BACKGROUND: The optimal osteotomy type and fixation method for hallux valgus correction have not been defined. This study examined the mechanical properties of corrective opening-wedge and Ludloff oblique osteotomies under conditions approximating postoperative weight-bearing. METHODS: Twenty-nine pairs of fresh-frozen metatarsals were divided into three groups. In Group 1, headless screws were compared with standard cortical screws for Ludloff osteotomy fixation. In Groups 2 and 3, Ludloff osteotomies fixed with headless screws were compared with opening-wedge osteotomies fixed with non-locking and locking plates, respectively. Constructs underwent dorsally-directed cantilever loading for 1000 cycles. FINDINGS: No significant differences in angulation or stiffness were demonstrable in Group 1. In Group 2, Ludloff/headless screw construct stiffness exceeded non-locking plate construct stiffness. The mean angulation on the 1000th load cycle was greater for plates than for Ludloff/headless screws. In Group 3, locking plate construct stiffness and angulation did not differ from Ludloff/headless screws in early cyclic loading, but fixation failure of the locking plate constructs was common. INTERPRETATION: The results indicate that screw type for Ludloff fixation may be left to surgeon preference and that opening-wedge plates exhibit mechanical properties inferior to that of the Ludloff osteotomy under the tested conditions. Lateral cortex continuity and bone density remain important factors in the performance of opening-wedge osteotomies.
BACKGROUND: The optimal osteotomy type and fixation method for hallux valgus correction have not been defined. This study examined the mechanical properties of corrective opening-wedge and Ludloff oblique osteotomies under conditions approximating postoperative weight-bearing. METHODS: Twenty-nine pairs of fresh-frozen metatarsals were divided into three groups. In Group 1, headless screws were compared with standard cortical screws for Ludloff osteotomy fixation. In Groups 2 and 3, Ludloff osteotomies fixed with headless screws were compared with opening-wedge osteotomies fixed with non-locking and locking plates, respectively. Constructs underwent dorsally-directed cantilever loading for 1000 cycles. FINDINGS: No significant differences in angulation or stiffness were demonstrable in Group 1. In Group 2, Ludloff/headless screw construct stiffness exceeded non-locking plate construct stiffness. The mean angulation on the 1000th load cycle was greater for plates than for Ludloff/headless screws. In Group 3, locking plate construct stiffness and angulation did not differ from Ludloff/headless screws in early cyclic loading, but fixation failure of the locking plate constructs was common. INTERPRETATION: The results indicate that screw type for Ludloff fixation may be left to surgeon preference and that opening-wedge plates exhibit mechanical properties inferior to that of the Ludloff osteotomy under the tested conditions. Lateral cortex continuity and bone density remain important factors in the performance of opening-wedge osteotomies.
Authors: Reinhard Schuh; Madeleine Willegger; Johannes Holinka; Robin Ristl; Reinhard Windhager; Axel H Wanivenhaus Journal: Int Orthop Date: 2013-07-25 Impact factor: 3.075
Authors: Heino Arnold; Christina Stukenborg-Colsman; Christof Hurschler; Frank Seehaus; Evgenij Bobrowitsch; Hazibullah Waizy Journal: Open Orthop J Date: 2012-04-04