| Popis: |
Restoring accurate alignment and achieving a lasting correction are two primary goals of any deformity corrective procedure. To achieve the first goal of accurate alignment, the basic components of the deformity must be identified so that they can individually or in combination be addressed with the corrective procedure. The starting point is the identification of the apex of the deformity, and the second concern is the definition of all planar components of the deformity or deformities. In the case of a bunion, there are no deformities within the metatarsal bone or the proximal phalanx, the bones themselves are intrinsically straight, and the segments are deviated at the TMTJ and MTPJ. Despite this anatomical fact, the correction most commonly recommended involves osteotomy of these straight but deviated bone segments. For the most part, surgeons and researchers prioritize transverse plane clinical and radiographic findings to define the HAV deformity. Although it has not been a commonplace in discussions on evaluation and management of HAV deformity, the three-dimensional orientation of the bone segments has profound effects on radiographic appearance, the kinematic function, and the surgical approach. In this section we discuss the anatomic alignment of the first ray in three dimensions and review the profound effect frontal plane alignment has on our understanding and approach to the deformity. |
