Anatomical reconstruction of first ray instability hallux valgus with a medial anatomical TMTJ1 plate.

Autor: McCabe FJ; Department of Trauma & Orthopaedics, St. Vincent's University Hospital, Elm Park, Dublin, D04 T6F4, Ireland. Electronic address: Fergusmccabe1@gmail.com., McQuail PM; Department of Trauma & Orthopaedics, St. Vincent's University Hospital, Elm Park, Dublin, D04 T6F4, Ireland., Turley L; Department of Trauma & Orthopaedics, St. Vincent's University Hospital, Elm Park, Dublin, D04 T6F4, Ireland., Hurley R; Department of Trauma & Orthopaedics, St. Vincent's University Hospital, Elm Park, Dublin, D04 T6F4, Ireland., Flavin RA; Department of Trauma & Orthopaedics, St. Vincent's University Hospital, Elm Park, Dublin, D04 T6F4, Ireland.
Jazyk: angličtina
Zdroj: Foot and ankle surgery : official journal of the European Society of Foot and Ankle Surgeons [Foot Ankle Surg] 2021 Dec; Vol. 27 (8), pp. 869-873. Date of Electronic Publication: 2020 Dec 05.
DOI: 10.1016/j.fas.2020.11.007
Abstrakt: Background: First tarsometatarsal joint (TMTJ1) arthrodesis is a powerful tool for hallux valgus correction. Past criticism of the TMTJ1 arthrodesis has focused on high non-union rates, and consequent need for delayed weightbearing as prevention. In this study we present a selection and treatment protocol to minimise non-union while allowing early weightbearing.
Methods: All TMTJ1 arthrodesis procedures for hallux valgus performed by the senior surgeon over the period June, 2016 to July, 2019 were included. An anatomically-designed, medial TMTJ1 plate and screw compression was utilised for TMTJ1 arthrodesis. The construct was augmented with synthetic intermetatarsal stabilisation. All patients were kept non-weightbearing for 2 weeks, followed by progressive weightbearing as tolerated for 4 weeks. Minimum follow-up was 1 year.
Results: 300 modified Lapidus procedures were performed for hallux valgus with mean IMA 17° (Range: 14-29). Mean age was 58 years, with 93% female. 284 (94%) had an Akin osteotomy, while 222 cases (74%) were associated with another forefoot procedure. Patients began progressive weight bearing as tolerated from 2 weeks. All were fully weight bearing by 8 weeks post-operatively. There was a 100% union rate in this group. Mean AOFAS Hallux MTP-IP scores rose from 59 pre-operatively to 97 post-operatively. One plate was removed due to tibialis anterior impingement. There were no recurrences at final follow-up.
Conclusions: We describe a selection and treatment protocol for TMTJ1 arthrodesis for hallux valgus. This yields high union rates while allowing early weight bearing.
Level of Evidence: 4.
(Copyright © 2020 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.)
Databáze: MEDLINE
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