Plate fixation for proximal chevron osteotomy has greater risk for hallux valgus recurrence than Kirschner wire fixation

Abstract

Purpose The purpose of this study was to compare the results of hallux valgus surgery between feet fixed with Kirschner wires and those fixed with a plate and screws. Methods Between December 2008 and November 2009, 53 patients (62 feet) were treated with proximal chevron osteotomy and distal soft tissue procedure for symptomatic moderate to severe hallux valgus deformity. Thirty-four patients (41 feet) were stabilised with Kirschner wires (K-wire group) and 19 patients (21 feet) were stabilised with a locking plate (plate group). Clinical results were assessed using American Orthopaedic Foot and Ankle Society (AOFAS) score. Radiographic parameters were compared between these groups. Recurrence rate at the last follow-up was compared between the K-wire and plate groups. Results Mean AOFAS score was lower in the plate group, however, the difference between the groups was not statistically significant in AOFAS score at the last follow-up. Hallux valgus angle and intermetatarsal angle were significantly larger in the plate group at the last follow-up. Mean 1-2 metatarsal (MT) distance on immediately postoperative radiographs was significant larger in the plate group. Four (9.8 %) of the 41 feet in the K-wire group and 7 (33.3 %) of the 21 feet in the plate group showed hallux valgus recurrence at the last follow-up. The plate group had a significantly higher risk of recurrence than the K-wire group. Conclusions Fixation of proximal chevron osteotomy using a plate and screws has a greater risk of hallux valgus recurrence than fixation using Kirschner wires.

Modified Chevron osteotomy for hallux valgus deformity in female athletes. A 2-year follow-up study

“…We also Page 12 of 21 A c c e p t e d M a n u s c r i p t recognize a disadvantage of the technique performed with the use of K-wires that can potentially provide a conduit for the introduction of bacteria to the operative area, or can be associated with an unpleasant sense due to pain in the surrounding skin or undesirable skin traction [35]. However, in the present study there were no complications regarding K-wire placement, and, as also shown in the literature, the use of K-wires has demonstrated favored outcome with minimal complications [36]. In addition, with the removal of the wire six weeks postoperatively, patient was entirely free of any internal or external fixation`s implant.…”

Osteodesis for Hallux Valgus Correction: Is it Effective?

“…Patients should be cautioned of this possibility and advised to return to normal walking activities gradually during the fourth postoperative month. We found the frequency of recurrence of metatarsus primus varus to be low, and the recurrences to be mild when compared with 10% to 33% reported after osteotomy [4,18]. This could be attributed to the first metatarsal stability issue by intermetatarsal fibrous bonding during the osteodesis.…”

Proximal opening wedge metatarsal osteotomy for correction of moderate to severe hallux valgus deformity using a locking plate

“…This angle remained constant from the time of union to the last follow-up. The mean pre-operative HVA was 39 (range 21-52) degrees, and the mean postoperative HVA was 11.8 (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19) degrees. The mean HVA at the last followup was 12.7 (range 6-30) degrees.…”

“…Different types of proximal metatarsal osteotomies have been used over the last decades including proximal crescentic osteotomy [7], proximal chevron osteotomy [8,9], scarf osteotomy [10,11], Ludloff osteotomy [12], Mau osteotomy [13], modified Mau [14], lateral closing wedge basal osteotomy [15] and medial opening wedge basal osteotomy [16].…”