Hallux Valgus Surgery - Richard Carey-Smith 22/2/2001

BACKGROUND

Confusing literature reports on the vast number of operative methods proposed for fixation of hallux valgus.  All will change as more data appears on the Scarf osteotomy and as yet no long term studies comparing it with the other proximal osteotomies.  Papers below are the classic on Mitchells,  a long term follow up on proximal crescentic osteotomy and a biomechanical study. The classic on Mitchells (bunionectomy and distal metatarsal osteotomy) and indicated moderate to severe hallux valgus with subluxed MTPJ. 

Authors

Mitchell, L; Fleming, J; Allen, R; Glenney, C; Sansford, Glenn

Title

Osteotomy-Bunionectomy for Hallux Valgus

Reference

J Bone Joint Surg [Am] 1958 : 40 A : 41-60

Summary

Mitchell describes his experience with over 400 operations. Precise technique, rationale for distal osteotomy, and failings are illustrated.  Pts happy 80% time (1-20 yrs).  Surgeons happy 51%.

Critique

Only looks at one method of fixation.  1/3pt 2 nd metatarsalgia, one pt requiring jt excision. Did not think metatarsalgia was related to 1 st MT shortening (average 8mm short).  Does state that only for patients with hallux valgus and metatarsus primus varus and pt selection essential.


Distal soft tissue procedure and proximal crescentic osteotomy indicated in HV angle >30deg with an incongruent joint

Authors

Mann,RA; Rudicel, S; Graves, SC

Title

Hallux valgus repair using distal soft tissue procedure and proximal metatarsal osteotomy.  Long term follow up.

Reference

JBJS (Am) 74; 124-129, 1992.

Summary

109 feet with HV angle 17-46deg pre to 9 (3 to 13) post op.  Demonstrates correction good correction of hallux valgus angle (76% to <16deg).

Critique

Carefully selected patient group but no comparison to other treatment modalities.



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