Extra-articular dorsal closing-wedge osteotomy in the treatment of late-stage Freiberg disease: clinical outcomes

Year 2017, Volume: 42 Issue: 3, 507 - 512, 30.09.2017

Osman Çiloğlu , Tuğhan Kalkan Muhsin Dursun Hakan Çiçek , Fırat Seyfettinoğlu , Ümit Tuhanioğlu

https://doi.org/10.17826/cutf.290345

Abstract

Purpose: The aim of this study was to evaluate the results of dorsal close wedge osteotomy in addition to the debridement application on Freiberg disease in terms of functional recovery and pain relief.

Material and Methods: Sixteen patients diagnosed with Freiberg disease (11 female,5 male) were included in the study and their articular surfaces were evaluated using direct roentgenogram and magnetic resonance imaging following the physical examination. The evaluation of the patients’ articular surface was based on Smilie Classification. The cases were evaluated previous to surgery and in the 12th week of the postoperative period using visual analogue scale (VAS) to determine pain levels and using American Orthopaedic Foot and Ankle Society score (AOFAS) score to assess their functional recovery.

Results: According to Smilie Classification, two cases were grade 2, six cases were grade 3, seven cases were grade 4 and one case was grade 5. The average dorsiflexion amount of the patients was 22 degrees (between 0 and 38) in preoperative period. It increased to 42 degrees on average (between 20 and 70) in the 12th week after the operation. The enlargement in arthroses and the swelling in metatarsophalangeal arthrosis due tosynovitis improved aesthetically in the 12th week after the operation.

Conclusion: The application of dorsal close wedge osteotomy in addition to debridement in the case of Freiberg disease is effective in the adjustment of the articular surface, in maintaining metatarsal length, in increasing the articular’s functionality.

Keywords

Debridement, Freiberg disease, close wedge osteotomy

İleri evre Freiberg hastalığında eklem dışı dorsal kapama kama osteotomisi: klinik sonuçlar

Abstract

Amaç: Bu çalışmanın amacı Freiberg hastalığında debridman uygulamasına ek olarak dorsal kapalı kama osteotomisinin sonuçlarını fonksiyonel iyileşme ve ağrı açısından değerlendirmektir.

Gereç ve Yöntem: Freiberg hastalığı teşhisi konulan 16 hasta (11 kadın, 5 erkek) çalışmaya dahil edildi. Hastaların fizik muayene sonrasında direk röntgenogram ve manyetik resonans görüntüleme ile eklem yüzeyleri değerlendirildi. Hastaların eklem yüzeyi değerlendirilmelerinde Smilie sınıflaması kullanıldı. Olguların ameliyat öncesi, ameliyat sonrası 12. haftada vizüel analog skalası (VAS) ile ağrı açısından ve American Orthopaedic Foot and Ankle Society (AOFAS) skoru ile fonksiyonel açıdan değerlendirmesi yapıldı.

Bulgular: Yapılan değerlendirmede Smilie sınıflamasına göre 2 olgu evre 2, 6 olgu evre 3, 7 olgu evre 4 ve 1 olgu ise evre 5 idi. Hastaların ameliyat öncesi ortalama dorsifleksiyon miktarları 22 derece (0 – 38 derece arası) iken ameliyat sonrası 12. haftada ortalama dorsifleksiyon miktarları 42 derece (20–70 derece arası) idi. Metatarsofalageal eklemdeki sinovite bağlı şişlik ve eklemdeki genişlemede ameliyat sonrası 12. haftada  kozmetik açıdan düzelme saptandı.

Sonuç: Freiberg hastalığında eklem debridmanı ile birlikte uygulanan dorsal kapalı kama osteotomisi eklem yüzeyinin uyumunun yeniden sağlanması ve metatars uzunluğunun korunması ile semptomların azaltılması ve eklem fonksiyonunun arttırılmasında etkili bir yöntemdir. 

Keywords

Debridman, Freiberg hastalığı, kapalı kama osteotomi, osteokondrosiz

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