M Walther1, P Simons, K Nass, A Röser. 1. Zentrum für Fuß- und Sprunggelenkchirurgie, Schön-Klinik München-Harlaching, Harlachingerstr. 51, 81547, München, Deutschland. MWalther@schoen-kliniken.de
Abstract
OBJECTIVE: Treatment of hallux valgus in patients with a pathology of the first metatarsocuneiform (MC) joint by a fusion of the first MC fixed by a plantar plate. The plantar plate has biomechanical advantages and has good soft tissue coverage by the M. abductor hallucis. INDICATIONS: Instability or degenerative arthritis of the first MC joint in patients with hallux valgus. CONTRAINDICATIONS: Short first metatarsal. SURGICAL TECHNIQUE: Bone-saving resection of the first MC joint. Arthrodesis using a compression screw and a plantar interlocking plate. Distal soft tissue procedure and resection of the exostosis. POSTOPERATIVE MANAGEMENT: For 6 weeks, a long sole, post-operative shoe with weight bearing as pain allows. Mobilization of the first metatarsophalangeal joint when the wound healing is assured. Full weight bearing after 6-8 weeks in a normal shoe, when the bone healing is completed on the x-rays. No sports with high demands on the foot for 12 weeks. Orthotics only in cases with persisted pain or associated pathology. RESULTS: In a case control study including 72 patients, a significantly lower rate of nonunion and soft tissue problems, compared to dorsal or medial plate positioning, was observed.
OBJECTIVE: Treatment of hallux valgus in patients with a pathology of the first metatarsocuneiform (MC) joint by a fusion of the first MC fixed by a plantar plate. The plantar plate has biomechanical advantages and has good soft tissue coverage by the M. abductor hallucis. INDICATIONS: Instability or degenerative arthritis of the first MC joint in patients with hallux valgus. CONTRAINDICATIONS: Short first metatarsal. SURGICAL TECHNIQUE: Bone-saving resection of the first MC joint. Arthrodesis using a compression screw and a plantar interlocking plate. Distal soft tissue procedure and resection of the exostosis. POSTOPERATIVE MANAGEMENT: For 6 weeks, a long sole, post-operative shoe with weight bearing as pain allows. Mobilization of the first metatarsophalangeal joint when the wound healing is assured. Full weight bearing after 6-8 weeks in a normal shoe, when the bone healing is completed on the x-rays. No sports with high demands on the foot for 12 weeks. Orthotics only in cases with persisted pain or associated pathology. RESULTS: In a case control study including 72 patients, a significantly lower rate of nonunion and soft tissue problems, compared to dorsal or medial plate positioning, was observed.
Authors: Graham A Hamilton; Samantha Mullins; John M Schuberth; Shannon M Rush; Lawrence Ford Journal: J Foot Ankle Surg Date: 2007 Nov-Dec Impact factor: 1.286
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