W Blauth1, A Falliner. 1. Orthopädische Universitätsklinik, Michaelisstraße 1, D-24105, Kiel.
Abstract
GOAL OF SURGERY: Correction of the deformity of the third metatarsus and of the malposition of the toes to improve form and function of the foot. INDICATIONS: Problems with shoe wear. Aesthetic appearance. (Limitation of function.) CONTRAINDICATIONS: None. PREOPERATIVE WORK UP: Drawing of surgery to be performed. POSITIONING AND ANAESTHESIA: Supine. General anaesthesia. SURGICAL TECHNIQUE: Excision of the distal half of the hypoplastic second metatarsus through a curvilinear dorsal incision. Osteotomy of the third metatarsus at the Y-junction and implantation of the mediodistal part into the proximal half of the second metatarsus. Corrective osteotomy of the third metatarsus at the Y-junction. Internal fixation of both metatarsi with transosseous, transarticular Kirschner wires. Four weeks later correction of the hallux valgus using the technique recommended by Kramer. POSTOPERATIVE MANAGEMENT: Below knee plaster of Paris. Removal of K'wires after consolidation of osteotomies. Progressive increase in weight bearing. Arch supports. POSSIBLE COMPLICATIONS: Injury to nerves, vessels or tendons. Wound infection. Delayed consolidation. Nonunion. Growth disturbances. RESULTS: 30 months postoperatively, when the patient was 13 years of age, both osteotomies had healed in good position: the foot looked nearly normal. At 21 years of age the patient has no problems. She is involved in sports and is satisfied with the result.
GOAL OF SURGERY: Correction of the deformity of the third metatarsus and of the malposition of the toes to improve form and function of the foot. INDICATIONS: Problems with shoe wear. Aesthetic appearance. (Limitation of function.) CONTRAINDICATIONS: None. PREOPERATIVE WORK UP: Drawing of surgery to be performed. POSITIONING AND ANAESTHESIA: Supine. General anaesthesia. SURGICAL TECHNIQUE: Excision of the distal half of the hypoplastic second metatarsus through a curvilinear dorsal incision. Osteotomy of the third metatarsus at the Y-junction and implantation of the mediodistal part into the proximal half of the second metatarsus. Corrective osteotomy of the third metatarsus at the Y-junction. Internal fixation of both metatarsi with transosseous, transarticular Kirschner wires. Four weeks later correction of the hallux valgus using the technique recommended by Kramer. POSTOPERATIVE MANAGEMENT: Below knee plaster of Paris. Removal of K'wires after consolidation of osteotomies. Progressive increase in weight bearing. Arch supports. POSSIBLE COMPLICATIONS: Injury to nerves, vessels or tendons. Wound infection. Delayed consolidation. Nonunion. Growth disturbances. RESULTS: 30 months postoperatively, when the patient was 13 years of age, both osteotomies had healed in good position: the foot looked nearly normal. At 21 years of age the patient has no problems. She is involved in sports and is satisfied with the result.