Biomechanical comparison of conventional versus modified technique in distal chevron osteotomies of the first metatarsal: A cadaver study

Trost, Matthias; Knieps, Matthias; Loweg, Lennard; Neiss, Wolfram F.; Eysel, Peer; Frey, Sönke P.; Schulte, Tobias L.; Bredow, Jan

doi:10.1016/j.fas.2018.07.009

Cited by 5 publications

(6 citation statements)

References 17 publications

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“…The biomechanical model used in the present study was based on 2 prior cadaveric studies with 9 cadaveric specimens per cohort. 21,22 However, a post hoc power analysis was conducted, 15 patients would be needed per cohort to detect a difference in ultimate load to failure between cohorts with 80% power and α of 5%. 21 As a result, the study was underpowered to detect statistically significant differences in outcomes.…”

Section: Discussionmentioning

confidence: 99%

Biomechanical Comparison of 2 Common Techniques of Minimally Invasive Hallux Valgus Correction

Aiyer

Massel

Siddiqui³

et al. 2020

Foot Ankle Int.

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Background: Hallux valgus is one of the most common surgically corrected forefoot deformities. Compared to open procedures, minimally invasive (MIS) treatment of hallux valgus has resulted in decreased operative time, reduced complication rates, and greater patient satisfaction. Historically, distal chevron osteotomies are the standard for moderate hallux valgus correction. To our knowledge, no studies have evaluated biomechanical strength of transverse and chevron distal first metatarsal osteotomy (DMO) constructs. The purpose of this study was to evaluate the biomechanical strength of these techniques. Methods: Eighteen cadaveric specimens (9 matched pairs) were randomized to transverse or chevron DMO. Each technique was performed by a separate fellowship-trained orthopedic foot and ankle surgeon. Radiographic images were analyzed. Biomechanical testing was performed using Instron Mechanical System. Ultimate load to failure, yield load, and stiffness were assessed. A 10-N preload was applied to the sesamoid bones for stability. A coaxial compression rate (10 mm/min) was applied until failure was observed. Mean and standard deviations were compared. All cadaveric specimens were male. Results: There was no significant difference in percent metadiaphyseal shift between osteotomies ( P = .453). The most common mode of failure was fracture at screw insertion site (55.6%), followed by failure at osteotomy site (44.4%). A trend toward increased ultimate load to failure ( P = .480), yield load ( P = .054), and stiffness ( P = .438) among transverse compared to chevron osteotomy was observed, but this difference was not statistically significant. Conclusion: Biomechanical testing demonstrated no significant difference in ultimate load, yield load, and stiffness between MIS transverse and chevron osteotomy constructs; a trend toward increased strength in the transverse osteotomy cohort was observed. Chevron osteotomies may result in early failure by relative ease of cutout through cancellous bone compared to transverse osteotomies in which failure requires cortical cutout. Clinical Relevance: Use of MIS techniques for hallux valgus correction is gaining clinical traction. Although various clinical studies have evaluated outcomes of these MIS techniques, biomechanical studies have been minimal. Specifically, the potential biomechanical benefits of various MIS hallux valgus osteotomy techniques have not been delineated to date. The content of this manuscript is quite timely, given the rise in use of these MIS techniques.

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Section: Discussionmentioning

confidence: 99%

Biomechanical Comparison of 2 Common Techniques of Minimally Invasive Hallux Valgus Correction

Aiyer

Massel

Siddiqui³

et al. 2020

Foot Ankle Int.

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“…The ROM decrease of hallux MPJ and IPJ is one of the most common complications (5) . Some authors have demonstrated in their studies that the ROM decrease, especially the MPJ, leads to the reduction of the ankle plantar flexion during the gait, generating an inefficient propulsion movement (7,8) , considering that it is necessary dorsiflexion between 40 o and 60° of the first MPJ for the propulsion to occur properly (11) . In our study, the MPJ extension maintained a mean of 55 o after one year of surgery.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, adequate MPJ dorsiflexion is essential during the terminal phase of gait support and in the pre-swing phase to allow a smooth progression of the foot body (7) . Without the ideal amplitude, the gait presents reduced step length, shorter duration of the support phase, and decreased ankle plantar flexion at the tip of the foot (7,8) . There is also a delay in the calcaneus detachment and a displacement of the reaction forces to the ground before the first MPJ on the side of lower ROM (12) .…”

Section: Discussionmentioning

confidence: 99%

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Evaluation of range of motion of hallux metatarsophalangeal and interphalangeal joints after periarticular osteotomies

et al. 2022

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Objective: Evaluate the impact of Chevron and extended Chevron techniques associated with Akin osteotomy on the range of motion (ROM) of hallux metatarsophalangeal joint (MPJ) and interphalangeal joint (IPJ) after three months and one year. Methods: Sixteen patients (17 feet) were evaluated for the ROM of hallux MPJ and IPJ pre-and postoperatively, the flexion-extension measurements were performed using a goniometer. Results: Comparing the pre-and postoperative measurements at three months and one year, the ROM decreased in MPJ extension and flexion, 9o and 5o, respectively, and IPJ flexion, 5o. The values presented statistical significance according to the analysis demonstrated (p>0.05). However, the decrease in IPJ extension was not statistically significant (decrease of 0.8o and p<0.05). Conclusions: Periarticular osteotomies of hallux MPJ had a significant decrease in the ROM after three months and one year. Level of Evidence II; Therapeutic Studies - Investigating the Results of Treatment; Prospective Comparative Study.

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“…An improvement of the original technique has been supported by lengthening one arm of the V cut and adding internal fixation with compression screws. A special concern regarding distal osteotomies is the risk for avascular necrosis of the metatarsal head as a result of damaging the particular blood supply of the area [24][25][26][27].…”

Section: Distal Metatarsal Osteotomies (Wilson Mitchell Chevron)mentioning

confidence: 99%

Review of current hallux valgus management options

Nica

Creţu

Ene

et al. 2019

Romanian Journal of Orthopaedic Surgery and Traumatology

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Hallux valgus is one of the most common forefoot pathologies, with a multifactorial etiology that causes important functional impairment and metatarsalgia. The characteristic deformity originates from a biomechanical imbalance induced by the disruption of first metatarsophalangeal joint alignment and manifests as an abnormal weight transfer on the first ray during walking. Conservative treatment is unable to correct the deformity or stop the evolution of the disease but can distinctly control the symptoms. With time, a myriad of surgical correction techniques have been developed but no definitive surgical treatment algorithm has been generally accepted. Nonetheless, the decision process for choosing the suitable technique must be completed on an individual basis after considering the deformity severity stratification, status of the metatarsophalangeal and tarsometatarsal joints, bone anatomy, and associated comorbidities. In spite of a large variety of surgical options, there are a few main strategies that incorporate these variations: metatarsophalangeal and/or tarsometatarsal joint fusion, metatarsal osteotomies and soft tissue procedures. Nowadays, the surgical management of hallux valgus is dominated by first metatarsal osteotomies performed through open surgery or minimally invasive techniques. Hallux valgus angle has been found to be the single most important parameter for surgical outcome prognostic.

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Biomechanical comparison of conventional versus modified technique in distal chevron osteotomies of the first metatarsal: A cadaver study

Cited by 5 publications

References 17 publications

Biomechanical Comparison of 2 Common Techniques of Minimally Invasive Hallux Valgus Correction

Biomechanical Comparison of 2 Common Techniques of Minimally Invasive Hallux Valgus Correction

Evaluation of range of motion of hallux metatarsophalangeal and interphalangeal joints after periarticular osteotomies

Review of current hallux valgus management options

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