Transverse Osteotomy Research Articles

Early effectiveness of modified minimally invasive Chevron-Akin osteotomy for moderate to severe hallux valgus

To explore early effectiveness of modified minimally invasive Chevron-Akin (MICA) osteotomy in the treatment of moderate to severe hallux valgus. A clinical data of 49 patients (61 feet) with moderate to severe hallux valgus, who met the selection criteria between December 2019 and October 2022, was retrospectively analyzed. There were 7 males (8 feet) and 42 females (53 feet) with an average age of 38.0 years (range, 15-59 years), including 37 of unilateral foot and 12 of bilateral feet. There were 41 feet of moderate hallux valgus [hallux valgus angle (HVA) 20°-40°] and 10 feet of severe hallux valgus (HVA>40°). All patients underwent modified MICA osteotomy. A transverse osteotomy on the distal end of the first metatarsal bone was performed to replaced the traditional Chevron osteotomy, and three Kirschner wires were used to assist in three-dimensional correction. The other treatments were the same as traditional MICA osteotomy. The HVA, inter metatarsal angle (IMA), Hardy score of the sesamoid, and American Orthopaedic Foot and Ankle Society (AOFAS) score of 61 feet before operation and at last follow-up were recorded, and the results were compared between the various severity of hallux valgus. All patients were followed up 6-24 months with an average of 12.0 months. After operation, the redness and swelling around the incision occurred in 1 foot; limited mobility of the metatarsophalangeal joint occurred in 2 feet; mild numbness of the skin occurred in 5 feet; mild inversion of the great toe occurred in 2 feet. No complication such as tendon injury was found. X-ray films showed no abnormal healing, nonunion, or necrosis of the metatarsal head after osteotomy. The healing time of osteotomy ranged from 3 to 4 months, with an average of 3.2 months. At last follow-up, the HVA, IMA, Hardy score of sesamoid, and AOFAS scores all significantly improved when compared with preoperative levels ( P<0.05). The AOFAS scores were excellent in 45 feet, good in 15 feet, and fair in 1 foot, with an excellent and good rate of 98.4%. The above indicators for moderate or severe hallux valgus patients were significantly improved when compared with preoperative levels ( P<0.05). The changes between pre- and post-operation in HVA, IMA, and Hardy scores of severe hallux valgus were all greater than those of moderate hallux valgus, with significant difference in HVA change between groups ( P<0.05), while there was no significant difference in the other two changes ( P>0.05). Modified MICA osteotomy can achieve good orthopedic effects and early functional improvement in the treatment of moderate to severe hallux valgus.

The Nasal Locator: An Innovative Instrument to Define the Exact Point of Osteotomy in Preservation or Structural Rhinoplasty.

One of the most common components of most dorsal preservation (DP) techniques is subdorsal septal excision. Whatever the instrument used for this procedure (piezoelectric, Rongeur, or long scissors), it is paramount to be able to determine the exact subdorsal point (SDoP) at which the osteotomy/ostectomy (or cartilage cut) has been reached. First, to avoid any unnecessary extension of the osteotomy that increases the risk of fracture spreading into the cribriform plate and a consequent cerebrospinal fluid leak; second, to be sure that the subdorsal cut is high enough and can be combined/unified with the planned radix osteotomy.In addition, transverse osteotomies are usually necessary in both preservation and structural rhinoplasties. Even though many surgeons are satisfied with their osteotomy lines, it sometimes proves difficult to be sure of their position, especially during a DP rhinoplasty when both the transverse lines have to go in the direction of the planned radix osteotomy.We have developed the Nasal Locator (NL) to precisely define various nasal points of interest, such as a subdorsal cut (cartilaginous or bony), or a transverse or medial osteotomy line. It ends in two tips. The lower tip is placed at the point we wish to determine (e.g., SDoP or a transverse osteotomy), while the upper tip is fixed a certain distance from it (in all three dimensions), showing its exact location.Our in-depth research of the literature and the market has not revealed any device similar in form and function to the NL.We have been using the NL for almost 2 years and are confident of its usefulness. It is easy to use, and practically no time is needed to become familiar with it. During surgery, it is needed for less than 30 seconds and is risk-free. It is fully sterilizable and can be used repeatedly.

Ulnar shaft diameter as it relates to plate osteosynthesis: A cadaveric study

BackgroundUlnar shaft fractures are common and the standard of care treatment is with 3.5 ​mm plating. The purpose of this study was to measure diameters along the length of the ulna to provide information on screw length and appropriateness of 3.5 ​mm screws and plate location. MethodsTen embalmed cadaveric ulnas were dissected free of all soft tissues. The length of the ulna was measured and then divided by four. Transverse osteotomies were performed along the length of the ulna at ¼, ½ and ¾ its full length. The diameter of the ulna at these locations was then measured in a radio-ulnar direction as well as a volar-dorsal direction. ResultsThere were five female and five male specimens with an average age of 83.6 and 78.8 respectively. The smallest diameter in both the female and male specimens was in the distal ¾ shaft measured in a volar-dorsal direction with an average of 9.1 ​mm and 12 ​mm. The average volar-dorsal measurement was less than radio-ulnar measurement at all locations. The diameters increased along the ulna heading proximally. ConclusionThis study provides information pertinent to screw width and length with respect to the ulnar shaft and calls in to question the use of 3.5 ​mm screws in the distal and midshaft ulnar diaphysis in females. Removal of 3.5 ​mm screws in the mid and distal ulnar shaft in females can leave a hole corresponding to 23% and 27% of the bone which can be concerning for a stress riser.

Fourth Generation Hallux Valgus Correction

Abstract: The surgical method described in this paper has shown numerous benefits when compared with traditional minimally invasive surgery (MIS) techniques for the correction of hallux valgus. Although modern, third-generation MIS techniques have been widely adopted for this purpose due to perceived improvements in patient outcomes, those can be largely attributed to the incorporation of a novel system of rigid internal fixation allowing for a reduced risk of surgical complications. By incorporating the second-generation MIS technique of transverse osteotomy with third-generation fixation techniques, the authors have been able to devise a hybrid, fourth-generation MIS technique that shows improvements both in terms of patient recovery and ease of surgical operation. Level of Evidence: The mechanism-based reasoning used in this study classifies it as diagnostic level V in accordance with the OCEBM 2011 Levels of Evidence. For a complete description of levels of evidence, see Instructions for Authors.

Periarticular soft tissue effect following fourth generation MIS Hallux Valgus correction: Formation of a pyramid-shaped first metatarsal osseous healing zone

Literature of fourth-generation minimally invasive surgery (MIS) on hallux valgus is scarce. In this study, extra-capsular transverse osteotomies were performed on ten cadaveric specimens. The capital fragment was shifted lateral to nearly 100% of the first metatarsal width and then fixated in contemporary fashion following MIS principles. A mixture of radio-opaque solution and methylene blue dye was injected through the second screw hole into the pyramid-shaped space created after the osteotomy shift. The injection was visualized under fluoroscopy and specimen were dissected in layered fashion to assess for containment versus extravasation. The purpose of this study is to observe and describe the preservation of the joint capsule, periosteum, and soft tissue structures adjacent to the osteotomy.

Morphological analysis of the distal femur as a surgical reference in biplane distal femoral osteotomy.

Distal femoral osteotomy (DFO) is performed alone or with high tibial osteotomy (HTO) for patients with osteoarthritis and distal femur deformities. DFO is technically demanding, particularly when creating an anterior flange. Herein, we examined the morphological characteristics of the distal femur based on the cortical shape as a surgical reference for biplanar DFO. Computed tomography images of 50 valgus and 50 varus knees of patients who underwent biplanar DFO or total knee arthroplasty were analyzed. Axial slices at the initial level of the transverse osteotomy in the DFO and slices 10mm proximal and 10mm distal to that level were selected. The medial and lateral cortical angles and heights (MCLA, LCLA, MCH, and LCH) were measured on axial slices. Statistical comparisons were performed between the medial and lateral cortices and valgus and varus knees. MCLA and MCH were significantly smaller and lower, respectively, than LCLA and LCH (P < 0.01). The MCLA and MCH of varus knees were significantly smaller and lower, respectively, than those of valgus knees (P < 0.01). Surgeons should carefully observe morphological differences in the distal femur cortex, distinguishing between medial and lateral knees and varus and valgus knees during the creation of the anterior flange in the DFO.

Local Application of Tanshinone IIA protects mesenchymal stem cells from apoptosis and promotes fracture healing in ovariectomized mice

BackgroundElderly patients suffering from osteoporotic fractures are more susceptible to delayed union or nonunion, and their bodies then are in a state of low-grade chronic inflammation with decreased antioxidant capacity. Tanshinone IIA is widely used in treating cardiovascular and cerebrovascular diseases in China and has anti-inflammatory and antioxidant effects. We aimed to observe the antioxidant effects of Tanshinone IIA on mesenchymal stem cells (MSCs), which play important roles in bone repair, and the effects of local application of Tanshinone IIA using an injectable biodegradable hydrogel on osteoporotic fracture healing.MethodsMSCs were pretreated with or without different concentrations of Tanshinone IIA followed by H2O2 treatment. Ovariectomized (OVX) C57BL/6 mice received a mid-shaft transverse osteotomy fracture on the left tibia, and Tanshinone IIA was applied to the fracture site using an injectable hydrogel.ResultsTanshinone IIA pretreatment promoted the expression of nuclear factor erythroid 2-related factor 2 and antioxidant enzymes, and inhibited H2O2-induced reactive oxygen species accumulation in MSCs. Furthermore, Tanshinone IIA reversed H2O2-induced apoptosis and decrease in osteogenic differentiation in MSCs. After 4 weeks of treatment with Tanshinone IIA in OVX mice, the bone mineral density of the callus was significantly increased and the biomechanical properties of the healed tibias were improved. Cell apoptosis was decreased and Nrf2 expression was increased in the early stage of callus formation.ConclusionsTaken together, these results indicate that Tanshinone IIA can activate antioxidant enzymes to protect MSCs from H2O2-induced cell apoptosis and osteogenic differentiation inhibition. Local application of Tanshinone IIA accelerates fracture healing in ovariectomized mice.

Effect of Plate Configuration in the Primary Stability of Osteotomies and Biological Reconstructions of Femoral Defects: Finite-Element Study.

Osteosynthesis is an alternative treatment for stabilizing femur-bone traumas. The initial stability of the fixation systems is one of the biomechanical parameters affecting implant failure and bone union, especially in surgeries of intercalary reconstructions after the removal of bone tumors. This study aimed to investigate the initial biomechanical effect of using one or two osteosynthesis plate configurations for femoral fixation and the effect of fastening the allograft to the osteosynthesis plate in the case of femoral allograft reconstructions. Three finite-element models of a femur with three different fixation conditions for a transverse osteotomy in the middle of the diaphysis, i.e., using one and two osteosynthesis plates and an intercalary allograft, were constructed. An eight-hole compression plate and a six-hole second plate were used to simulate osteosynthesis plates. The plate screws were tightened previously to the loading, and the tightening sequences simulate the bolt-tightening procedure in a surgical environment. The models were imported into the ADINA System for nonlinear analysis, using compression loads applied over the femur head. Models with the dual fixation systems had the most outstanding compression stiffness. The femur head movement in the dual plate system was 24.8% smaller than in the single plate system. A statistical analysis of a region of interest (VOI) placed in the femur diaphysis showed that the biomechanical effect of using the dual plate system is smaller in the osteotomy region than at the femur head, e.g., a displacement average decrease of only 5% between the two systems, while the maximum value decreases by 26.8%. The allograft fixation to the second osteosynthesis plate leads to an improvement in the system stability. The results presented in this work show that including the bolt analysis in the femoral diaphysis osteotomy fixation will allow for capturing the nonlinear behavior of the osteotomy region more realistically. The stability of the intercalary reconstruction of the femoral diaphysis was higher when the allograft was fastened to the second osteosynthesis plate.

Fracture healing on non-union fracture model promoted by non-thermal atmospheric-pressure plasma.

Non-thermal atmospheric-pressure plasma (NTAPP) is attracting widespread interest for use in medical applications. The tissue repair capacity of NTAPP has been reported in various fields; however, little is known about its effect on fracture healing. Non-union or delayed union after a fracture is a clinical challenge. In this study, we aimed to investigate how NTAPP irradiation promotes fracture healing in a non-union fracture model and its underlying mechanism, in vitro and in vivo. For the in vivo study, we created normal and non-union fracture models in LEW/SsNSlc rats to investigate the effects of NTAPP. To create a fracture, a transverse osteotomy was performed in the middle of the femoral shaft. To induce the non-union fracture model, the periosteum surrounding the fracture site was cauterized after a normal fracture model was created. The normal fracture model showed no significant difference in bone healing between the control and NTAPP-treated groups. The non-union fracture model demonstrated that the NTAPP-treated group showed consistent improvement in fracture healing. Histological and biomechanical assessments confirmed the fracture healing. The in vitro study using pre-osteoblastic MC3T3-E1 cells demonstrated that NTAPP irradiation under specific conditions did not reduce cell proliferation but did enhance osteoblastic differentiation. Overall, these results suggest that NTAPP is a novel approach to the treatment of bone fractures.

Is step-cut shortening osteotomy a better choice than transverse osteotomy for total hip arthroplasty for Crowe type III-IV hip dysplasia?

IntroductionTotal hip arthroplasty for developmental hip dysplasia is a challenging surgery due to anatomic abnormalities. Crowe III and Crowe IV hip dysplasia generally necessitates a subtrochanteric shortening osteotomy. Transverse and step-cut osteotomy are the most common procedures for shortening of femur although there is still no consensus which one is a superior method. The objective of this study was to demonstrate whether transverse or step-cut osteotomy is superior in hips who undergo arthroplasty for high riding hip dysplasia. HypothesisOur hypothesis was that higher rates of union would be achieved in patients with Crowe III-IV hip dysplasia when the step-cut osteotomy was performed compared to transverse osteotomies. Material and methodsA total of 99 hips from 90 patients (9 bilateral, 81 unilateral; 79 female, 11 male), each with a minimum follow-up duration of two years, were included in this study. The hips were classified as Crowe III (n=16) or IV (n=83). All hips were implanted cementless. Transverse or step-cut osteotomy was chosen for osteotomy type. The clinical and functional outcomes were assessed using the Harris Hip Score (HHS), limb length discrepancy (LLD), and limping. The complications and management of these were noted. The union rates were compared between osteotomy types. ResultsThe mean age at surgery was 48.8 (range, 21–79 years). The follow-up period was 64.3 months in average (range, 24 to 192 months). The mean Harris Hip Score before surgery was 35.6 (range, 18–50), and increased to 88.1 (range, 61–98) points at the most recent follow-up. The preoperative leg length discrepancy (LLD) measured 5.3cm (with a range of 3 to 6.8), while the postoperative LLD reduced to 0.8cm (with a range of 0 to 1.6). There were a total of 38 complications in 35 patients out of 99 cases, resulting in a complication rate of 38.4%. The most frequent complication observed was intraoperative femoral fractures, occurring in 13 cases. Residual limping was seen in 73.7% of all. Step-cut osteotomy was performed in 64 hips (35 CDH stem [Zimmer Biomet, Warsaw, IN, USA], 29 Wagner Cone stem [Zimmer Biomet, Warsaw, IN, USA]) and, transverse in 35 hips (22 CDH, 13 Wagner Cone). Six hips had nonunion problem and all of them were operated with a step-cut osteotomy (z-score: –7.12 and p<0.00001, Mann-Whitney U Test). ConclusionTransverse osteotomy may be a better option while performing a shortening subtrochanteric level osteotomy for total hip arthroplasty for Crowe III-IV hips. Level of evidenceLevel III; observational retrospective cohort study.

Preservation of 1st Metatarsal Head Blood Supply with Minimally Invasive Chevron vs Transverse Osteotomy

Introduction/Purpose: The purpose of this study is to evaluate damage to the first dorsal metatarsal artery, first plantar metatarsal artery, and the superficial branch of the medial plantar artery after different types of minimally invasive osteotomies are performed on cadaveric specimen. Methods: 10 cadaveric feet were injected with methylene blue dye to aid in visualizing the vessels. We then randomly divided the samples into 2 groups of 5. Group A received a chevron osteotomy and group B received a transverse cut osteotomy. We then dissected the specimen and studied the damage to the first metatarsal head vascular plexus and recorded the distance of our cuts from the center of the metatarsal head. We plan to take 6 additional cadaveric feet and inject them with silicone based dye prior to performing osteotomies on these additional specimen; 3 chevron and 3 transverse. We will then dissect these specimen in a similar manner to evaluate for vascular plexus damage. We believe this will improve our scientific process. Results: After careful dissection we did not find major damage to the vascular plexus in any of the specimen. Please note: we will be continuing this project with additional cadaveric specimen and improved dye techniques. Conclusion: We did not find a difference in vascular risk between MIS transverse and chevron osteotomy techniques. If the primary safe zone guidelines are respected and care is taken to avoid common pitfalls, surgeons can confidently choose between the two constructs without accommodating further AVN risk. Gross Dissection Displaying First Dorsal Metatarsal Artery

A Comparison of Post-Operative Patient Reported Outcome Measurements Following Bunion Surgery: Modified Lapidus vs Minimally Invasive Techniques

Introduction/Purpose: The modified Lapidus procedure (MLP) or a minimally invasive surgery distal transverse osteotomy (MISDTO) are acceptable surgical treatment options for hallux valgus. The current literature is evolving when comparing the effects of each procedure on patient reported outcomes and post-operative complications. The purpose of this study is to compare postoperative outcomes, time to weight bear, and patient reported outcomes using the Patient Reported Outcome Instrumentation System (PROMIS) for the MLP and MISDTO. Methods: This study retrospectively reviewed patients who underwent a MLP or MISDTO for hallux valgus correction at Prisma Health Midlands between February 2020 – February 2022. Data collected included: demographic data, postoperative outcomes, time to weight bear, and PROMIS scores, including Pain Interference (PI), Physical Function (PF), and Mobility scores. Paired Student’s T-Test and Wilcoxon Rank Sum test were used to compare continuous variables and Chi-Squared test for categorical variables. Results: A total of 81 patients undergoing MLP and 78 undergoing MISDTO were included in the study. Average follow-up for MLP and MISDTO patients was 53.7 and 43.4 weeks, respectively. MLP demonstrated significant improvement in PI (52.5 vs 56.8, P&lt; 0.001) and Mobility (46.3 vs 43.4, P=0.044) scores, while MISDTO demonstrated a significant improvement in PI (48.8 vs 57.1, P&lt; 0.001), PF (50.2 vs 44.9, P&lt; 0.001), and Mobility (49 vs 42.8, P&lt; 0.001) scores. MISDTO patients had significantly larger improvements in PI (7.6 vs 4.5, P=0.008), PF (5.3 vs 2.2, P=0.026), and Mobility (5.5 vs 2.9, P=0.02) compared to MLP patients. MISDTO patients had a significantly lower non-union rate (13.6% vs 2.6%, P=0.025), hardware failure rate (0% vs 9.9%, P=0.007), and time to weight-bear (2.2 vs 7.8 weeks, P&lt; 0.001). Conclusion: Both MLP and MISDTO procedures are effective treatments for improving the pain and mobility issues associated with hallux valgus while maintaining patients’ function. MISDTO was found to improve patient reported outcomes significantly more than MLP, with a lower non-union rate, lower hardware failure rate, and shorter time to weight-bear. These findings suggest MISDTO is superior to MLP in improving patient reported outcomes and postoperative outcomes in the treatment of hallux valgus. Further study multicenter and long term outcome studies could be useful further evaluate these short term findings.

Evaluation of Intraoperative Fluoroscopic Techniques to Estimate Femoral Rotation: A Cadaveric Study.

To compare three fluoroscopic methods for determining femoral rotation. Native femoral version was measured by computed tomography in 20 intact femurs from 10 cadaveric specimens. Two Steinmann pins were placed into each left femur above and below a planned transverse osteotomy which was completed through the diaphysis. Four surgeons utilized the true lateral (TL), neck-horizontal angle (NH), and lesser trochanter profile (LTP) techniques to correct the injured femur's rotation using the intact right femur as reference, yielding 120 measurements. Accuracy was assessed by comparing the angle subtended by the two Steinmann pins before and after manipulation and comparing against version measurements of the right femur. Absolute mean rotational error in the fractured femur compared to its uninjured state was 6.0° (95% CI, 4.6-7.5), 6.6° (95% CI, 5.0-8.2), and 8.5° (95% CI, 6.5-10.6) for the TL, NH, and LTP techniques, respectively, without significant difference between techniques ( p = 0.100). Compared to the right femur, absolute mean rotational error was 6.6° (95% CI, 1.0-12.2), 6.4° (95% CI, 0.1-12.6), and 8.9° (95% CI, 0.8-17.0) for the TL, NH, and LTP techniques, respectively, without significant difference ( p = 0.180). Significantly more femurs were malrotated by >15° using the LTP method compared to the TL and NH methods (20.0% vs 2.5% and 5.0%, p = 0.030). Absolute mean error in estimating femoral rotation of the intact femur using the TL and NH methods compared to CT was 6.6° (95% confidence interval [CI], 5.1-8.2) and 4.4° (95% CI, 3.4-5.4), respectively, with significant difference between the two methods ( p = 0.020). The true lateral (TL), neck-horizontal angle (NH), and the lesser trochanter profile (LTP) techniques performed similarly in correcting rotation of the fractured femur, but significantly more femurs were malrotated by >15° using the LTP technique. This supports preferential use of the TL or NH methods for determining femoral version intraoperatively.

The effect of various modes of electrical influence on the skeletal muscles of the lengthened ­segment during distraction of the lower leg according to Ilizarov

BACKGROUND: When using electrical muscle stimulation in clinical practice, it is important to select the optimal mode of this effect, since muscles largely determine the movement of the limb during the rehabilitation period.&#x0D; AIM: Study of the tibialis anterior muscle reaction during Ilizarov distraction of the tibia in combination with the direct effect of direct electric current on the regenerated area in the experiment.&#x0D; MATERIAL AND METHODS: The tibialis anterior muscle and biochemical parameters of blood serum (creatin kinase activity, lactate concentration) of 27 male Soviet chinchilla rabbits aged 12 months, weighing 3.85±0.18 kg, tibia length 11.2±0.13 cm, were studied. The animals were divided into three groups: control (n=9), first (n=9) and second experimental (n=9). The right tibia was fixed with an Ilizarov apparatus, a transverse osteotomy was performed in the middle third of the diaphysis, and from the 5th day, distraction began at a rhythm of 0.125 mm in 4 steps to an amount of 10% of the original length for 26 days. Fixation lasted 40 days, the period without the device was 30 days. For electrical stimulation, wire-electrodes were inserted into the diaphysis, and electrical stimulation of the bone regenerate was performed for 1 minute with a current intensity of 150 mAm. In the first group, electrical stimulation was performed starting from the day of surgery and on days 2, 4, 6, 8, 10 of the experiment. In group 2, electrical stimulation began on the 10th day after surgery and on the 12th, 14th, 16th, 18th, and 20th days of the experiment. In the control group, no electrical stimulation was applied. Using the methods of stereometric analysis of digitized images of tibialis muscle’s cross sections, the volumetric density of myosymplasts, microvessels, endomysium and nuclear component, the numerical density of myosymplasts and microvessels were determined, and the vascularization index was calculated. For statistical processing of data, the Wilcoxon W test and the Mann–Whitney T test were used; numerical data were presented in tables.&#x0D; RESULTS: A positive effect of electrical stimulation on the muscles of the experimental groups was established in comparison with the control group, where fibrosis of muscle tissue at the end of the experiment was 0.2777±0.0055 mm3/mm3, which was 230% relative to the parameter of the first group (0.1217±0.0121 mm3/mm3) and 370% relative to the second group (0.0752±0.0062 mm3/mm3). An advantage was noted for the second group, where electrical stimulation was carried out from the 5th day of distraction and at the end of the experiment the histostructure of the muscle, characteristic of the intact norm, prevailed.&#x0D; CONCLUSION: Electrical impact on bone regenerate from the 5th day of distraction stimulates reparative processes in the tibialis anterior muscle and serves as an organ-saving method.

The Duration of Bone Healing and Nonunion Ratio After Ulnar Shortening Osteotomy Using a 5-Hole Forearm Compression Plate With Transverse Osteotomy.

Ulnar shortening osteotomy using various osteotomy sites, osteotomy methods, and surgical techniques with a variety of implants has been reported, but nonunion rates and the duration of bone healing are not uniform by the authors. The purpose of this study was to investigate the duration of bone healing and nonunion ratio in patients who underwent ulnar shortening osteotomy by a 5-hole nonlocking plate with a simple transverse osteotomy for ulnar impaction syndrome and to determine the correlation between the gap length of the osteotomy site and the duration of bone healing. We assessed patients who underwent ulnar shortening osteotomy for ulnar impaction syndrome using a 5-hole nonlocking plate fixation followed by a simple transverse osteotomy between July 2012 and October 2021. This study was a case series study, and the level of evidence was IV. A total of 80 patients were included. The mean age of the patients was 46.7 years, and 46 patients were men. The average bone union period was 41.8 ± 18.7 weeks. The correlation between the gap length of the osteotomy site and the duration of bone union of the osteotomy site was not significant. The nonunion ratio of our method was 2.5%. The nonunion rate of our ulnar shortening osteotomy with a simple transverse osteotomy and a 5-hole nonlocking plate was comparable to that in previous reports, but our method required slightly longer periods for bone union. There was no correlation between the gap length of the osteotomy and the duration of bone union. Level IV (Case series).

A longitudinal rat model for assessing postoperative recovery and bone healing following tibial osteotomy and plate fixation

BackgroundRodent models are commonly employed to validate preclinical disease models through the evaluation of postoperative behavior and allodynia. Our study investigates the dynamic interplay between pain and functional recovery in the context of traumatic osteotomy and surgical repair. Specifically, we established a rat model of tibial osteotomy, followed by internal fixation using a 5-hole Y-plate with 4 screws, to explore the hypothesis that histological bone healing is closely associated with functional recovery.ObjectiveOur primary objective was to assess the correlation between bone healing and functional outcomes in a rat model of tibial osteotomy and plate fixation.MethodsSeventeen male Sprague–Dawley rats underwent a metaphyseal transverse osteotomy of the proximal tibia, simulating a fracture-like injury. The resultant bone defect was meticulously repaired by realigning and stabilizing the bone surfaces with the Y-plate. To comprehensively assess recovery and healing, we performed quantitative and qualitative evaluations at 2, 4, 6, and 8 weeks post-surgery. Evaluation methods included micro-CT imaging, X-ray analysis, and histological examination to monitor bone defect healing. Concurrently, we employed video recording and gait analysis to evaluate functional recovery, encompassing parameters such as temporal symmetry, hindlimb duty factor imbalance, phase dispersion, and toe spread.ResultsOur findings revealed complete healing of the bone defect at 8 weeks, as confirmed by micro-CT and histological assessments. Specifically, micro-CT data showed a decline in fracture volume over time, indicating progressive healing. Histological examination demonstrated the formation of new trabecular bone and the resolution of inflammation. Importantly, specific gait analysis parameters exhibited longitudinal changes consistent with bone healing. Hindlimb duty factor imbalance, hindlimb temporal symmetry, and phase dispersion correlated strongly with the healing process, emphasizing the direct link between bone healing and functional outcomes.ConclusionsThe establishment of this tibia osteotomy model underscores the association between bone healing and functional outcomes, emphasizing the feasibility of monitoring postoperative recovery using endpoint measurements. Our overarching objective is to employ this model for assessing the local efficacy of drug delivery devices in ameliorating post-surgical pain and enhancing functional recovery.

Biomechanical Evaluation of 4th Generation Minimally Invasive Distal First Metatarsal Osteotomy-Akin Osteotomy Technique on First Ray Articular Contact Properties

Category: Bunion; Basic Sciences/Biologics Introduction/Purpose: Hallux valgus is a common deformity encountered, but remains a complex clinical entity. Fourth generation minimally invasive (MIS) techniques consisting of a percutaneous distal metatarsal transverse osteotomy combined with an Akin osteotomy have been utilized to address mild to severe hallux valgus deformities. Benefits of a MIS approach include improved cosmesis, faster recovery, lower opiate requirement, immediate weightbearing, and favorable outcomes relative to a traditional, open procedure. An understudied area with respect to hallux valgus correction is the effect that osteotomies can have on the articular contact properties of the first ray following correction. Methods: Sixteen paired cadaveric specimens were dissected to include the first ray and tested in a customized apparatus. Specimens were randomized to receive a distal transverse osteotomy translated either 50% or 100% of the width of the first metatarsal shaft. The osteotomy was performed with either a 00or 200 distal angulation of the burr relative to the shaft in the axial plane. Specimens were tested in the intact state and following the distal first metatarsal osteotomy for peak pressure, contact area, contact force and center of pressure at the first metarsophalangeal joint (MTP) and first tarsometatarsal joint (TMT). An Akin osteotomy was then performed on each specimen and peak pressure, contact area, contact force and center of pressure were recalculated. Results: There was a notable decrease in peak pressure, contact area, and contact force across the TMT joint with greater shifts of the capital fragment. However, at 100% translation of the capital fragment, distal angulation of the osteotomy by 200 appears to improve loading across the TMT joint. Addition of the Akin osteotomy at 100% translation also aids in increasing the contact force across the TMT joint. The MTP joint is less sensitive to changes in shifts and angulation of the capital fragment. The Akin osteotomy also leads to increased contact force across the MTP joint when the capital fragment is translated 100%. Conclusion: While the clinical significance is unknown, larger shifts of the capital fragment lead to greater load alterations at the level of the TMT joint than the MTP joint. Distal angulation of the capital fragment and the addition of an Akin osteotomy can aid in reducing the size of those changes. The Akin can lead to increased contact forces at the MTP joint with 100% translation of the capital fragment.

Minimally Invasive Transverse Distal Metatarsal Osteotomy for Hallux Valgus Correction: Is there a Difference in Outcome Between Moderate and Severe Deformities?

Category: Midfoot/Forefoot; Bunion Introduction/Purpose: We compared the radiological and clinical outcomes of moderate and severe hallux valgus (HV) treated with minimally invasive distal metatarsal transverse osteotomy (MITO) performed by a single surgeon. Methods: Eighty-four patients who underwent MITO between May 2018 and March 2020 were recruited and followed for at least 24 months. The severe group was defined as having a preoperative hallux valgus angle (HVA) greater than 40° or preoperative first-to-second intermetatarsal angle (1–2 IMA) greater than 16°; the moderate group was defined as having an HVA less than 40° and a 1–2 IMA less than 16°. Pre- and postoperative measurements of the HVA, 1–2 IMA, distal metatarsal articular angle, and tibial sesamoid position were obtained. The Visual Analogue Scale for pain, the Foot and Ankle Outcome Score, and the Medical Outcomes Study Short Form Health Survey-36 Physical Component Summary were used to assess clinical outcomes. Results: Both groups showed significant improvements in all radiologic parameters postoperatively with the degrees of correction greater in the severe group than in the moderate group. All clinical scores improved significantly from the preoperative to the last follow-up visit. Final clinical outcomes and degrees of improvement were comparable in both groups. Conclusion: This study showed that short-term radiographic results for patients with either moderate or severe HV treated with MITO were favorable. Overall clinical outcomes were comparable to those of conventional treatments. MITO with screw fixation is a satisfactory surgical option for patients with HV deformities.

Heat Generation during Minimally Invasive First Metatarsal Osteotomy: A Cadaveric Study

Category: Bunion; Midfoot/Forefoot Introduction/Purpose: Bunions are one of the most common pathologies treated by orthopedic foot and ankle surgeons. The usage of minimally invasive and percutaneous surgical techniques continues to rise due to evidence of less pain, improved functional outcomes and low recurrence rates. Still, concern regarding heat generation during these procedures, osteonecrosis of bone, and nonunion persists. Literature suggests cool irrigation is superior to room temperature irrigation, but the question remains if irrigation is needed at all. This study evaluates the heat generation during percutaneous bunion surgery and analyzes the use of cooled irrigation compared to no irrigation at all. This study tested the hypothesis that cool irrigation would lead to overall lower heat generation compared to no irrigation at all. Methods: 5 matched paired cadavers (10 legs) were used to simulate MIS first metatarsal distal transverse osteotomy for all trials. Prior to osteotomy, 4 temperature probes were inserted as to the border where the Shannon burr would travel along the osteotomy site (Image 1). Probes were secured by suture and temperature was recorded using K-type thermocouples. All trials were completed using a pulse technique of 20 seconds on, 5 seconds off with a Shannon Burr and fluoroscopic guidance. Trials were complete with continuous cold irrigation (N=5) and without any irrigation at all (N=4). Temperatures were evaluated at baseline, during burring, and after burring to assess total heat generation and dissipation. A two-tailed t-test was used to analyze differences in heat generation and dissipation between procedures completed with irrigation and without irrigation (P &lt; 0.05). Results: 5 cadavers with a mean age of 86.2 were evaluated (10 total simulations, 9 analyzed). Cadavers underwent 1 trial with irrigation, and 1 without on opposite feet. 88.9% of patients showed heat generation below the level of bone necrosis (50 oC). One trial with irrigation temperature rose to 79.1oC. Matching specimen without irrigation had probe failure and no temperature was obtained. Average burr time was 51.2±2.4 seconds with irrigation, and 35±0.5 seconds without. Irrigation was associated with a significant increase in burr time (P=0.002). Average temperature change was 13.62±11.9 and 0.7±0.5 during burring, 7.1±1.8 and 5.8±0.3 after burring in procedures with and without irrigation, respectively. No significant difference was detected between heat generation in irrigated vs non-irrigated procedures (P = 0.371, 0.548). Conclusion: This study found that in a cadaveric model the use of cooled irrigation, compared to no irrigation, did not lead to a significant difference in the heat generation during MIS first metatarsal distal transverse osteotomy. However, 1 out of the 9 samples used in this study showed a heat generation above 50 oC. Additionally, to our surprise the use of irrigation led to a significant increase in burring time. This may be useful information for a surgeon when considering the usage of cooled irrigation to reduce the potential risk of osteonecrosis when performing a MIS first metatarsal distal transverse osteotomy.

Minimally Invasive Transverse Distal Metatarsal Osteotomy (MITO) for Hallux Valgus Correction: Early Outcomes of Mild to Moderate vs Severe Deformities.

We compared the radiological and clinical outcomes of mild to moderate and severe hallux valgus (HV) treated with minimally invasive distal metatarsal transverse osteotomy (MITO) performed by a single surgeon. Eighty-four patients who underwent MITO between May 2018 and March 2020 were recruited and followed for at least 24 months. The severe group was defined as having a preoperative hallux valgus angle (HVA) >40 degrees or preoperative first-to-second intermetatarsal angle (1-2 IMA) >16 degrees; the mild to moderate group was defined as having an HVA <40 degrees and a 1-2 IMA <16 degrees. Pre- and postoperative measurements of the HVA, 1-2 IMA, distal metatarsal articular angle, and tibial sesamoid position were obtained. The visual analog scale for pain, the Foot and Ankle Outcome Score, and the Medical Outcomes Study Short Form Health Survey-36 physical component summary were used to assess clinical outcomes. A total of 116 feet were included in this study and median follow-up period of 29.0 months (range, 24-52 months). Both groups showed significant improvements in all radiologic parameters postoperatively, with the degrees of correction greater in the severe group than in the mild to moderate group. All clinical scores improved significantly from the preoperative to the last follow-up visit. Final clinical outcomes and degrees of improvement were comparable in both groups. This study showed that short-term radiographic results for patients with either mild to moderate or severe HV treated with MITO were favorable. Overall clinical outcomes were comparable to those of conventional treatments. In this series, we found MITO with screw fixation to be a satisfactory surgical option for patients with mild to severe HV deformities. Level III, retrospective comparative study.