.1016/j.fcl.2004.10.001
2. Coughlin MJ, Smith BW. Hallux valgus and first ray mobility. Surgical technique. J Bone Joint Surg Am 2008;90(Suppl 2, Pt 2):153-70. https://doi.org/10.2106/JBJS.H.00095
3. Coughlin MJ, Roger A. Mann Award. Juvenile hallux valgus: Etiology and treatment. Foot Ankle Int
1995;16(11):682-97. https://doi.org/10.1177/107110079501601104
4. Bai LB, Lee KB, Seo CY, Song EK, Yoon TR. Distal chevron osteotomy with distal soft tissue procedure for moderate to severe hallux valgus deformity. Foot Ankle Int 2010;31(8):683-8. https://doi.org/10.3113/FAI.2010.0683
5. Chuckpaiwong B. Comparing proximal and distal metatarsal osteotomy for moderate to severe hallux valgus. Int Orthop 2012;36(11):2275-8. https.//doi.org/10.1007/s00264-012-1656-9
6. Yee G, Lau J. Current concepts review: hallux rigidus. Foot Ankle Int 2008;29(6):637-46.
https://doi.org/10.3113/FAI.2008.0637
7. Deenik A, van Mameren H, de Visser E, de Waal Malefijt M, Draijer F, et al. Equivalent correction in scarf and chevron osteotomy in moderate and severe hallux valgus: a randomized controlled trial. Foot Ankle Int 2008;29(12):1209-15. https://doi.org/10.3113/FAI.2008.1209
8. Austin D, Leventen E. A new osteotomy for hallux valgus. Clin Orthop Relat Res 1981;(157):25-30.
PMID: 7249456
9. Wirth CJ, Mutschler W-E, Bischoff H-P. Komplikationen in Orthopädie und Unfallchirurgie. Stuttgart: Thieme; 2010.
10. 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):1016-20. https://doi.org/10.1302/0301-620x.86b7.15108
11. Cueva-del Castillo JF, Valdés-Gutiérrez GA, Elizondo-Vázquez F, Pérez-Ortiz O, Piña BMC. Tratamiento de pérdidas óseas, pseudoartrosis, artrodesis y tumores óseos benignos con un xenoimplante mexicano (estudio clínico). Cir Ciruj 2009;77(4):287-91. Disponible en: https://www.medigraphic.com/pdfs/circir/cc-2009/cc094f.pdf
12. Rodriguez-Merchan EC, Forriol F. Nonunion: general principles and experimental data. Clin Orthop Relat Res 2004;(419):4-12. PMID: 15021125
13. Gelalis ID, Politis AN, Arnaoutoglou CM, Korompilias AV, Pakos EE, Vekris MD, et al. Diagnostic and treatment modalities in nonunions of the femoral shaft: A review. Injury 2012;43:(7):980-8.
https://doi.org/10.1016/j.injury.2011.06.030
14. Benazzo F, Mosconi M, Bove F, Quattrini F. Treatment of femoral diaphyseal non-unions: Our experience. Injury 2010;41(11):1156-60. https://doi.org/10.1016/j.injury.2010.08.010
15. W-Dahl A, Toksvig-Larsen S. Cigarette smoking delays bone healing: A prospective study of 200 patients operated on by the hemicallotasis technique. Acta Orthop Scand 2004;75(3):347-51.
https://doi.org/10.1080/00016470410001303
16. Kempf I, Grosse A, Rigaut P. The treatment of noninfected pseudarthrosis of the femur and tibia with locked intramedullary nailing. Clin Orthop Relat Res 1986;(212):142-54. PMID: 3769280
17. Salinas Gilabert JE, Lajara Marco F, Ruiz Herrera M. La osteotomía distal percutánea en el tratamiento de la metatarsalgia de los radios menores. Rev Esp Cir Ortop Traumatol 2009;53(3):192-7.
https://doi.org/10.1016/j.recot.2008.04.001
18. Mifsut D, Franco E, Turowicz M, Subías A, Cutillas B. Osteotomía de Weil percutánea en el tratamiento de las metatarsalgias: correlación clínico-radiológica. Rev Esp Cir Osteoart 2009;44(237):30-5. Disponible en: http://hdl.handle.net/10550/40727
19. Piqué-Vidal C. The effect of temperature elevation during discontinuous use of rotatory burrs in the correction of hallux valgus. J Foot Ankle Surg 2005;44(5):336-44. https://doi.org/10.1053/j.jfas.2005.07.009
20. Krause WR, Bradbury DW, Kelly JE, Lunceford EM. Temperature elevations in orthopaedic cutting operations. J Biomech 1982;15(4):267-75. https://doi.org/10.1016/0021-9290(82)90173-7
21. Richardson EG. Complications after hallux valgus surgery. Instr Course Lect 1999;48:331-42. PMID: 10098059
22. Vora AM, Myerson MS. First metatarsal osteotomy nonunion and malunion. Foot Ankle Clin 2005;10(1):117-27. https://doi.org/10.1016/j.fcl.2004.10.001