Clin Orthop Surg.  2017 Dec;9(4):514-520. 10.4055/cios.2017.9.4.514.

Biomechanical Comparison Study of Three Fixation Methods for Proximal Chevron Osteotomy of the First Metatarsal in Hallux Valgus

Affiliations
  • 1Surgery of Foot and Ankle, Department of Orthopedic Surgery, CM Chungmu General Hospital, Seoul, Korea.
  • 2Foot and Ankle Clinic, Eulji Medical Center, Eulji University College of Medicine, Seoul, Korea. part4uos@naver.com
  • 3KT Lee's Orthopedic Hospital, Seoul, Korea.

Abstract

BACKGROUND
Fixation of proximal chevron metatarsal osteotomy has been accomplished using K-wires traditionally and with a locking plate recently. However, both methods have many disadvantages. Hence, we developed an intramedullary fixation technique using headless cannulated screws and conducted a biomechanical study to evaluate the superiority of the technique to K-wire and locking plate fixations.
METHODS
Proximal chevron metatarsal osteotomy was performed on 30 synthetic metatarsal models using three fixation techniques. Specimens in group I were fixated with K-wires (1.6 mm × 2) and in group II with headless cannulated screws (3.0 mm × 2) distally through the intramedullary canal. Specimens in group III were fixated with a locking X-shaped plate (1.3-mm thick) and screws (2.5 mm × 4). Eight metatarsal specimens were selected from each group for walking fatigue test. Bending stiffness and dorsal angulation were measured by 1,000 repetitions of a cantilever bending protocol in a plantar to dorsal direction. The remaining two samples from each group were subjected to 5 mm per minute axial loading to assess the maximal loading tolerance.
RESULTS
All samples in group I failed walking fatigue test while group II and group III tolerated the walking fatigue test. Group II showed greater resistance to bending force and smaller dorsal angulation than group III (p = 0.001). On the axial loading test, group I and group II demonstrated superior maximum tolerance to group III (54.8 N vs. 47.2 N vs. 28.3 N).
CONCLUSIONS
Authors have demonstrated proximal chevron metatarsal osteotomy with intramedullary screw fixation provides superior biomechanical stability to locking plate and K-wire fixations. The new technique using intramedullary screw fixation can offer robust fixation and may lead to better outcomes in surgical treatment of hallux valgus.

Keyword

Hallux valgus; Proximal chevron metatarsal osteotomy; Headless cannulated screws; Fixation technique

MeSH Terms

Biomechanical Phenomena
Bone Plates
Bone Screws
Bone Wires
Fracture Fixation, Intramedullary/instrumentation/*methods
Hallux Valgus/*surgery
Humans
*Internal Fixators
Materials Testing
Metatarsal Bones/*surgery
Models, Anatomic
Osteotomy/*methods
Prosthesis Failure
Stress, Mechanical
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