LOCKING PLATE VERSUS INTRAMEDULLARY DEVICE FIXATION FOR THE DISTAL METATARSAL CHEVRON OSTEOTOMY IN HALLUX VALGUS: A RETROSPECTIVE STUDY

Öz

Objective: Recently, an innovative intramedullary device was introduced for the fixation of the capital fragment in the distal metatarsal chevron osteotomy. The aim of the present study was to compare the outcomes of locking plate and intramedullary device fixation in the distal metatarsal chevron osteotomy in the surgical treatment of hallux valgus.

Material and Methods: We reviewed 29 patients (29 feet) treated with distal metatarsal chevron osteotomies fixated by locking plate or intramedullary device for hallux valgus. Locking plate fixation were used for 14 patients (14 feet) and intramedullary device fixation were used for 15 patients (15 feet).

Results: The mean follow-up period was 31 (6–56) months. The locking plate and intramedullary device groups did not differ significantly with respect to age, affected side, surgical time, duration of hospital stay, follow – up period or postoperative American Orthopedic Foot and Ankle Society scores (p>0.05). The hallux valgus angle and the intermetatarsal angle decreased significantly in both the locking plate and the intramedullary device groups (p<0.01). Two patients (14.3%) in the locking plate group and 5 patients (33.3%) in the intramedullary device group had implant removal surgery because of implant irritation but the difference in implant removal rates were not statistically significant.

Conclusion: We found both locking plate and intramedullary device fixation methods were effective in the fixation of distal metatarsal chevron osteotomy for correction of moderate hallux valgus. However, both locking plate and intramedullary device fixation methods were associated with a relatively high implant removal rate.

Anahtar Kelimeler

• Chevron osteotomy,hallux valgus,implant removal,intramedullary device,locking plate,osteotomy plate

Halluks Valgus Cerrahisinde Distal Metatars Chevron Osteotomisinin Kilitli Plak ve İntramedüller Cihaz ile Tespitinin Geriye Dönük Olarak Karşılaştırılması.

Öz

Amaç: Yakın zamanda, distal metatars chevron osteotomisinin tespitinde kullanılmak üzere yeni bir intramedüller cihaz geliştirilmiştir. Çalışmamızın amacı halluks valgus cerrahisinde yapılan distal metatars chevron osteotomisinde, kilitli plak tespiti sonuçlarını intramedüller cihaz tespiti sonuçları ile karşılaştırmaktır.

Gereç ve Yöntemler: Geriye dönük olarak, halluks valgus tedavisi için distal metatarsal chevron osteotomisi yapılmış ve kilitli plak veya intramedüller cihaz ile tespit edilmiş 29 hastanın 29 ayağı incelenmiştir. Kilitli plak ile tespit 14 hastada (14 ayakta) ve intramedüller cihaz tespit 15 hastada (15 ayakta) kullanılmıştır.

Bulgular: Ortalama takip süresi 31 aydır (6–56). Kilitli plak ve intramedüller cihaz grupları arasında hastanın yaşı, ameliyat edilen taraf, ameliyat süresi, hastanede kalış süresi, takip süresi veya postop Amerikan Ortopedik Ayak ve Ayak Bileği Skoru (AOFAS) açısından anlamlı bir fark saptanmamıştır (p>0.05). Ameliyat sonrası dönemde halluks valgus açısı ve intermetatarsal açı ameliyat öncesi döneme göre her iki grupta da anlamlı bir şekilde azalmıştır (p<0.01). Kilitli plak grubunda 2 (%14.3) hastada ve intramedüller cihaz grubunda 5 (%33.3) hastada implant irritasyonu sebebi ile implant çıkarma ameliyatı gerçekleştirilmiştir. Ancak implant çıkarma oranları açısından gruplar arasında anlamlı fark bulunmamıştır (p>0.05).

Sonuç: Distal metatars chevron osteotomisinde hem kilitli plak hem de intramedüller cihaz tespitinin orta dereceli halluks valgusun cerrahi tedavisinde etkili olduğu bulunmuştur. Ancak hem kilitli plak hem de intramedüller cihaz tespitinin nispeten yüksek implant çıkarma oranları ile karakterize olduğu saptanmıştır.a

Anahtar Kelimeler

• chevron osteotomisi,halluks valgus,implant çıkarma,intramedüller cihaz,kilitli plak,osteotomi plağı

Kaynakça

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