TY - JOUR
T1 - Operative treatment of Freiberg disease using extra-articular dorsal closing-wedge osteotomy
T2 - Technical tip and clinical outcomes in 13 patients
AU - Lee, Hyun Joo
AU - Kim, Jeong Woo
AU - Min, Woo Kie
PY - 2013/1
Y1 - 2013/1
N2 - Background: Extra-articular dorsal closing wedge osteotomy has been used with successful results for Freiberg disease; however, there has been concern regarding the technical difficulty. The purpose of this study was to address technical tips and report on the clinical and radiographic outcome using Kirchner wire-assisted dorsal closing wedge osteotomy. Methods: A retrospective review of 13 patients with a mean age of 29.1 years was conducted. Extra-articular dorsal wedge osteotomy was performed after debridement of the joint. Two Kirschner wires were inserted and used as a joystick to manipulate the osteotomized bone. The osteotomy site was fixed with crossed pins. Clinical outcome was assessed according to American Orthopaedic Foot and Ankle Society score, range of motion of the metatarsophalangeal joint, and visual analogue scale. Head necrosis was classified according to Smillie stage; time to bone union and metatarsal shortening were reviewed. Patients were followed for a mean period of 44.2 months. Results: Mean American Orthopaedic Foot and Ankle Society score at the latest follow-up was 92.2 (range, 92-100). The range of motion of the metatarsophalangeal joint showed a mean increase of 6.2 degrees (range, -10 to 25) at the latest follow-up. The mean visual analogue scale score decreased from 7.5 (range, 5-10) preoperatively to 1 (range, 0-4) at the latest follow-up (P < .01). All osteotomies healed on average after 7.0 weeks (range, 4-13.6) without nonunion. The average metatarsal shortening was 0.5 mm (range, -3.1 to 3.5). None of the patients showed progression of osteonecrosis or joint space narrowing. Conclusion: Extra-articular closing dorsal wedge osteotomy can yield good articular congruity with bone remodeling, with easy performance of the procedure with temporary Kirschner wires without complication. Level of Evidence: Level IV, retrospective case series.
AB - Background: Extra-articular dorsal closing wedge osteotomy has been used with successful results for Freiberg disease; however, there has been concern regarding the technical difficulty. The purpose of this study was to address technical tips and report on the clinical and radiographic outcome using Kirchner wire-assisted dorsal closing wedge osteotomy. Methods: A retrospective review of 13 patients with a mean age of 29.1 years was conducted. Extra-articular dorsal wedge osteotomy was performed after debridement of the joint. Two Kirschner wires were inserted and used as a joystick to manipulate the osteotomized bone. The osteotomy site was fixed with crossed pins. Clinical outcome was assessed according to American Orthopaedic Foot and Ankle Society score, range of motion of the metatarsophalangeal joint, and visual analogue scale. Head necrosis was classified according to Smillie stage; time to bone union and metatarsal shortening were reviewed. Patients were followed for a mean period of 44.2 months. Results: Mean American Orthopaedic Foot and Ankle Society score at the latest follow-up was 92.2 (range, 92-100). The range of motion of the metatarsophalangeal joint showed a mean increase of 6.2 degrees (range, -10 to 25) at the latest follow-up. The mean visual analogue scale score decreased from 7.5 (range, 5-10) preoperatively to 1 (range, 0-4) at the latest follow-up (P < .01). All osteotomies healed on average after 7.0 weeks (range, 4-13.6) without nonunion. The average metatarsal shortening was 0.5 mm (range, -3.1 to 3.5). None of the patients showed progression of osteonecrosis or joint space narrowing. Conclusion: Extra-articular closing dorsal wedge osteotomy can yield good articular congruity with bone remodeling, with easy performance of the procedure with temporary Kirschner wires without complication. Level of Evidence: Level IV, retrospective case series.
KW - Dorsal wedge osteotomy
KW - Extra-articular
KW - Freiberg disease
KW - Kirschner wire
UR - http://www.scopus.com/inward/record.url?scp=84874794302&partnerID=8YFLogxK
U2 - 10.1177/1071100712460185
DO - 10.1177/1071100712460185
M3 - Article
C2 - 23386770
AN - SCOPUS:84874794302
SN - 1071-1007
VL - 34
SP - 111
EP - 116
JO - Foot and Ankle International
JF - Foot and Ankle International
IS - 1
ER -