Treatment of Freiberg Disease with Intra-articular Dorsal Wedge Osteotomy and Absorbable Pin Fixation

Lee, Sang Ki; Chung, Moon Sang; Baek, Goo Hyun; Oh, Joo Han; Lee, Young Ho; Gong, Hyun Sik

doi:10.3113/fai.2007.0008

Cited by 57 publications

(65 citation statements)

References 16 publications

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“…Freiberg's infraction of the second metatarsophalangeal joint results in widening of the joint space, and flattening and central collapse of the metatarsal head [4][5][6]. However, we have experienced many cases of degenerative osteoarthritis without any radiographic or intraoperative or histopathological evidence of avascular necrosis of the second metatarsal head.…”

Section: Introductionmentioning

confidence: 99%

Degenerative osteoarthritis of the second metatarsophalangeal joint: second toe rigidus

Cho

Kim

Lee

2013

International Orthopaedics (SICOT)

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Purpose The purpose of this study was to evaluate the radiographic characteristics and structural configurations of a series of patients with a primary degenerative arthritis of the second metatarsophalangeal joint. Methods We studied 37 feet that had undergone surgical treatment for primary degenerative arthritis of the second metatarsophalangeal joint. The patients were compared with a randomly selected control group, without arthritis of the second metatarsophalangeal joint. The first, second, and fourth metatarsal lengths, and the size of the second metatarsal head were measured on weight-bearing anteroposterior radiographs. The patients were classified on the basis of joint-space narrowing, subchondral sclerosis, osteophyte formation, and subchondral cystic change. Results The average second metatarsal length was significantly longer in the study group (P=0.01). The average length of the first metatarsal relative to the fourth metatarsal was significantly shorter (P=0.02) in the study group, while the average length of the second metatarsal relative to the fourth metatarsal was significantly longer (P=0.01) in the study group. The average diameter of the second metatarsal head was significantly larger in the study group (P=0.00), and the average ratio of this diameter relative to the length of the fourth metatarsal was significantly higher in the study group (P=0.00). A total of four feet were classified as grade 0, nine as grade 1, 17 as grade 2, and seven as grade 3. Conclusions Second toe rigidus should be considered as a diagnosis in patients with painful limited dorsiflexion of the second metatarsophalangeal joint without evidence of Freiberg's infraction or trauma.

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Section: Introductionmentioning

confidence: 99%

Degenerative osteoarthritis of the second metatarsophalangeal joint: second toe rigidus

Cho

Kim

Lee

2013

International Orthopaedics (SICOT)

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“…Moreover, the wire needs to be removed before weight-bearing and ROM training. Lee et al also reported cross-pinning using K-wire in 13 cases and noted that bone union was obtained following an average of seven weeks [10]. Lee et al performed a fixing method using absorbable pins for intra-articular closing-wedge osteotomy and observed bone union after an average of ten weeks [9].…”

Section: Discussionmentioning

confidence: 99%

“…Surgical treatment is typically only performed when conservative therapy fails. Although various operative procedures, including resection arthroplasty, joint debridement, osteotomy, and osteochondral transplant, have been reported, no consensus regarding the best surgical approach has been reached to date [2][3][4][5][6][7][8][9][10][11][12]. Gauthier and Elbaz reported good results for dorsal intra-articular closingwedge osteotomy procedures regardless of the disease stage [4].…”

Section: Introductionmentioning

confidence: 99%

Extra-articular dorsal closing-wedge osteotomy to treat late-stage Freiberg disease using polyblend sutures: technical tips and clinical results

Ikoma

Maki

Kido

et al. 2014

International Orthopaedics (SICOT)

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Purpose The purpose of this study was to evaluate the clinical outcomes regarding the dorsal wedge osteotomy fixed using a polyblend suture and describe the usefulness of this fixation method for the treatment of Freiberg disease. Methods The subjects consisted of 13 feet from 13 cases suffering from Freiberg disease that underwent extra-articular dorsal closing-wedge osteotomy using a polyblend suture. The average age was 31.7 (range 13-72) years. The average followup period was 17 (range 14-24) months. Regarding image findings, time to bone union and metatarsal shortening was reviewed. The investigation was carried out using the range of motion (ROM), visual analog scale (VAS), and Japanese Society of the Surgery of Foot lesser toe scale (JSSF score) in the MTP joint before surgery and at the latest follow-up. Results Calluses under the metatarsal head were not observed in any cases. The mean metatarsal shortening was 2.33± 2.07 mm at follow-up. The bone union required an average of 8.4±0.8 weeks. The average ROM of dorsal flexion improved from 37.2±5.3°before surgery to 73.6±9.9°at latest follow-up (p<0.0001). The average ROM of plantar flexion improved from 16.0±10.1°before surgery to 19.5±8.6°at latest follow-up (p=0.35). The average VAS significantly improved from 75.3±8.5 before surgery to 4.9±4.2 at latest follow-up (p<0.0001). The average JSSF score significantly improved from 67.3±9.4 points before surgery to 98.8±3.0 points at the latest follow-up (p<0.0001). Conclusion Extra-articular dorsal closing-wedge osteotomy using a polyblend suture was carried out to treat Freiberg disease. The bone union was observed in all cases with improved clinical results. Fixation using a polyblend suture was considered to be useful.

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“…The second comprises procedures that restore articular congruity or address the degenerative features encountered in the later stages of the disease. These include debridement, osteotomy, grafting, and arthroplasty [8][9][10][11][12][13][14][15][16][17]. By reason of multi variety of treatment modalities, leads to uncertainties in predicting the choice of method and results when combining the low incidence of the disease.…”

Section: Introductionmentioning

confidence: 99%

“…The first comprises procedures that alter the pathophysiology and abnormal biomechanics that may predispose an individual to the disease or worsen the clinical course. These include core decompression and corrective metatarsal osteotomy [8][9][10][11][12][13]. The second comprises procedures that restore articular congruity or address the degenerative features encountered in the later stages of the disease.…”

Section: Introductionmentioning

confidence: 99%

A comperative study between two different surgical techniques in the treatment of late-stage Freiberg's disease

Kilic¹,

Cepni²,

Aybar³

et al. 2013

Foot and Ankle Surgery

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Treatment of Freiberg Disease with Intra-articular Dorsal Wedge Osteotomy and Absorbable Pin Fixation

Abstract: In patients with Freiberg disease, intra-articular dorsal wedge osteotomy restores congruity of the metatarsophalangeal joint, and fixation with absorbable pins provides adequate fixation and avoids a second procedure for implant removal.

Cited by 57 publications

References 16 publications

Degenerative osteoarthritis of the second metatarsophalangeal joint: second toe rigidus

Degenerative osteoarthritis of the second metatarsophalangeal joint: second toe rigidus

Extra-articular dorsal closing-wedge osteotomy to treat late-stage Freiberg disease using polyblend sutures: technical tips and clinical results

A comperative study between two different surgical techniques in the treatment of late-stage Freiberg's disease

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