Operative Treatment of Freiberg Disease Using Extra-articular Dorsal Closing-Wedge Osteotomy

Abstract

Extra-articular dorsal closing wedge osteotomy has been used with successful results for Freiberg disease; however, there has been concern regarding the technical difficulty. The purpose of this study was to address technical tips and report on the clinical and radiographic outcome using Kirchner wire-assisted dorsal closing wedge osteotomy. A retrospective review of 13 patients with a mean age of 29.1 years was conducted. Extra-articular dorsal wedge osteotomy was performed after debridement of the joint. Two Kirschner wires were inserted and used as a joystick to manipulate the osteotomized bone. The osteotomy site was fixed with crossed pins. Clinical outcome was assessed according to American Orthopaedic Foot and Ankle Society score, range of motion of the metatarsophalangeal joint, and visual analogue scale. Head necrosis was classified according to Smillie stage; time to bone union and metatarsal shortening were reviewed. Patients were followed for a mean period of 44.2 months. Mean American Orthopaedic Foot and Ankle Society score at the latest follow-up was 92.2 (range, 92-100). The range of motion of the metatarsophalangeal joint showed a mean increase of 6.2 degrees (range, -10 to 25) at the latest follow-up. The mean visual analogue scale score decreased from 7.5 (range, 5-10) preoperatively to 1 (range, 0-4) at the latest follow-up (P < .01). All osteotomies healed on average after 7.0 weeks (range, 4-13.6) without nonunion. The average metatarsal shortening was 0.5 mm (range, -3.1 to 3.5). None of the patients showed progression of osteonecrosis or joint space narrowing. Extra-articular closing dorsal wedge osteotomy can yield good articular congruity with bone remodeling, with easy performance of the procedure with temporary Kirschner wires without complication. Level IV, retrospective case series.