Abstract
Purpose
The proximal chevron osteotomy provides high correctional power. However, relatively high rates of dorsiflexion malunion of up to 17 % are reported for this procedure. This leads to insufficient weight bearing of the first ray and therefore to metatarsalgia. Recent biomechanical and clinical studies pointed out the importance of rigid fixation of proximal metatarsal osteotomies. Therefore, the aim of the present study was to compare biomechanical properties of fixation of proximal chevron osteotomies with variable locking plate and cancellous screw respectively.
Methods
Ten matched pairs of human fresh frozen cadaveric first metatarsals underwent proximal chevron osteotomy with either variable locking plate or cancellous screw fixation after obtaining bone mineral density. Biomechanical testing included repetitive plantar to dorsal loading from 0 to 31 N with the 858 Mini Bionix® (MTS® Systems Corporation, Eden Prairie, MN, USA). Dorsal angulation of the distal fragment was recorded.
Results
The variable locking plate construct reveals statistically superior results in terms of bending stiffness and dorsal angulation compared to the cancellous screw construct. There was a statistically significant correlation between bone mineral density and maximum tolerated load until construct failure occurred for the screw construct (r = 0.640, p = 0.406).
Conclusion
The results of the present study indicate that variable locking plate fixation shows superior biomechanical results to cancellous screw fixation for proximal chevron osteotomy. Additionally, screw construct failure was related to levels of low bone mineral density. Based on the results of the present study we recommend variable locking plate fixation for proximal chevron osteotomy, especially in osteoporotic bone.
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References
Coughlin MJ (1996) Instructional course lectures, The American Academy of Orthopaedic Surgeons -Hallux valgus. J Bone Joint Surg Am 78(1):932–966
Easley ME, Trnka HJ (2007) Current concepts review: hallux valgus part II: operative treatment. Foot Ankle Int 28(6):748–758
Radl R, Leithner A, Zacherl M et al (2004) The influence of personality traits on the subjective outcome of operative hallux valgus correction. Int Orthop 28(5):303–306
Schneider W (2013) Distal soft tissue procedure in hallux valgus surgery: biomechanical background and technique. Int Orthop 37(9):1669–1675
Schneider W, Knahr K (2001) Surgery for hallux valgus. The expectations of patients and surgeons. Int Orthop 25(6):382–385
Schuh R, Willegger M, Holinka J et al (2013) Angular correction and complications of proximal first metatarsal osteotomies for hallux valgus deformity. Int Orthop 37(9):1771–1780
Badekas A, Georgiannos D, Lampridis V et al (2013) Proximal opening wedge metatarsal osteotomy for correction of moderate to severe hallux valgus deformity using a locking plate. Int Orthop 37(9):1765–1770
Castaneda DA, Myerson MS, Neufeld SK (2013) The Ludloff osteotomy: a review of current concepts. Int Orthop 37(9):1661–1668
Sammarco GJ, Conti SF (1993) Proximal chevron metatarsal osteotomy: single incision technique. Foot Ankle Int 14(1):44–47
Sammarco GJ, Brainard BJ, Sammarco VJ (1993) Bunion correction using proximal chevron osteotomy. Foot Ankle Int 14(1):8–14
Sammarco GJ, Russo-Alesi FG (1998) Bunion correction using proximal chevron osteotomy: a single-incision technique. Foot Ankle Int 19(7):430–437
Easley ME, Kiebzak GM, Davis WH (1996) Prospective, randomized comparison of proximal crescentic and proximal chevron osteotomies for correction of hallux valgus deformity. Foot Ankle Int 17(6):307–316
Trnka HJ (2005) Osteotomies for hallux valgus correction. Foot Ankle Clin 10(1):15–33
Trnka HJ, Parks BG, Ivanic G et al (2000) Six first metatarsal shaft osteotomies: mechanical and immobilization comparisons. Clin Orthop Relat Res 381:256–265
Wanivenhaus A, Bock P, Gruber F et al (2009) Deformity-associated treatment of the hallux valgus complex. Orthopade 38(11):1117–1126
Zettl R, Trnka HJ, Easley M et al (2000) Moderate to severe hallux valgus deformity: correction with proximal crescentic osteotomy and distal soft-tissue release. Arch Orthop Trauma Surg 120(7–8):397–402
Chuckpaiwong B (2012) Comparing proximal and distal metatarsal osteotomy for moderate to severe hallux valgus. Int Orthop 36(11):2275–2278
Anderson RB, Davis WH (1997) Internal fixation of the proximal chevron osteotomy. Foot Ankle Int 18(6):371–372
Glasoe W et al (1999) Anatomy and biomechanics of the first ray. Phys Ther 79(9):854–859
Hofstaetter SG, Glisson RR, Alitz CJ et al (2008) Biomechanical comparison of screws and plates for hallux valgus opening-wedge and Ludloff osteotomies. Clin Biomech (Bristol, Avon) 23(1):101–108
Nyska M, Trnka HJ, Parks BG et al (2002) Proximal metatarsal osteotomies: a comparative geometric analysis conducted on sawbone models. Foot Ankle Int 23(10):938–945
Schuh R, Trnka HJ, Sabo A et al (2011) Biomechanics of postoperative shoes: plantar pressure distribution, wearing characteristics and design criteria: a preliminary study. Arch Orthop Trauma Surg 131(2):197–203
Acevedo JI, Sammarco VJ, Boucher HR et al (2002) Mechanical comparison of cyclic loading in five different first metatarsal shaft osteotomies. Foot Ankle Int 23(8):711–716
McCluskey LC, Johnson JE, Wynarsky GT et al (1994) Comparison of stability of proximal crescentic metatarsal osteotomy and proximal horizontal "V" osteotomy. Foot Ankle Int 15(5):263–270
Lian GJ, Markolf K, Cracchiolo A 3rd (1992) Strength of fixation constructs for basilar osteotomies of the first metatarsal. Foot Ankle Int 13(9):509–514
Jones C, Coughlin M, Petersen W et al (2005) Mechanical comparison of two types of fixation for proximal first metatarsal crescentic osteotomy. Foot Ankle Int 26(5):371–374
Arnold H, Stukenborg-Colsman C, Hurschler C et al (2012) Biomechanical in vitro-stability testing on human specimens of a locking plate system against conventional screw fixation of a proximal first metatarsal lateral displacement osteotomy. Open Orthop J 6:133–139
Gallentine JW, Deorio JK, Deorio MJ (2007) Bunion surgery using locking-plate fixation of proximal metatarsal chevron osteotomies. Foot Ankle Int 28(3):361–368
Scott AT, DeOrio JK, Montijo HE et al (2010) Biomechanical comparison of hallux valgus correction using the proximal chevron osteotomy fixed with a medial locking plate and the Ludloff osteotomy fixed with two screws. Clin Biomech (Bristol, Avon) 25(3):271–276
Sharma KM, Parks BG, Nguyen A et al (2005) Plantar-to-dorsal compared to dorsal-to-plantar screw fixation for proximal chevron osteotomy: a biomechanical analysis. Foot Ankle Int 26(10):854–858
Kim DG, Dong XN, Cao T et al (2006) Evaluation of filler materials used for uniform load distribution at boundaries during structural biomechanical testing of whole vertebrae. J Biomech Eng 128(1):161–165
Varner KE, Matt V, Alexander JW et al (2009) Screw versus plate fixation of proximal first metatarsal crescentic osteotomy. Foot Ankle Int 30(2):142–149
Tsilikas SP, Stamatis ED, Kourkoulis SK et al (2011) Mechanical comparison of two types of fixation for Ludloff oblique first metatarsal osteotomy. J Foot Ankle Surg 50(6):699–702
Klos K, Gueorguiev B, Muckley T et al (2010) Stability of medial locking plate and compression screw versus two crossed screws for lapidus arthrodesis. Foot Ankle Int 31(2):158–163
Klos K, Simons P, Hajduk AS et al (2011) Plantar versus dorsomedial locked plating for Lapidus arthrodesis: a biomechanical comparison. Foot Ankle Int 32(11):1081–1085
Scranton PE, Coetzee JC, Carreira D (2009) Arthrodesis of the first metatarsocuneiform joint: a comparative study of fixation methods. Foot Ankle Int 30(4):341–345
Funding
Implants were provided by Königsee Implantate GmbH, which did not assume a role in the study design, collection, analysis and interpretation of data, writing of the manuscript, or in the decision to submit the manuscript for publication.
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Schuh, R., Hofstaetter, J.G., Benca, E. et al. Biomechanical analysis of two fixation methods for proximal chevron osteotomy of the first metatarsal. International Orthopaedics (SICOT) 38, 983–989 (2014). https://doi.org/10.1007/s00264-014-2286-1
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DOI: https://doi.org/10.1007/s00264-014-2286-1