Artikel
Intraoperative stresstest for hypermobility of the metatarsus primus varus in open and percutaneous hallux valgus reconstruction
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Autoren
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Christian Kinast
- Orthopädie Zentrum Arabellapark, Orthopädie und Unfallchirurgie, Isarklinikum, München, Germany
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Mohamed Karray
- Orthopädie Zentrum Arabellapark, Orthopädie und Unfallchirurgie, Isarklinikum, München, Germany
| Veröffentlicht: | 10. Oktober 2016 |
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Gliederung
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Objectives: This study was done to investigate the degree of motion in the ap view on x-rays before and after distal soft tissue release. This might be of interest to better understand the role of distal soft tissue fixation at the level of the MPJ und metatarso-tarsal joint level.
Material: Two groups were studied : 1. Open soft tissue release in the open osteotomy group 2. percutaneous distal soft tissue release. All procedures and stresstests were done by one surgeon. 50 feet were tested in each group.
Methods: All patients had preoperative standing x-rays under standardized conditions. All feet had non-weight bearing x-rays with a mini C- arm ( fluroscan ( Hologic ) ) intraoperatively . The radiologic examination consisted of 1. ap view ; 2. stresstest pushing the great toe in max valgus and axial load to push the first metatarsal into maximal medial displacement. 3. reverse action and maximal lateral displacement and 4. repeated test into max varus of the first metatarsal. After performing open soft tissue release test 2 3 and 4 were repeated and x rays were recorded for each testing position. All x-rays where evaluated with a dicom pacs ( oehm ) and angles and distances in mm where measured.
Results: The ap intermetatarsal angle of the preoperative standing weight bearing x-rays equals that of the 1. stress test non weight bearing open group 15,6 ° min/ max 10°- 22 ° / pc group 14.3° min / max.7-24°. After soft tissue release the intermetatarsal angle is increased to 19.5 °;14 / 26° min/max open group and pc group/ 15.8° 11-23,5 ° min/ max. The full valgus / varus motion increased from 5 ( 0-8) to 8.5mm ( 4- 12°) for the open group and from 3 (0-8 ° ) to 6° (1- 9°) in the percutaneous group after soft tissue release.
Conclusion: The distal soft tissues contribute to the fixation of the metatarsal 1 to the 2nd metatarsal. For bigger angles and distances between M 1 and M 2 the angular change was relatively bigger than for smaller angles. The stabilizing structures at the TMT level hold the metatarsal in place . In percutaneous procedures no distal fixation of the soft tissues are performed and soft tissue fixation is relying solely on the TMT structures.
