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Proximal oblique sliding closing wedge osteotomy for hallux valgus.
Foot Ankle Int 2013; 34(11):1493-500FA

Abstract

BACKGROUND

The proximal oblique sliding closing wedge osteotomy (POSCOW) technique was developed to address moderate to severe hallux valgus deformity. We present a retrospective multicenter study to analyze the midterm radiological and clinical outcomes of patients treated with this type of proximal osteotomy fixed with plates.

MATERIALS AND METHODS

One hundred and forty-four patients (187 feet) were operated on between May 2005 and June 2010 in 2 separate centers. Inclusion criteria were symptomatic moderate to severe incongruent hallux valgus deformity, no significant restriction in the first metatarsophalangeal joint movement, none to minimal degenerative changes in the first metatarsophalangeal or the tarsometatarsal joints, and no hypermobility. The median age was 60 years. The preoperative hallux valgus angle (HV) was 35.6 degrees, intermetatarsal angle (IM) was 15.3 degrees, AOFAS score was 53 points. The median follow-up was 35 months (range, 12-73). A POSCOW osteotomy was performed in all patients and fixed with plates. We recorded the satisfaction rate, postoperative clinical and radiological results, and complications.

RESULTS

The patient satisfaction rate was 87%. The mean postoperative HV angle was 12.3 degrees, IM angle 4.8 degrees, AOFAS score 89 points. The mean decrease in the first metatarsal length was 2.2 mm (range, 0-8). Twelve feet (6.4%) with recurrence of the deformity required revision surgeries. Removal of complete or partial hardware was needed in 23 feet (12.3%) for symptomatic hardware. Five feet (2.6%) developed hallux varus but only 2 required surgery. Transfer metatarsalgia was noted in 9 feet (4.8%).

CONCLUSIONS

The POSCOW osteotomy was an effective and reliable method for relieving pain and improving function. A learning curve was present, as most of the complications happened in the initial cases. To our knowledge, this is the largest reported series of proximal closing wedge osteotomy for hallux valgus deformities.

LEVEL OF EVIDENCE

Level IV, case series.

Authors+Show Affiliations

Foot and Ankle Surgeon, Clínica Alemana-Universidad del Desarrollo, Santiago, Chile.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study

Language

eng

PubMed ID

23863313

Citation

Wagner, Emilio, et al. "Proximal Oblique Sliding Closing Wedge Osteotomy for Hallux Valgus." Foot & Ankle International, vol. 34, no. 11, 2013, pp. 1493-500.
Wagner E, Ortiz C, Gould JS, et al. Proximal oblique sliding closing wedge osteotomy for hallux valgus. Foot Ankle Int. 2013;34(11):1493-500.
Wagner, E., Ortiz, C., Gould, J. S., Naranje, S., Wagner, P., Mococain, P., ... Espinosa, M. (2013). Proximal oblique sliding closing wedge osteotomy for hallux valgus. Foot & Ankle International, 34(11), pp. 1493-500. doi:10.1177/1071100713497933.
Wagner E, et al. Proximal Oblique Sliding Closing Wedge Osteotomy for Hallux Valgus. Foot Ankle Int. 2013;34(11):1493-500. PubMed PMID: 23863313.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Proximal oblique sliding closing wedge osteotomy for hallux valgus. AU - Wagner,Emilio, AU - Ortiz,Cristián, AU - Gould,John S, AU - Naranje,Sameer, AU - Wagner,Pablo, AU - Mococain,Pablo, AU - Keller,Andrés, AU - Valderrama,Juan José, AU - Espinosa,Maximiliano, Y1 - 2013/07/17/ PY - 2013/7/19/entrez PY - 2013/7/19/pubmed PY - 2014/7/23/medline KW - hallux valgus KW - proximal oblique sliding closing wedge osteotomy KW - proximal osteotomies SP - 1493 EP - 500 JF - Foot & ankle international JO - Foot Ankle Int VL - 34 IS - 11 N2 - BACKGROUND: The proximal oblique sliding closing wedge osteotomy (POSCOW) technique was developed to address moderate to severe hallux valgus deformity. We present a retrospective multicenter study to analyze the midterm radiological and clinical outcomes of patients treated with this type of proximal osteotomy fixed with plates. MATERIALS AND METHODS: One hundred and forty-four patients (187 feet) were operated on between May 2005 and June 2010 in 2 separate centers. Inclusion criteria were symptomatic moderate to severe incongruent hallux valgus deformity, no significant restriction in the first metatarsophalangeal joint movement, none to minimal degenerative changes in the first metatarsophalangeal or the tarsometatarsal joints, and no hypermobility. The median age was 60 years. The preoperative hallux valgus angle (HV) was 35.6 degrees, intermetatarsal angle (IM) was 15.3 degrees, AOFAS score was 53 points. The median follow-up was 35 months (range, 12-73). A POSCOW osteotomy was performed in all patients and fixed with plates. We recorded the satisfaction rate, postoperative clinical and radiological results, and complications. RESULTS: The patient satisfaction rate was 87%. The mean postoperative HV angle was 12.3 degrees, IM angle 4.8 degrees, AOFAS score 89 points. The mean decrease in the first metatarsal length was 2.2 mm (range, 0-8). Twelve feet (6.4%) with recurrence of the deformity required revision surgeries. Removal of complete or partial hardware was needed in 23 feet (12.3%) for symptomatic hardware. Five feet (2.6%) developed hallux varus but only 2 required surgery. Transfer metatarsalgia was noted in 9 feet (4.8%). CONCLUSIONS: The POSCOW osteotomy was an effective and reliable method for relieving pain and improving function. A learning curve was present, as most of the complications happened in the initial cases. To our knowledge, this is the largest reported series of proximal closing wedge osteotomy for hallux valgus deformities. LEVEL OF EVIDENCE: Level IV, case series. SN - 1944-7876 UR - https://www.unboundmedicine.com/medline/citation/23863313/Proximal_oblique_sliding_closing_wedge_osteotomy_for_hallux_valgus_ L2 - http://journals.sagepub.com/doi/full/10.1177/1071100713497933?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -