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Üç Farklı Osteotomi İle Tedavi Edilen Halluks Valgus Hastalarında, Sesamoid Kemik Redüksiyonun Değerlendirilmesi

Year 2018, Volume: 2 Issue: 2, 91 - 95, 02.07.2018
https://doi.org/10.30565/medalanya.399896

Abstract

Amaç: Bu çalışmanın amacı halluks valgus cerrahisinde üç farklı osteotominin sesamoid rotasyonuna etkisini araştırmaktır. 

Yöntem: Mart 2012-Ocak 2015 arasında 108 hastanın 64'ü retrospektif olarak incelendi. Sırasıyla 26,18 ve 20 hastaya distal chevron osteotomisi, proksimal domeosteotomisi ve lapidus osteotomisi uygulandı. Hastaların yaş ortalaması 46,6 (26-62) ve takip süresi ortalama 17 ay (12- 26) idi. 

Bulgular: Son kontrollerinde ortalama Halluks valgus açısı 18.4º , intermetatarsal açısı 7.4 º, AOFAS skoru 86.1, sesamoid rotasyonu 13,5 idi. Preoperatif ve postoperatif sesamoid rotasyon farklılıkları sesamoid pozisyonlarının çoğunu kendi başlarına düzeltebilme kabiliyetleri açısından üç farklı osteotomi karşılaştırıldığında, Lapidus osteotomisi yapılan hastalarda hem proksimal dome yapılan hastalara göre (p:0.02) hem de distal chevron yapılan hastalara göre (p:0.000) sesamoid redüksiyonu başarısı açısından anlamlı bir fark bulunmuştur. Proksimal dome yapılan hastalarla distal chevron yapılan hastalar arasında sesamoid redüksiyon başarısı açısından anlamlı bir fark bulunmamıştır (p=0.242). 













Sonuç: Lapidus osteotomisi uygulanan hastalarda hem sesamoid rotasyon açılarının değişimi bakımından hem de sesamoid redüksiyonu açısından diğer iki osteotomi çeşidine göre daha iyi sonuçlar bulunmuştur. Çalışmamıza göre, Lapidus prosedürünün, sesamoid redüksiyonun nüks ile ilişkili olduğu düşünüldüğünde, orta ve şiddetli halluks valguslu hastalarda daha iyi sonuçlar vereceğini düşünüyoruz. 

References

  • 1. Alexander Ian J. Pathophysiology of hallux valgus. J Foot ankle Surg 2000; 1: 39-43.
  • 2. Andrew H. N. Robinson. Variation of the Distal Metatarsal Articular Angle with Axial Rotation and Inclination of the First Metatarsal. Foot & Ankle Internatıonal. 2006; 27(12):1036-40
  • 3. Banks AS.,Downey MS, McGlamry's. Comprehensive Textbook of Foot and Ankle Surgery. 3nd ed, Lipincott Williams, Philadelphia. 2004; pp :145-148
  • 4. Campbell's Operative Orthopaedics, 11th ed. pp:4471-4472
  • 5. Catanese D, Popowitz D, Gladstein AZ. Measuring Sesamoid Position in Hallux Valgus: When Is the Sesamoid Axial View Necessary? Foot Ankle Spec. 2014;7(6):457-9
  • 6. Christman RA, Foot and Ankle Radiology 3th ed, Churchill-Livingstone. 2002; pp:132-133
  • 7. Christy M. King, Graham A. Hamilton, Effects of the lapidus arthrodesis and chevron bunionectomy on plantar forefoot pressures. The Journal of Foot & Ankle Surgery. 2014; 53: 415–419
  • 8. Fox HR, Fırsheın DB. Variation in practitioner-measured x-ray angles in hallux abductovalgus evaluation. J Foot Surg. 1989; 28: 33-41
  • 9. Haines RW. The anatomy of hallux valgus. J Bone Joint Surg. 1954; 36(B): 272-294.
  • 10. Kuwano T.Nagamine R, Sakaki K. New radıographic analysis of sesamoid rotation in hallux valgus: camparasion with conventional evaluation methods. Foot Ankle Int. 2002:23(9):811-7
  • 11. Lapidus P.W., History and mechanics of the bunion. J Bone Joint Surg Am. 1940; 22:627-637.
  • 12. Laporta DM, Melıllo TV, hetherıngton VJ. Preoperative assessment in hallux valgus and forefoot surgery, ed by VJ Hetherington. Churchill Livingstone, New York. 1994; p:107 -108
  • 13. Lazarides SP. Hildreth A. Association amongst angular deformities in Hallux Valgus and impact of the deformity in health-related quality of life. Foot and Ankle Surgery. 2005; 11: 193–196
  • 14. Lui TH, Chan KB, Chan LK. Endoscopic distal soft release in the treatment of halluks valgus: a cadaveric study. Arthroskopy. 2010;26: 8-14
  • 15. Mann RA, Coughlin MJ, DuVries HL. Hallux Valgus: A review of the literature and a method of treatment. Clin Orthop Relat Res. 1979; 142: 270- 276
  • 16. Mann RA, Coughlin MJ. Hallux valgus etiology, anatomy, treatment and surgical considerations. Clin Orthop. 1981; 157: 31-41.
  • 17. Markbreiter LA, Thompson FM. Proximal metatarsal osteotomy in hallux valgus correction : a comparison of crescentic and chevron procedures. Foot Ankle Int. 1997;18(2):71-76.
  • 18. Okuda R, Kinoshita M, Postoperative incomplete reduction of the sesamoids as a risk factor for recurrence of hallux valgus. J Bone Joint Surg Am. 2009; 91: 1637-45
  • 19. Palladıno SJ. Preoperative evaluation of the bunion patient: etiology, biomechanics, clinical and radiographic assessment, Textbook of Bunion Surgery, 2nd Ed. 1991; p:107
  • 20. Park CH, Jang JH, Lee WC A Comparasion of proximal and distal chevron osteotomy fort he correction of moderate hallux valgus deformity. Bone joint J. 2013; 6: 649-56
  • 21. Steven M, Raikin M, Adam G et al. Recurrence of Hallux Valgus A Review. Foot Ankle Clin N Am. 2014; 19: 259–274
  • 22. Suzuki J, Tanak Y, Takaoka Y et al. Axial radiographic evaluation in hallux valgus: evaluation of the transverse arch in the forefoot. Ort.Science. 2004; 9: 446 – 451
  • 23. Yıldırım Y Cubukcuoğlu C. Effect of metatarsophalangeal joint position on the reliability of the tangential sesamoid view in determining sesamoid position. Foot and ankle. 2005; 3: 247 – 251

Evaluation of Sesamoid Bone Reduction in Hallux Valgus Patients Treated With Three Different Osteotomy

Year 2018, Volume: 2 Issue: 2, 91 - 95, 02.07.2018
https://doi.org/10.30565/medalanya.399896

Abstract

Aim:The aim of this study is to investigate the effect of three different osteotomies on sesamoid rotation in hallux valgus surgery. 

Patients and Method: 64 out of 108 patients between March 2012-January 2015 were included retrospectively. Procedure of distal chevron, proximal dome and lapidus was applied to 26,18 and 20 patients respectively. Mean age of patients was 46,6 (26-62) and mean time of follow-up was 17 months. 

Results: At the last follow - up of patients, the mean hallux valgus angle was 18.4º, intermetatarsal angle was 7.4 º, AOFAS score was 86.1, sesamoid rotation was 13,5. When three different osteotomies were compared in terms of preop and postop sesamoid rotation differences in terms of their ability to correct most sesamoid position within themselves, a significant difference was found in patients treated with lapidus osteotomy in terms of success of sesamoid reduction compared to both patients treated with proximal dome osteotomy (p: 0.02) and patients treated with distal chevron osteotomy (p: 0.000). There was no significant difference in the success rate of sesamoid reduction between patients with proximal dome and patients with distal chevron. (P = 0.242) 













Discussion: Patients treated with lapidus osteotomy; both sesamoid rotation angle changes and sesamoid reduction were found to be better than the other two osteotomy types. According to the study, we think that the lapidus procedure will give better results in patients with moderate and severe hallux valgus when sesamoid reduction is considered to be related to recurrence. 

References

  • 1. Alexander Ian J. Pathophysiology of hallux valgus. J Foot ankle Surg 2000; 1: 39-43.
  • 2. Andrew H. N. Robinson. Variation of the Distal Metatarsal Articular Angle with Axial Rotation and Inclination of the First Metatarsal. Foot & Ankle Internatıonal. 2006; 27(12):1036-40
  • 3. Banks AS.,Downey MS, McGlamry's. Comprehensive Textbook of Foot and Ankle Surgery. 3nd ed, Lipincott Williams, Philadelphia. 2004; pp :145-148
  • 4. Campbell's Operative Orthopaedics, 11th ed. pp:4471-4472
  • 5. Catanese D, Popowitz D, Gladstein AZ. Measuring Sesamoid Position in Hallux Valgus: When Is the Sesamoid Axial View Necessary? Foot Ankle Spec. 2014;7(6):457-9
  • 6. Christman RA, Foot and Ankle Radiology 3th ed, Churchill-Livingstone. 2002; pp:132-133
  • 7. Christy M. King, Graham A. Hamilton, Effects of the lapidus arthrodesis and chevron bunionectomy on plantar forefoot pressures. The Journal of Foot & Ankle Surgery. 2014; 53: 415–419
  • 8. Fox HR, Fırsheın DB. Variation in practitioner-measured x-ray angles in hallux abductovalgus evaluation. J Foot Surg. 1989; 28: 33-41
  • 9. Haines RW. The anatomy of hallux valgus. J Bone Joint Surg. 1954; 36(B): 272-294.
  • 10. Kuwano T.Nagamine R, Sakaki K. New radıographic analysis of sesamoid rotation in hallux valgus: camparasion with conventional evaluation methods. Foot Ankle Int. 2002:23(9):811-7
  • 11. Lapidus P.W., History and mechanics of the bunion. J Bone Joint Surg Am. 1940; 22:627-637.
  • 12. Laporta DM, Melıllo TV, hetherıngton VJ. Preoperative assessment in hallux valgus and forefoot surgery, ed by VJ Hetherington. Churchill Livingstone, New York. 1994; p:107 -108
  • 13. Lazarides SP. Hildreth A. Association amongst angular deformities in Hallux Valgus and impact of the deformity in health-related quality of life. Foot and Ankle Surgery. 2005; 11: 193–196
  • 14. Lui TH, Chan KB, Chan LK. Endoscopic distal soft release in the treatment of halluks valgus: a cadaveric study. Arthroskopy. 2010;26: 8-14
  • 15. Mann RA, Coughlin MJ, DuVries HL. Hallux Valgus: A review of the literature and a method of treatment. Clin Orthop Relat Res. 1979; 142: 270- 276
  • 16. Mann RA, Coughlin MJ. Hallux valgus etiology, anatomy, treatment and surgical considerations. Clin Orthop. 1981; 157: 31-41.
  • 17. Markbreiter LA, Thompson FM. Proximal metatarsal osteotomy in hallux valgus correction : a comparison of crescentic and chevron procedures. Foot Ankle Int. 1997;18(2):71-76.
  • 18. Okuda R, Kinoshita M, Postoperative incomplete reduction of the sesamoids as a risk factor for recurrence of hallux valgus. J Bone Joint Surg Am. 2009; 91: 1637-45
  • 19. Palladıno SJ. Preoperative evaluation of the bunion patient: etiology, biomechanics, clinical and radiographic assessment, Textbook of Bunion Surgery, 2nd Ed. 1991; p:107
  • 20. Park CH, Jang JH, Lee WC A Comparasion of proximal and distal chevron osteotomy fort he correction of moderate hallux valgus deformity. Bone joint J. 2013; 6: 649-56
  • 21. Steven M, Raikin M, Adam G et al. Recurrence of Hallux Valgus A Review. Foot Ankle Clin N Am. 2014; 19: 259–274
  • 22. Suzuki J, Tanak Y, Takaoka Y et al. Axial radiographic evaluation in hallux valgus: evaluation of the transverse arch in the forefoot. Ort.Science. 2004; 9: 446 – 451
  • 23. Yıldırım Y Cubukcuoğlu C. Effect of metatarsophalangeal joint position on the reliability of the tangential sesamoid view in determining sesamoid position. Foot and ankle. 2005; 3: 247 – 251
There are 23 citations in total.

Details

Primary Language English
Subjects Surgery
Journal Section Research Article
Authors

Çağrı Özcan 0000-0002-6651-3322

Raşit Ozcafer This is me 0000-0001-7043-0530

Hakan Bahar This is me 0000-0002-4152-7007

Sarper Gürsu 0000-0003-1770-6969

Publication Date July 2, 2018
Submission Date February 28, 2018
Acceptance Date March 9, 2018
Published in Issue Year 2018 Volume: 2 Issue: 2

Cite

Vancouver Özcan Ç, Ozcafer R, Bahar H, Gürsu S. Evaluation of Sesamoid Bone Reduction in Hallux Valgus Patients Treated With Three Different Osteotomy. Acta Med. Alanya. 2018;2(2):91-5.

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