The Functional Outcome of Four-In-One Technique: Dorsal Closing-Wedge & Shortening Osteotomy, Debridement, Micro-Fracture in the Treatment of Freiberg’s Disease

Abstract

Conservative measures reducing the load and stress on the metatarsal are used in treating Freiberg's disease 4-6 as the first line management. However, failures of conservative management are dealt with operative techniques including debridement, 7 osteotomy (either dorsal closing-wedge 8 or shortening, 9 osteochondral plug transplantation, 10 resection arthroplasty. 11 We proposed a multipronged approach to the management of Freiberg disease. A combined dorsal closing wedge with shortening of the metatarsal and joint debridement and micro-fracture for treating the Freiberg infarction was done. The hypothesis is that dorsal closing wedge and shortening alone cannot help cartilage regeneration. Addition of micro-fracture aids in cartilage regeneration and debridement clears the joint of debris which might further perpetuate damage if left unattended.The aim of our study is to evaluate the functional outcome of Freiberg's disease patients who were surgically treated with this four in one procedure.