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The influence of the number of screws and additional surgical procedures on outcome in hallux valgus treatment.
J Orthop Surg Res 2018; 13(1):99JO

Abstract

BACKGROUND

Surgical treatment of hallux valgus (HV) is one of the major flagships of orthopedic surgeons. Due to relatively unsatisfactory radiological and clinical outcomes, the search for the best surgical technique and causes for unsatisfactory outcomes continues. The objective was to investigate associations of the number of screws and additional surgical techniques for HV with radiological and clinical outcome after reversed L-shaped osteotomy (ReveL).

METHODS

A retrospective cohort study of adults from a single University Hospital between 2004 and 2013 was performed. The primary exposure was the number of screws (one vs two) used for osseous fixation after ReveL. The secondary exposure was an additional surgical technique for HV (e.g., Akin osteotomy). The primary outcome was a radiological recurrence of HV (HV angle (HVA) > 15°) at last follow-up. The secondary outcomes were limited patient satisfaction, complication, revision surgery, and elective hardware removal. Odds ratio (OR) and 95% confidence interval (CI) were estimated by logistic regression adjusting for confounders.

RESULTS

The recurrence was 45% less likely with the use of one screw, independent of age, sex, additional technique, and preoperative HVA (odds ratio (ORadjusted) = 0.55 [95% CI 0.30-0.98], p = 0.043). The recurrence was 162% more likely with an additional surgical technique for HV (ORadjusted = 2.62 [1.24-5.52], p = 0.011).

CONCLUSION

In ReveL for HV, a single screw (instead of two screws) may be sufficient enough for a similar or even better outcome, which may also reduce costs. Additional surgical procedures for HV may be refrained from if possible. Due to limitations of a retrospective study, results may need validation with clinical trials.

Authors+Show Affiliations

Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland. thorsten.jentzsch@gmail.com.Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland.Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland.Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland.University of Zurich, Zurich, Switzerland.University of Zurich, Zurich, Switzerland.San Camillo Hospital IRCCS, Venice, Italy.Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

29695272

Citation

Jentzsch, Thorsten, et al. "The Influence of the Number of Screws and Additional Surgical Procedures On Outcome in Hallux Valgus Treatment." Journal of Orthopaedic Surgery and Research, vol. 13, no. 1, 2018, p. 99.
Jentzsch T, Renner N, Niehaus R, et al. The influence of the number of screws and additional surgical procedures on outcome in hallux valgus treatment. J Orthop Surg Res. 2018;13(1):99.
Jentzsch, T., Renner, N., Niehaus, R., Farei-Campagna, J., Deggeller, M., Scheurer, F., ... Wirth, S. H. (2018). The influence of the number of screws and additional surgical procedures on outcome in hallux valgus treatment. Journal of Orthopaedic Surgery and Research, 13(1), p. 99. doi:10.1186/s13018-018-0796-z.
Jentzsch T, et al. The Influence of the Number of Screws and Additional Surgical Procedures On Outcome in Hallux Valgus Treatment. J Orthop Surg Res. 2018 Apr 25;13(1):99. PubMed PMID: 29695272.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The influence of the number of screws and additional surgical procedures on outcome in hallux valgus treatment. AU - Jentzsch,Thorsten, AU - Renner,Niklas, AU - Niehaus,Richard, AU - Farei-Campagna,Jan, AU - Deggeller,Marcel, AU - Scheurer,Fabrice, AU - Palmer,Katie, AU - Wirth,Stephan H, Y1 - 2018/04/25/ PY - 2018/01/19/received PY - 2018/03/29/accepted PY - 2018/4/27/entrez PY - 2018/4/27/pubmed PY - 2018/10/3/medline KW - Hallux valgus (HV) KW - Long plantar arm osteotomy KW - Patient satisfaction KW - Recurrence KW - Reversed L-shaped osteotomy (ReveL) KW - Screws SP - 99 EP - 99 JF - Journal of orthopaedic surgery and research JO - J Orthop Surg Res VL - 13 IS - 1 N2 - BACKGROUND: Surgical treatment of hallux valgus (HV) is one of the major flagships of orthopedic surgeons. Due to relatively unsatisfactory radiological and clinical outcomes, the search for the best surgical technique and causes for unsatisfactory outcomes continues. The objective was to investigate associations of the number of screws and additional surgical techniques for HV with radiological and clinical outcome after reversed L-shaped osteotomy (ReveL). METHODS: A retrospective cohort study of adults from a single University Hospital between 2004 and 2013 was performed. The primary exposure was the number of screws (one vs two) used for osseous fixation after ReveL. The secondary exposure was an additional surgical technique for HV (e.g., Akin osteotomy). The primary outcome was a radiological recurrence of HV (HV angle (HVA) > 15°) at last follow-up. The secondary outcomes were limited patient satisfaction, complication, revision surgery, and elective hardware removal. Odds ratio (OR) and 95% confidence interval (CI) were estimated by logistic regression adjusting for confounders. RESULTS: The recurrence was 45% less likely with the use of one screw, independent of age, sex, additional technique, and preoperative HVA (odds ratio (ORadjusted) = 0.55 [95% CI 0.30-0.98], p = 0.043). The recurrence was 162% more likely with an additional surgical technique for HV (ORadjusted = 2.62 [1.24-5.52], p = 0.011). CONCLUSION: In ReveL for HV, a single screw (instead of two screws) may be sufficient enough for a similar or even better outcome, which may also reduce costs. Additional surgical procedures for HV may be refrained from if possible. Due to limitations of a retrospective study, results may need validation with clinical trials. SN - 1749-799X UR - https://www.unboundmedicine.com/medline/citation/29695272/The_influence_of_the_number_of_screws_and_additional_surgical_procedures_on_outcome_in_hallux_valgus_treatment_ L2 - https://josr-online.biomedcentral.com/articles/10.1186/s13018-018-0796-z DB - PRIME DP - Unbound Medicine ER -