Die belastungsstabile Lapidus-Arthrodese bei Hallux-valgus-Deformität mittels IVP-Plattenfixateur (V-TEK®-System)

Abstract

Correction of hallux valgus deformities without loss of toe length. Achievement of full weight-bearing. Hallux valgus with intermetatarsal angle of more than 20°. Hypermobility of the first metatarsal bone combined with instability. Recurrence of hallux valgus deformity. Hallux limitus combined with metatarsus primus elevatus. Painful arthrosis of the metatarsal-cuneiform-medial joint (TMT1). Arterial occlusive disease. Infection of the foot. Nicotine abuse. Strict verification of indication in patients with diabetes mellitus. Lateral release of the proximal phalanx joint of the hallux with tenotomy of the adductor hallucis tendon. Resection of the medial pseudoexostosis. Cartilage removal at the joint basis of the metatarsus 1 and the joint basis of the medial cuneiform bone to prepare for the corrective arthrodesis. Proximal osteotomy of the metatarsus 1. Lateralization and, if required, derotation of the distal metatarsus 1 segments using a special L-type chisel to prepare the intramedullary bed for the plate, going right into the medial cuneiform. Insertion of the IVP plate and fixation using stable screws in the correct angle. Medial capsuloraphy. Early functional rehabilitation with increasing weight-bearing using a special shoe for 6-8weeks. Full weight-bearing usually after 2weeks. Physical therapy, lymphatic drainage, cryotherapy. Leg elevation. In all, 21consecutive patients, 19women, 2men, between 41 and 75years of age (mean age 62.3years) were included. Mean follow-up was 21months (12-27months). Preoperative hallux valgus angle (48°; range 40-63°) improved to 15° (range 6-28°). The intermetatarsal angle averaged 18° (range 12-27°) preoperatively and 8° (range 7-10°) postoperatively. The Kitaoka score improved from 47points (37-49points) preoperatively to 81points (77-86points) postoperatively. Complications included loosening of screws in 4cases. All were treated by partial hardware removal under local anesthesia without further sequelae. In 5cases, prolonged wound secretion (up to 5weeks) healed without infection.