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Surgical treatment of advanced stage Freiberg disease

Year 2014, Volume: 41 Issue: 3, 502 - 506, 01.09.2014
https://doi.org/10.5798/diclemedj.0921.2014.03.0462

Abstract

Objective: Freiberg disesase is an avascular necrosis of the 2nd and 3rd metatarsal head and which kind of surgical option to be used is controversial in symptomatic patients. In this study the results of the advanced stage Freiberg's disease patients, who were treated with surgery were evaluated. Methods: 12 patients (8 female, 4 male) whose pain could not be solved with conservative method and underwent surgery (6 debridement, 3 osteotomy, 3 excision of the metatarsal head) were included in this study. The mean age of the patients 19.1 (range 13- 31) and the mean follow-up 30.8(range 25-94) months. According to the Smillie classification 3 patients had type 5, 8 patients had type 4 and 1 patient had type 3 osteonecrosis. The results of the patients were evaluated according to Lesser Metatarsophalangeal-Interphalangeal Scale. Results: According to Lesser Metatarsophalangeal-Interphalangeal Scale 3 patients (%25) had excellent, 6 patients (%50) had good and 3 patients had poor results were obtained. 2 of 3 patients with poor results were type 5, and 1 patient was type 4 and all three patients underwent joint debridement. Conclusion: The method of surgical treatment of Freiberg disease determined according to the stage of the disease. Debridement alone in the treatment of patients with late stage is not enough, it should be combined with other methods.

References

  • Smillie IS. Freiberg’s infarction (Kohler’s second disease). J Bone Joint Surg Br 1957;39:580.
  • Farrar MJ, Walker AP. Freiberg’s disease following fracture of the second metatarsal bone. The Foot 1997:7;52-53.
  • Murphy AG, Richardson GE. Lesser toe abnormalities. Campbell’s operative orthopaedics. Vol. 2, 11th ed. St. Louis Philadelphia: Mosby; 2008. 1252-1253.
  • Ihedioha U, Sinha S, Campbell AC. Surgery for symptomatic Freiberg ’s disease: Excision arthroplasty in eight patients. The Foot 2003;13:143-145.
  • Freiberg JA. The diagnosis and treatment of common painful conditions of the foot. Instr Course Lect 1957;14:238-247.
  • Gauthier G, Elbaz R. Freiberg’s infarction: A subchondral bone fatigue fracture: a new surgical treatment. Clin Orthop Relat Res 1979;42:93-95.
  • Kitaoka HB, Alexander IJ, Adelaar RS, et al. Clinical rating systems for the ankle-hindfoot, midfoot, hallux, andlesser- toes. Foot Ankle Int 1994;15:349-353.
  • Shih AT, Quint RE, Armstrong DG. Treatment of Freiberg’s infraction with the titanium hemi-implant. J Am Podiatr Med Assoc 2004;94:590-593.
  • Hayashi K, Ochi M, Uchio Y, et al. A new surgical tech- nique for treating bilateral Freiberg disease. Arthroscopy 2002;18:660-664.
  • McGlamry ED, Ruch JA. Status of implant arthroplasty of the lesser metatarsophalangeal joints. J Am Podiatry Assoc 1976;66:155-164.
  • Chao KH, Lee CH, Lin LC. Surgery for symptomatic Frei- berg’s disease: extraarticular dorsal closing wedging oste- otomy in 13 patients followed for 2-4 years. Acta Orthop Scand 1999;70:483-486.
  • Lee S, Chung M, Baek G. Treatment of Freiberg disease with intra-articular dorsal wedge osteotomy and absorbable pin fixation. Foot Ankle Int 2007;28:43-48.
  • Sansone V, Morandi A, Dupplicato P. Treatment of late- stage Freiburg’s disease using a temporary metal interposi- tional device. J Bone Joint Surg Br 2010;92:807-810.
  • Miyamoto W, Takao M, Uchio Y, et al. Late stage Freiberg disease treated by osteochondral plug transplantation: a case series. Foot Ankle Int 2008;29:950-955.
  • Ozkan Y, Ozturk A, Ozdemir R. Interpositional arthroplasty with extensor digitorum brevis tendon in Freiberg’s disease: a new surgical technique. Foot Ankle Int 2008;29:488-492.
  • Hofstaetter SG, Hofstaetter JG, Petroutsas JA, et al. The Weil osteotomy: a seven-year follow-up. J Bone Joint Surg Br 2005;87:1507-1511.

İleri evre Freiberg hastalığında cerrahi tedavi

Year 2014, Volume: 41 Issue: 3, 502 - 506, 01.09.2014
https://doi.org/10.5798/diclemedj.0921.2014.03.0462

Abstract

Amaç: Freiberg hastalığı sıklıkla 2. ve 3. metatars başını tutan bir avasküler nekrozdur ve semptomatik olgularda cerrahi tedavi yöntemi tartışmalıdır. Bu çalışmada cerrahi yöntemle tedavi edilen ileri evre Freiberg hastalarının sonuçları değerlendirildi. Yöntemler: Nonoperatif yöntemle ağrıları giderilemeyen ve cerrahi uygulanan (6 debridman, 3 osteotomi, 3 metatars başı eksizyonu) 12 hasta (8 kadın, 4 erkek) çalışmaya dahil edildi. Hastaların ortalama yaşı 19,1 (en küçük 13, en büyük 31) ve ortalama takip süresi 30,8 ay (en az 25, en çok 94 ay) idi. Hastaların 9\'unda 2. metatarsta, 3\'ünde 3. metatarsta tutulum vardı. Smillie sınıflama sistemine göre 3 hastada tip 5, 8 hastada tip 4 ve 1 hastada tip 3 osteonekroz mevcuttu. Hastaların sonuçları Lesser Metatarsophalangeal-Interphalangeal Skalasına göre değerlendirildi. Bulgular: Lesser Metatarsophalangeal-Interphalangeal skalasına göre 3 olguda mükemmel (%25), 6 olguda iyi (%50) ve 3 olguda (%25) kötü sonuç elde edildi. Kötü sonuç alınan hastaların 2\'si tip 5, 1\'i tip 4 idi ve her üç hastaya da eklem debridmanı uygulanmıştı. Sonuç: Freiberg hastalığının cerrahi tedavisinde seçilecek yöntem hastalığın evresine göre belirlenmelidir. Geç dönem hastaların tedavisinde debridman tek başına çoğu zaman yeterli olmadığı için diğer yöntemlerle kombine edilmelidir.

References

  • Smillie IS. Freiberg’s infarction (Kohler’s second disease). J Bone Joint Surg Br 1957;39:580.
  • Farrar MJ, Walker AP. Freiberg’s disease following fracture of the second metatarsal bone. The Foot 1997:7;52-53.
  • Murphy AG, Richardson GE. Lesser toe abnormalities. Campbell’s operative orthopaedics. Vol. 2, 11th ed. St. Louis Philadelphia: Mosby; 2008. 1252-1253.
  • Ihedioha U, Sinha S, Campbell AC. Surgery for symptomatic Freiberg ’s disease: Excision arthroplasty in eight patients. The Foot 2003;13:143-145.
  • Freiberg JA. The diagnosis and treatment of common painful conditions of the foot. Instr Course Lect 1957;14:238-247.
  • Gauthier G, Elbaz R. Freiberg’s infarction: A subchondral bone fatigue fracture: a new surgical treatment. Clin Orthop Relat Res 1979;42:93-95.
  • Kitaoka HB, Alexander IJ, Adelaar RS, et al. Clinical rating systems for the ankle-hindfoot, midfoot, hallux, andlesser- toes. Foot Ankle Int 1994;15:349-353.
  • Shih AT, Quint RE, Armstrong DG. Treatment of Freiberg’s infraction with the titanium hemi-implant. J Am Podiatr Med Assoc 2004;94:590-593.
  • Hayashi K, Ochi M, Uchio Y, et al. A new surgical tech- nique for treating bilateral Freiberg disease. Arthroscopy 2002;18:660-664.
  • McGlamry ED, Ruch JA. Status of implant arthroplasty of the lesser metatarsophalangeal joints. J Am Podiatry Assoc 1976;66:155-164.
  • Chao KH, Lee CH, Lin LC. Surgery for symptomatic Frei- berg’s disease: extraarticular dorsal closing wedging oste- otomy in 13 patients followed for 2-4 years. Acta Orthop Scand 1999;70:483-486.
  • Lee S, Chung M, Baek G. Treatment of Freiberg disease with intra-articular dorsal wedge osteotomy and absorbable pin fixation. Foot Ankle Int 2007;28:43-48.
  • Sansone V, Morandi A, Dupplicato P. Treatment of late- stage Freiburg’s disease using a temporary metal interposi- tional device. J Bone Joint Surg Br 2010;92:807-810.
  • Miyamoto W, Takao M, Uchio Y, et al. Late stage Freiberg disease treated by osteochondral plug transplantation: a case series. Foot Ankle Int 2008;29:950-955.
  • Ozkan Y, Ozturk A, Ozdemir R. Interpositional arthroplasty with extensor digitorum brevis tendon in Freiberg’s disease: a new surgical technique. Foot Ankle Int 2008;29:488-492.
  • Hofstaetter SG, Hofstaetter JG, Petroutsas JA, et al. The Weil osteotomy: a seven-year follow-up. J Bone Joint Surg Br 2005;87:1507-1511.
There are 16 citations in total.

Details

Primary Language Turkish
Journal Section Research Articles
Authors

Emin Özkul This is me

Mehmet Gem This is me

Celil Alemdar This is me

Hüseyin Arslan This is me

Ferit Boğatekin This is me

Gökhan Meriç This is me

Publication Date September 1, 2014
Submission Date March 1, 2015
Published in Issue Year 2014 Volume: 41 Issue: 3

Cite

APA Özkul, E., Gem, M., Alemdar, C., Arslan, H., et al. (2014). İleri evre Freiberg hastalığında cerrahi tedavi. Dicle Tıp Dergisi, 41(3), 502-506. https://doi.org/10.5798/diclemedj.0921.2014.03.0462
AMA Özkul E, Gem M, Alemdar C, Arslan H, Boğatekin F, Meriç G. İleri evre Freiberg hastalığında cerrahi tedavi. diclemedj. September 2014;41(3):502-506. doi:10.5798/diclemedj.0921.2014.03.0462
Chicago Özkul, Emin, Mehmet Gem, Celil Alemdar, Hüseyin Arslan, Ferit Boğatekin, and Gökhan Meriç. “İleri Evre Freiberg hastalığında Cerrahi Tedavi”. Dicle Tıp Dergisi 41, no. 3 (September 2014): 502-6. https://doi.org/10.5798/diclemedj.0921.2014.03.0462.
EndNote Özkul E, Gem M, Alemdar C, Arslan H, Boğatekin F, Meriç G (September 1, 2014) İleri evre Freiberg hastalığında cerrahi tedavi. Dicle Tıp Dergisi 41 3 502–506.
IEEE E. Özkul, M. Gem, C. Alemdar, H. Arslan, F. Boğatekin, and G. Meriç, “İleri evre Freiberg hastalığında cerrahi tedavi”, diclemedj, vol. 41, no. 3, pp. 502–506, 2014, doi: 10.5798/diclemedj.0921.2014.03.0462.
ISNAD Özkul, Emin et al. “İleri Evre Freiberg hastalığında Cerrahi Tedavi”. Dicle Tıp Dergisi 41/3 (September 2014), 502-506. https://doi.org/10.5798/diclemedj.0921.2014.03.0462.
JAMA Özkul E, Gem M, Alemdar C, Arslan H, Boğatekin F, Meriç G. İleri evre Freiberg hastalığında cerrahi tedavi. diclemedj. 2014;41:502–506.
MLA Özkul, Emin et al. “İleri Evre Freiberg hastalığında Cerrahi Tedavi”. Dicle Tıp Dergisi, vol. 41, no. 3, 2014, pp. 502-6, doi:10.5798/diclemedj.0921.2014.03.0462.
Vancouver Özkul E, Gem M, Alemdar C, Arslan H, Boğatekin F, Meriç G. İleri evre Freiberg hastalığında cerrahi tedavi. diclemedj. 2014;41(3):502-6.