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Endolog technique for correction of hallux valgus: a prospective study of 30 patients with 4-year follow-up.

Biz C, Corradin M, Petretta I, Aldegheri R - J Orthop Surg Res (2015)

Bottom Line: The postoperative radiographic assessments showed a statistically significant improvement compared with preoperative values.The mean corrections for each angular value at the last follow-up were as follows: IMA 5.95°; HVA 16.81°; DMAA 10.70°; and tibial sesamoid 1.36°.The Endolog is a safe and effective technique for the correction of HV deformity, to relieve pain and to preserve joint movement.

View Article: PubMed Central - PubMed

Affiliation: Orthopaedic Clinic, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padua, via Giustiniani 2, 35128, Padova, Italy. carlo.biz@unipd.it.

ABSTRACT

Background: Hallux valgus (HV) is a complex deformity of the forefoot altering the kinematics of walking. Many different treatment alternatives exist for the correction of hallux valgus, but to date, none has been shown to be more effective than any other. The rate of complications following hallux valgus surgery is variable and has been reported as ranging from 1 to 55 % in the scientific literature. The purpose of this preliminary prospective study was to evaluate the result of the Endolog device, an innovative titanium endomedullary nail, for the treatment of HV.

Methods: Thirty patients with mild-to-severe HV were treated with the Endolog device. Clinical evaluation was assessed preoperatively, as well as at 3, 6, 12, 24, and 48 months after surgery with a final follow-up at 4 years, using the American Orthopaedic Foot and Ankle Society (AOFAS) hallux grading system. Computer-assisted measurement of weight-bearing antero-posterior radiographs was taken preoperatively and postoperatively, as well as at 3, 6, 12, 24, and 48 months after surgery. Non-weight-bearing radiographs were taken before the patients were discharged. The radiological parameters measured included the intermetatarsal angle (IMA), the hallux valgus angle (HVA), the distal metatarsal articular angle (DMAA), and the tibial sesamoid position. Statistical analysis was carried out using the paired t test (p < 0.05).

Results: The mean AOFAS score was 93.98 points at the 48-month follow-up. The postoperative radiographic assessments showed a statistically significant improvement compared with preoperative values. The mean corrections for each angular value at the last follow-up were as follows: IMA 5.95°; HVA 16.81°; DMAA 10.70°; and tibial sesamoid 1.36°.

Conclusion: The Endolog is a safe and effective technique for the correction of HV deformity, to relieve pain and to preserve joint movement.

No MeSH data available.


Related in: MedlinePlus

a–b The oblique exostosectomy will permit the correction of the DMAA value and sesamoid subluxation during the subsequent derotation and translation of the metatarsal head while the nail is inserted after osteotomy at the neck level. c Perfect coplanarity and maximum adherence of the pallet support to the flat surface of the metatarsal head
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Fig3: a–b The oblique exostosectomy will permit the correction of the DMAA value and sesamoid subluxation during the subsequent derotation and translation of the metatarsal head while the nail is inserted after osteotomy at the neck level. c Perfect coplanarity and maximum adherence of the pallet support to the flat surface of the metatarsal head

Mentions: Using a standard oscillating saw in a distal to proximal direction, a very minimal, oblique exostosectomy was performed to remove the medial eminence and to produce a flat surface on the head in order to support the impactor’s blade upon which the device was assembled (Figs. 2a and 3a, b). For a correct position of the device, perfect coplanarity and maximum adherence of the pallet support to the flat surface previously created on the metatarsal head is crucial (Fig. 3c). The oblique exostosectomy was carried out with a thickness of no more than 2–4 mm from the distal part of the medial eminence, close to the articular surface, to zero at the level of the metatarsal neck, making a lateral translation of the head possible, pushed and maintained by the nail after its application, and correcting both the DMAA and the dislocated sesamoid apparatus due to pronation of the big toe during the following derotation of the metatarsal head (Fig 3a, b). For this purpose, two 1.8-mm Kirschner wires, acting as joysticks, were inserted to allow the derotation of the metatarsal head during its lateral translation. A linear osteotomy, at times perpendicular to the proximal level of the neck and at times oblique in order to lengthen or to shorten the metatarsal, was performed (Fig. 2b). Once the trial Endolog device was assembled on the impactor, it was gently introduced into the medullary cavity with progressively lateral displacement of the head and contemporary derotation of the metatarsal head, using the K-wires like joysticks and correcting the DMAA and sesamoid subluxation (Fig. 2c).Fig. 2


Endolog technique for correction of hallux valgus: a prospective study of 30 patients with 4-year follow-up.

Biz C, Corradin M, Petretta I, Aldegheri R - J Orthop Surg Res (2015)

a–b The oblique exostosectomy will permit the correction of the DMAA value and sesamoid subluxation during the subsequent derotation and translation of the metatarsal head while the nail is inserted after osteotomy at the neck level. c Perfect coplanarity and maximum adherence of the pallet support to the flat surface of the metatarsal head
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4492074&req=5

Fig3: a–b The oblique exostosectomy will permit the correction of the DMAA value and sesamoid subluxation during the subsequent derotation and translation of the metatarsal head while the nail is inserted after osteotomy at the neck level. c Perfect coplanarity and maximum adherence of the pallet support to the flat surface of the metatarsal head
Mentions: Using a standard oscillating saw in a distal to proximal direction, a very minimal, oblique exostosectomy was performed to remove the medial eminence and to produce a flat surface on the head in order to support the impactor’s blade upon which the device was assembled (Figs. 2a and 3a, b). For a correct position of the device, perfect coplanarity and maximum adherence of the pallet support to the flat surface previously created on the metatarsal head is crucial (Fig. 3c). The oblique exostosectomy was carried out with a thickness of no more than 2–4 mm from the distal part of the medial eminence, close to the articular surface, to zero at the level of the metatarsal neck, making a lateral translation of the head possible, pushed and maintained by the nail after its application, and correcting both the DMAA and the dislocated sesamoid apparatus due to pronation of the big toe during the following derotation of the metatarsal head (Fig 3a, b). For this purpose, two 1.8-mm Kirschner wires, acting as joysticks, were inserted to allow the derotation of the metatarsal head during its lateral translation. A linear osteotomy, at times perpendicular to the proximal level of the neck and at times oblique in order to lengthen or to shorten the metatarsal, was performed (Fig. 2b). Once the trial Endolog device was assembled on the impactor, it was gently introduced into the medullary cavity with progressively lateral displacement of the head and contemporary derotation of the metatarsal head, using the K-wires like joysticks and correcting the DMAA and sesamoid subluxation (Fig. 2c).Fig. 2

Bottom Line: The postoperative radiographic assessments showed a statistically significant improvement compared with preoperative values.The mean corrections for each angular value at the last follow-up were as follows: IMA 5.95°; HVA 16.81°; DMAA 10.70°; and tibial sesamoid 1.36°.The Endolog is a safe and effective technique for the correction of HV deformity, to relieve pain and to preserve joint movement.

View Article: PubMed Central - PubMed

Affiliation: Orthopaedic Clinic, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padua, via Giustiniani 2, 35128, Padova, Italy. carlo.biz@unipd.it.

ABSTRACT

Background: Hallux valgus (HV) is a complex deformity of the forefoot altering the kinematics of walking. Many different treatment alternatives exist for the correction of hallux valgus, but to date, none has been shown to be more effective than any other. The rate of complications following hallux valgus surgery is variable and has been reported as ranging from 1 to 55 % in the scientific literature. The purpose of this preliminary prospective study was to evaluate the result of the Endolog device, an innovative titanium endomedullary nail, for the treatment of HV.

Methods: Thirty patients with mild-to-severe HV were treated with the Endolog device. Clinical evaluation was assessed preoperatively, as well as at 3, 6, 12, 24, and 48 months after surgery with a final follow-up at 4 years, using the American Orthopaedic Foot and Ankle Society (AOFAS) hallux grading system. Computer-assisted measurement of weight-bearing antero-posterior radiographs was taken preoperatively and postoperatively, as well as at 3, 6, 12, 24, and 48 months after surgery. Non-weight-bearing radiographs were taken before the patients were discharged. The radiological parameters measured included the intermetatarsal angle (IMA), the hallux valgus angle (HVA), the distal metatarsal articular angle (DMAA), and the tibial sesamoid position. Statistical analysis was carried out using the paired t test (p < 0.05).

Results: The mean AOFAS score was 93.98 points at the 48-month follow-up. The postoperative radiographic assessments showed a statistically significant improvement compared with preoperative values. The mean corrections for each angular value at the last follow-up were as follows: IMA 5.95°; HVA 16.81°; DMAA 10.70°; and tibial sesamoid 1.36°.

Conclusion: The Endolog is a safe and effective technique for the correction of HV deformity, to relieve pain and to preserve joint movement.

No MeSH data available.


Related in: MedlinePlus