Optimization of Surgical Treatment of Severe Hallux Valgus by Modified Osteosynthesis Method

Introduction. Attention to the problem of Valgus deviation of the first toe (VDFT) does not weaken for about 200 years, due to its considerable population distribution (18,0-20,0%), as well as the lack of treatment efficacy, the recurring nature of deformation Aim. To optimize the treatment of VDFT, improving the methods of osteosynthesis after the corrective osteotomy of the I pectoral bone. Materials and methods. The results of treatment of 42 patients with severe forms of VDFT were analyzed. The average age of patients was 52 years. The clinical, orthopedic, and roentgenologic examination according to standard methods was conducted. The angle of the VDFT was more than 35°, the first inter-axial angle was more than 18°, the first finger was pierced, and in the I-membranous-phalangeal joint - subluxated, the displacement of the lateral sesameiform bone reached 100.0%. All the patients were treated with proximal corrective osteotomy of the I pectoral bone with an osteosynthesis using screw according to the technique we upgraded. Results. Postoperative wounds in all cases were healed by the initial tension. The consolidation of osteotomy based on the results of the X-ray examination took place in the period of five to six weeks. According to the assessment of the AOFAS scale, in three cases (7.1%) satisfactory results were noted. Of these, in one patient (2.4%), although there was a good correction of the shape of the foot, contracture in the I plexus- phalangeal joint arose because of the patient's late removing of the syringe. In two patients (4.8%) the correction was partially lost (up to 10 °) with a satisfactory foot function and no pain. This correlated with the phenomena of osteoporosis of the bones of the foot in these patients. In 39 operated patients (42.4%) there were good and excellent results. In particular, in 17 patients (40.5%) - the average score was 82.4 and in 22 (52.4%) - 95.7. The results of the treatment were consistent with the results obtained in patients operated with the use of plates with angular stability, which today are considered as "golden standard" of osteosynthesis in foot surgery, but compared with them, the proposed method is less traumatic, technically simpler, significantly lower (on average in 10 times cost of implants. Conclusions. Fixing the fragments of the I pectoral bone after osteotomy due to VDFT with a long screw according to our modified method provided early activation, comfortable treatment and a good cosmetic and functional result. The applied method of fixation is effective, technically simple, minimally invasive, economically viable, and allows to improve the results of treatment of patients with VDFT.