Complications de la chirurgie de l’hallux valgus : étude prospective. À propos d’une série continue de 804 pieds opérés par ostéotomie scarf du premier rayon

Abstract

AimsThe first aim of this prospective study was to find out the complication rate occurring after hallux valgus surgery treated by scarf osteotomies of the first metatarsal and shortening/varus displacement of the first phalange. Our second aim was to evaluate the impact of additional procedures on lateral metatarsals on the occurrence of secondary complications. Our third aim was to compare our results to those reported in the literature.Materials and methodsWe enrolled in this trial all patients who underwent hallux valgus surgery and had no associated systemic disease, from 1998 to 2005 (804 operated feet). The minimal required follow-up was 4 months. In case of problems at this date, the patient was re-scheduled for a 12-month follow-up visit. We identified complications during the hospital stay and at the time of the systematic follow-up visits at 35 and 120 days. We divided the patients into two groups: group 1: first ray surgery only; and group 2: first ray surgery and additional procedure on lateral metatarsals. We calculated two types of data: the global incidence rate of complications and a univariate analysis to assess the role of lateral metatarsals surgery on complication occurrence.ResultsOur findings confirmed a stiffness of the first metatarsophalangeal joint (MTP1) in 5.2% of cases. It was serious for 0.9% of cases, which corresponded to the onset of reflex sympathetic dystrophy (0.9% of cases). Delay in wound healing had an incidence of 4.2%. Each of the other complications had an incidence lower than 1%: superficial infection (0.9%), secondary displacement (0.6%), nerve injury (0.6%), phlebitis (0.5%), and device breaking (0.1%). Some complications were not found in this series: elevation of the first metatarsal head and transfer metatarsalgia, pseudarthrosis, necrosis, iatrogenic hallux valgus, deep site infection. Apart from a longer period of postoperative MTP1 stiffness, lateral metatarsal osteotomies did not affect the complication rate for the first ray.DiscussionThe literature confirms the rarity of the complications of these osteotomies and does not show a lower incidence of complications with the techniques appeared after the scarf (percutaneous surgery).ConclusionKnowing the rate of complications enables us to better inform patients during the preoperative interview.