İleri Evre Halluks Rijidusta Tek Başsız Kompresyon Vidası ve Patik Şeklinde yapılan Alçı ile Uygulanan Artrodez Sonuçlarının Retrospektif Değerlendirilmesi

Year 2022, , 53 - 58, 29.04.2022

Abdullah Küçükalp , Bilal Aykaç

https://doi.org/10.47572/muskutd.867398

Abstract

Bu çalışmada, halluks rijidus tanılı hastalarda bir adet başsız kompresyon vidası ve patik şeklinde yapılan alçılama ile artrodez uygulamasının sonuçları değerlendirildi. Halluks rijidus tanısı ile Aralık 2017-Temmuz 2019 tarihleri arasında opere edilen; 12 hastanın 13 ayağına artrodez işlemi gerçekleştirildi. Ameliyat sırasında proksimal falanksın ve 1. metatarsın eklem yüzlerine kıkırdak dokular çıkarılacak şekilde rezeksiyon uygulandı. Başsız kanüllü kompresyon vidası ile artrodez uygulandı, patik şeklinde alçı yapılarak takip edildi. Ameliyat öncesi ve sonrası radyografik değerlendirmelerde halluks valgus ve birinci parmak dorsifleksiyon açıları ölçüldü. Hastalar American Orthopaedic Foot and Ankle Society (AOFAS) halluks metatarsofalangeal-interfalangeal skalası ile klinik olarak değerlendirildi. Hastalar ortalama 11.6 ay takip edildi. AOFAS skoruna göre, son takipte sekiz ayak mükemmel, üç ayak iyi, iki ayak orta sonuç olarak bulundu. Cerrahi öncesine göre AOFAS skorunda ortalama 39.8 puanlık artış elde edildi (p=0.001). Radyolojik değerlendirmede halluks valgus açısında ortalama yaklaşık 13° azalma saptanırken dorsofleksiyon açısında 2° artış saptandı. Komplikasyon olarak iki ayakta kaynamama gelişti. Hiçbir hastada yara yerinde enfeksiyon ve ciltte nekroz gelişmedi. Halluks rijidus cerrahisinde bir adet başsız kompresyon vidası ve patik şeklinde yapılan alçılama ile uygulanan artrodez işlemi ileri evre artrozu olan hastalar için uygun bir tedavi yöntemidir.

Keywords

Artrodez, Başsız Kompresyon Vidası, Halluks Rijidus, Metatarsofalangeal Eklem

Supporting Institution

Yok

Project Number

Proje Çalışması değil

Retrospective Evaluation of the Results of Arthrodesis Applied with a Single Headless Compression Screw and a Plaster in the Shape of a Bootie in Advanced Hallux Rigidus

Abstract

In this study, the results of arthrodesis application with a single headless compression screw and a plaster in the shape of a bootie patients with hallux rigidus were evaluated. Operated with the diagnosis of hallux rigidus between December 2017 and July 2019; Arthrodesis was performed on 13 feet of 12 patients. During the operation, resection was performed to remove the cartilage tissues of the proximal phalanx and the first metatarsal joint surfaces. Arthrodesis was applied with a headless cannulated compression screw, followed by plaster in the form of a bootie. Hallux valgus and first finger dorsiflexion angles were measured by radiographic evaluations before and after surgery. The patients were clinically evaluated with the American Orthopaedic Foot and Ankle Society (AOFAS) hallux metatarsophalangeal-interphalangeal scale. The patients were followed up for an average of 11.6 months. According to the AOFAS score, eight feet were excellent, three feet were good, and two feet were moderate in the last follow-up. An average of 39.8-point increase in AOFAS score was obtained compared to preoperative (p=0.001). In radiological evaluation, an average of 13° decrease was observed in the angle of hallux valgus, while a 2° increase was observed in the angle of dorsiflexion. As a complication, nonunion developed in two feet. None of the patients developed infection at the wound site and necrosis of the skin. Arthrodesis applied with a headless compression screw and a plaster cast in hallux rigidus surgery is a suitable treatment method for patients with advanced stage arthrosis.

Keywords

Arthrodesis, Hallux Rigidus, Headless Compression Screw, Metatarsophalangeal Joint

Project Number

Proje Çalışması değil

References

• 1. Ozan F, Bora OA, Filiz MA, Kement Z. Interposition arthroplasty in the treatment of hallux rigidus. Acta Orthop Traumatol Turc. 2010;44(2):143-51.
• 2. Thermann H, Becher C, Kilger R. Hallux rigidus treatment with cheilectomy, extensive plantar release, and additional microfracture technique. Tech Foot Ankle Surg. 2004;3:210-5.
• 3. Yetkin H, Kanatlı U, Songür M. Halluks rijidus’ta güncel tedavi yöntemleri. TOTBİD Derg. 2006;5:95-100.
• 4. Shereff MJ, Baumhauer JF. Hallux rigidus and osteoarthrosis of the first metatarsophalangeal joint. J Bone Joint Surg. 1998;80:898-908.
• 5. Clutton HH. The treatment of hallux valgus. St. Thom. Hosp. Rep. 1894;22:1-12.
• 6. Yee G, Lau J. Current concepts review: hallux rigidus. Foot Ankle Int. 2008;29(6):637-46.
• 7. Chang T, Camasta C. Hallux limitus and hallux rigidus. McGlamry’s comprehensive textbook of foot and ankle surgery. Philadelphia: Lippincott Williams and Wilkins; 2001.p.679-714.
• 8. Coughlin MJ, Shurnas PS. Hallux rigidus. Grading and long-term results of operative treatment. J Bone Joint Surg Am. 2003;85(11):2072-88.
• 9. Van Doeselaar DJ, Heesterbeek PJ, Louwerens JW, Swierstra BA. Foot function after fusion of the first metatarsophalangeal joint. Foot Ankle Int. 2010;31(8):670-5.
• 10. Yavuz U, Gül M, Özer D, ve ark. İleri evre halluks rigidus tedavisinde tek kortikal vida ile primer artrodez. Haseki Tıp Bült. 2014;52(3):158-63.
• 11. McNeil DS, Baumhauer JF, Glazebrook MA. Evidence-based analysis of the efficacy for operative treatment of hallux rigidus. Foot Ankle Int. 2013;34(1):15-32.
• 12. Polzer H, Polzer S, Brumann M, Mutschler W, Regauer M. Hallux rigidus: Joint preserving alternatives to arthrodesis - a review of the literature. World J Orthop. 2014;5(1):6-13.
• 13. Kilmartin TE. Phalangeal osteotomy versus first metatarsal decompression osteotomy for the surgical treatment of hallux rigidus: a prospective study of age-matched and condition-matched patients. J Foot Ankle Surg. 2005;44(1):2-12.
• 14. Keiserman LS, Sammarco VJ, Sammarco GJ. Surgical treatment of the hallux rigidus. Foot Ankle Clin. 2005;10(1):75-96.
• 15. Lau JT, Daniels TR. Outcomes following cheilectomy and interpositional arthroplasty in hallux rigidus. Foot Ankle Int. 2001;22(6):462-70.
• 16. Erdil M, Bilsel K, Imren Y, Mutlu S, Güler O, Gürkan V ve ark. Metatarsal head resurfacing hemiarthroplasty in the treatment of advanced stage hallux rigidus: outcomes in the short-term. Acta Orthop Traumatol Turc. 2012;46(4):281-5.
• 17. Coughlin M. Arthritides. Surgery of the foot and ankle. 7th ed. St. Louis: Mosby; 1999.p.560-650.
• 18. Goucher NR, Coughlin MJ. Hallux metatarsophalangeal joint arthrodesis using dome-shaped reamers and dorsal plate fixation: a prospective study. Foot Ankle Int. 2006;27(11):869-76.
• 19. Santos Silva M, Rodrigues-Pinto R, Barros LH, Sousa A, Muras J. Arthrodesis versus arthroplasty of the first metatarsophalangeal joint in the treatment of hallux rigidus - A comparative study of appropriately selected patients. Rev Bras Ortop (Sao Paulo). 2020;55(1):40-7.
• 20. Erdil M, Elmadağ NM, Polat G, Tunçer N, Bilsel K, Uçan V ve ark. Comparison of arthrodesis, resurfacing hemiarthroplasty, and total joint replacement in the treatment of advanced hallux rigidus. J Foot Ankle Surg. 2013;52(5):588-93.
• 21. Brodsky JW, Passmore RN, Pollo FE, Shabat S. Functional outcome of arthrodesis of the first metatarsophalangeal joint using parallel screw fixation. Foot Ankle Int. 2005;26(2):140-6.
• 22. Aas M, Johnsen TM, Finsen V. Arthrodesis of the first metatarsophalangeal joint for hallux rigidus--optimal position of fusion. Foot (Edinb). 2008;18(3):131-5.
• 23. Shereff MJ, Baumhauer JF. Hallux rigidus and osteoarthrosis of the first metatarsophalangeal joint. J Bone Joint Surg Am. 1998;80(6):898-908.