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Mini-Invasive floating metatarsal osteotomy for resistant or recurrent neuropathic plantar metatarsal head ulcers.

Tamir E, Finestone AS, Avisar E, Agar G - J Orthop Surg Res (2016)

Bottom Line: When conservative management with orthotics and shoes does not cure the ulcer, surgical metatarsal osteotomy may be indicated to relieve the pressure and enable the ulcer to heal.After 17/20 operations, the ulcer completely resolved after 6 weeks and did not recur after a mean follow-up of 11.5 months.Asymptomatic radiological non-union developed in six cases (30 %).

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic Surgery, Assaf HaRofeh Medical Center, Zerrifin, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.

ABSTRACT

Background: Patients with peripheral neuropathy and pressure under a relatively plantar deviated metatarsal head frequently develop plantar foot ulcers. When conservative management with orthotics and shoes does not cure the ulcer, surgical metatarsal osteotomy may be indicated to relieve the pressure and enable the ulcer to heal. The purpose of this study is to evaluate the use of a mini-invasive floating metatarsal osteotomy in treating recalcitrant ulcers or recurrent ulcers plantar to the metatarsal heads in patients with diabetes mellitus (DM) related neuropathy.

Methods: Computerized medical files of patients with diabetic neuropathy treated with an osteotomy during 2013 and 2014 were retrospectively reviewed. There were 20 osteotomies performed on 17 patients (mean age 58 years). The patients had a diagnosis of DM for a mean of 17 years. All ulcers were University of Texas grade 1A; mean ulcer age was 19 months.

Results: After 17/20 operations, the ulcer completely resolved after 6 weeks and did not recur after a mean follow-up of 11.5 months. One patient developed an early post-operative infection with osteomyelitis at the osteotomy site (proximal shaft of the fifth metatarsal) that needed debridement and IV antibiotics. In the other 19 cases, the surgical wound healed within 1 week. Asymptomatic radiological non-union developed in six cases (30 %).

Conclusions: Mini-invasive floating metatarsal osteotomy can cure resistant and recurrent University of Texas grade 1A ulcerations plantar to the metatarsal heads in neuropathic patients.

No MeSH data available.


Related in: MedlinePlus

Surgical procedure for metatarsal osteotomy using Shannon burr, fluoroscopic view
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Fig2: Surgical procedure for metatarsal osteotomy using Shannon burr, fluoroscopic view

Mentions: Antibiotics (2 gr IV cephalosporin) were given preoperatively. Anesthesia by ankle block was performed with 15 cm3 of 1 % lidocaine except in patients with neuropathy severe enough to make anesthesia unnecessary. A 3-mm incision was made dorsally at the planned osteotomy site after fluoroscopic identification. The bone was exposed by blunt dissection with a mosquito. A perpendicular or short oblique osteotomy was made at the neck or diaphysis of the affected metatarsus with a 12 × 2 mm Shannon burr at a speed of 1600 RPM and a torque of 80 Nm (Figs. 1, 2, and 3). Fluoroscopy was used again to confirm completion of the osteotomy. Following the osteotomy, the metatarsal head was displaced dorsally. Skin closure was achieved with a single 4-0 nylon suture. Full weight-bearing in a post-operative shoe was permitted immediately.Fig. 1


Mini-Invasive floating metatarsal osteotomy for resistant or recurrent neuropathic plantar metatarsal head ulcers.

Tamir E, Finestone AS, Avisar E, Agar G - J Orthop Surg Res (2016)

Surgical procedure for metatarsal osteotomy using Shannon burr, fluoroscopic view
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4940965&req=5

Fig2: Surgical procedure for metatarsal osteotomy using Shannon burr, fluoroscopic view
Mentions: Antibiotics (2 gr IV cephalosporin) were given preoperatively. Anesthesia by ankle block was performed with 15 cm3 of 1 % lidocaine except in patients with neuropathy severe enough to make anesthesia unnecessary. A 3-mm incision was made dorsally at the planned osteotomy site after fluoroscopic identification. The bone was exposed by blunt dissection with a mosquito. A perpendicular or short oblique osteotomy was made at the neck or diaphysis of the affected metatarsus with a 12 × 2 mm Shannon burr at a speed of 1600 RPM and a torque of 80 Nm (Figs. 1, 2, and 3). Fluoroscopy was used again to confirm completion of the osteotomy. Following the osteotomy, the metatarsal head was displaced dorsally. Skin closure was achieved with a single 4-0 nylon suture. Full weight-bearing in a post-operative shoe was permitted immediately.Fig. 1

Bottom Line: When conservative management with orthotics and shoes does not cure the ulcer, surgical metatarsal osteotomy may be indicated to relieve the pressure and enable the ulcer to heal.After 17/20 operations, the ulcer completely resolved after 6 weeks and did not recur after a mean follow-up of 11.5 months.Asymptomatic radiological non-union developed in six cases (30 %).

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic Surgery, Assaf HaRofeh Medical Center, Zerrifin, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.

ABSTRACT

Background: Patients with peripheral neuropathy and pressure under a relatively plantar deviated metatarsal head frequently develop plantar foot ulcers. When conservative management with orthotics and shoes does not cure the ulcer, surgical metatarsal osteotomy may be indicated to relieve the pressure and enable the ulcer to heal. The purpose of this study is to evaluate the use of a mini-invasive floating metatarsal osteotomy in treating recalcitrant ulcers or recurrent ulcers plantar to the metatarsal heads in patients with diabetes mellitus (DM) related neuropathy.

Methods: Computerized medical files of patients with diabetic neuropathy treated with an osteotomy during 2013 and 2014 were retrospectively reviewed. There were 20 osteotomies performed on 17 patients (mean age 58 years). The patients had a diagnosis of DM for a mean of 17 years. All ulcers were University of Texas grade 1A; mean ulcer age was 19 months.

Results: After 17/20 operations, the ulcer completely resolved after 6 weeks and did not recur after a mean follow-up of 11.5 months. One patient developed an early post-operative infection with osteomyelitis at the osteotomy site (proximal shaft of the fifth metatarsal) that needed debridement and IV antibiotics. In the other 19 cases, the surgical wound healed within 1 week. Asymptomatic radiological non-union developed in six cases (30 %).

Conclusions: Mini-invasive floating metatarsal osteotomy can cure resistant and recurrent University of Texas grade 1A ulcerations plantar to the metatarsal heads in neuropathic patients.

No MeSH data available.


Related in: MedlinePlus