Freiberg's disease treated with dorsal closed V-shaped osteotomy and Charlotte breakage screw fixation

Abstract

Objective To evaluate the clinical outcomes of treating Freiberg's disease with dorsal wedge osteotomy and Charlotte breakage screw fixation. Methods From June 2010 to June 2014, 11 patients with Freiberg's disease were treated at our department. They were 5 males and 6 females at an average age of 32 years (range, from 15 to 52 years) . X-ray revealed osteosclerosis and collapse of the metatarsal head. According to Smillie classification system, there were 5 cases of stage Ⅱ and 6 ones of stage Ⅲ. The duration of symptoms was from 7 to 48 months (average, 23 months) . The metatarsal heads were rotated to reconstruct the joint surface. After dorsal closed V-shaped osteotomy, Charlotte breakage screws were implanted. Results All wounds healed with no complications in the early postoperative period. The 11 patients were followed up for 14 to 48 months (average, 19 months) , showing obvious pain relief. X-ray showed that the osteotomy sites got solid union in all patients at an average time of 10 weeks (range, from 8 to 13 weeks) after operation. Average shortening of the metatarsal was 1.5 mm (range, from 1.1 to 1.8 mm) . The American Orthopaedic Foot and Ankle Society (AOFAS) score, Lesser Metatarsophalangeal-Interphalangeal Scale (LMIS) score, and range of motion at one day, one month and one year after operation were significantly improved compared with the preoperative ones (P<0.05) . Significant differences were also observed between all postoperative time points (P<0.05) . No such complications happened as referred pain from the adjacent metatarsophalangeal joint, displacement, nonunion, necrosis or infection. All patients returned to sports and recreational activities at 6 months after operation, except one case of stage Ⅲ who had constant swelling in the metatarsophalangeal joint but eventually recovered at 10 months after operation. According to patients' satisfaction at the last follow-ups, including 7 cases were excellent, 3 good and one poor. Conclusion Dorsal closed V-shaped osteotomy with Charlotte breakage screw fixation is an effective procedure for Freiberg's disease of stages Ⅱ and Ⅲ, because it leads to effective reconstruction of the metatarsophalangeal joint, allows early joint motion and avoids a second operation. Key words: Osteonecrosis; Metatarsal bones; Osteotomy; Bone nails