Proximal Oblique Slide Closing Wedge Metatarsal Osteotomy With Plate Fixation for Severe Hallux Valgus Deformities

Abstract

Proximal metatarsal osteotomies are generally recommended for severe hallux valgus deformities. The most common problems encountered with these osteotomies are overcorrection, that is, hallux varus and dorsal malunion because of either technical errors or fixation failure. We report our first 12 cases of severe hallux valgus deformities treated with a modified proximal metatarsal osteotomy fixed with angular stable plates, with an average American Orthopaedic Foot and Ankle Society preoperative score of 50 points, average intermetatarsal angle of 15 degrees, and metatarsophalangeal angle of 36 degrees. The osteotomy was performed from the dorsal to the plantar aspect of the bone, removing a small bone wedge laterally as determined in the preoperative planning, and translating laterally the distal fragment. In this way, rotation and lateral displacement of the distal fragment was performed until intraoperative parallelism between the first and second metatarsal bone was obtained. The osteotomy was fixed with an angular stable plate, with 2 locked screws proximally and 3 distal nonlocked screws. The geometric model of the osteotomy, preoperative planning, technique, early results, and complications are shown.