Yonsei Med J.  2015 May;56(3):744-752. 10.3349/ymj.2015.56.3.744.

First Metatarsal Proximal Opening Wedge Osteotomy for Correction of Hallux Valgus Deformity: Comparison of Straight versus Oblique Osteotomy

• Han SH
• Park EH
• Jo J
• Koh YG
• Lee JW
• Choi WJ
• Kim YS

• KMID: 2450349
• DOI: http://doi.org/10.3349/ymj.2015.56.3.744

Abstract

PURPOSE
The aim of this study was to compare clinical and radiographic outcomes of proximal opening wedge osteotomy using a straight versus oblique osteotomy.
MATERIALS AND METHODS
We retrospectively reviewed 104 consecutive first metatarsal proximal opening wedge osteotomies performed in 95 patients with hallux valgus deformity. Twenty-six feet were treated using straight metatarsal osteotomy (group A), whereas 78 feet were treated using oblique metatarsal osteotomy (group B). The hallux valgus angle (HVA), intermetatarsal angle (IMA), distal metatarsal articular angle, and distance from the first to the second metatarsal (distance) were measured for radiographic evaluation, whereas the American Orthopaedic Foot and Ankle Society (AOFAS) forefoot score was used for clinical evaluation.
RESULTS
Significant corrections in the HVA, IMA, and distance from the first to the second metatarsal were obtained in both groups at the last follow-up (p<0.001). There was no difference in the mean IMA correction between the 2 groups (6.1+/-2.7degrees in group A and 6.0+/-2.1degrees in group B). However, a greater correction in the HVA and distance from the first to the second metatarsal were found in group B (HVA, 13.2+/-8.2degrees; distance, 25.1+/-0.2 mm) compared to group A (HVA, 20.9+/-7.7degrees; distance, 28.1+/-0.3 mm; p<0.001). AOFAS scores were improved in both groups. However, group B demonstrated a greater improvement relative to group A (p=0.005).
CONCLUSION
Compared with a straight first metatarsal osteotomy, an oblique first metatarsal osteotomy yielded better clinical and radiological outcomes.

Keyword

Hallux valgus; proximal opening wedge osteotomy; straight; oblique; low-profile plate

MeSH Terms

Adult
Aged
Bone Plates
Epiphyses/surgery
Ethnic Groups
Female
Foot
Fracture Fixation, Internal/*instrumentation
Hallux Valgus/radiography/*surgery
Humans
Lower Extremity
Male
Metatarsal Bones/*radiography/*surgery
Middle Aged
Osteotomy/*methods
Range of Motion, Articular
Retrospective Studies
Treatment Outcome
Upper Extremity

Figure

• 

  Fig. 1 Preoperative (left) and 3-month postoperative (right) weight-bearing anteroposterior radiographs (A) and schematic drawings (B) of a proximal opening wedge osteotomy utilizing a straight osteotomy. Although the intermetatarsal angle was corrected after surgery, the distance from the first to the second metatarsal was not significantly decreased, and the hallux valgus angle was not corrected.

• 

  Fig. 2 Preoperative (left) and 12-month postoperative (right) weight-bearing anteroposterior radiographs (A) and schematic drawings (B) of a proximal opening wedge osteotomy utilizing an oblique osteotomy. After surgery, the intermetatarsal angle and hallux valgus angle were corrected, and the distance from the first to the second metatarsal was decreased.

• 

  Fig. 3 Associations between the American Orthopaedic Foot and Ankle Society (AOFAS) score and final follow-up radiographic outcomes, including the hallux valgus angle (HVA), intermetatarsal angle (IMA), and distance from the first to the second metatarsal (distance), in group A.

• 

  Fig. 4 Associations between the American Orthopaedic Foot and Ankle Society (AOFAS) score and final follow-up radiographic outcomes, including the hallux valgus angle (HVA), intermetatarsal angle (IMA), and distance from the first to the second metatarsal (distance), in group B.

• 

  Fig. 5 In an oblique osteotomy (right), the center of rotation of angulation (CORA) is located more proximally and closer to the second metatarsal base than in a straight osteotomy (left). Thus, the distance from the first to the second metatarsal decreases more in an oblique osteotomy than in a straight osteotomy. In a straight osteotomy, correction of the hallux valgus angle (dotted line) is decreased because of the wide distance from the first to the second metatarsal.

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