title: Avascular necrosis of the first metatarsal head: incidence in distal osteotomy combined with lateral soft tissue release.
abstract: The incidence of avascular necrosis of the metatarsal head following distal first metatarsal osteotomy combined with adductor tendon release has not been documented in a large series of patients. Of 82 consecutive procedures in 64 patients performed between 1986 and 1988, 42 patients (58 procedures) were available for clinical and radiographic examination. Average follow-up was 2.5 years (range 1.0-4.2 years). There were 35 L-shaped and 23 chevron osteotomies which were combined with a lateral soft tissue release that included adductor tenotomy. Preoperative hallux valgus angle averaged 25 degrees (range 15-40 degrees), and intermetatarsal angle averaged 12 degrees (range 5-24 degrees). Follow-up amount of correction averaged 13 degrees and 5 degrees, respectively. Eighty-four percent of patients were satisfied with their result. There was one case of avascular necrosis. The patient was asymptomatic at 4.2 years' follow-up, and the remaining patients included two with infections, one hallux varus, and no nonunions.
authors.affiliation: Department of Orthopedics, Naval Medical Center, San Diego, California 92134-5000.
authors.forename: D A
authors.initials: DA
authors.lastname: Peterson
authors.forename: J L
authors.initials: JL
authors.lastname: Zilberfarb
authors.forename: M A
authors.initials: MA
authors.lastname: Greene
authors.forename: R C
authors.initials: RC
authors.lastname: Colgrove
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006215:Hallux Valgus / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D015994:Incidence; D008297:Male; D008683:Metatarsophalangeal Joint / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D008875:Middle Aged; D010020:Osteonecrosis / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology; D010027:Osteotomy / Q000009:adverse effects*; D011859:Radiography; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D013710:Tendons / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*