Treatment of Freiberg disease with intra-articular dorsal wedge osteotomy and absorbable pin fixation.
BACKGROUND
The purpose of this study was to evaluate the outcome of intra-articular dorsal wedge osteotomy and absorbable pin fixation for the treatment of Freiberg disease.


METHODS
From January of 1997, to July of 2003, 12 patients with symptomatic Freiberg disease had intra-articular dorsal wedge osteotomy through the affected metatarsal head fixed with absorbable polyglycolide pins. All 12 patients were women with an average age of 36 (range 16 to 59) years. The Smillie stage of necrosis ranged from II to V. Active range-of-motion exercise was allowed after 4 weeks of short-leg walking cast wear, and weightbearing on the forefoot was allowed after radiographic union was achieved. The mean followup was 45 (range 22 to 84) months.


RESULTS
Radiographically, solid healing of all osteotomies was observed at an average of 10 (range 8 to 16) weeks. There was no evidence of displacement, osteolysis, sinus formation, or progression of osteonecrosis at final followup. Pain measurement on a visual analog scale had improved significantly from an average of 8.0 to 2.3 (p<0.05). The range of motion of the metatarsophalangeal joint increased by a mean of 26 (range 5 to 60) degrees. All patients were satisfied with the results and would have the surgery again.


CONCLUSIONS
In patients with Freiberg disease, intra-articular dorsal wedge osteotomy restores congruity of the metatarsophalangeal joint, and fixation with absorbable pins provides adequate fixation and avoids a second procedure for implant removal.
Lee
Sang Ki
SK
Orthopaedics, Seoul National University Bundang Hospital, Seoul, Republic of Korea.
Chung
Moon Sang
MS
Baek
Goo Hyun
GH
Oh
Joo Han
JH
Lee
Young Ho
YH
Gong
Hyun Sik
HS
D020341:Absorbable Implants; D000293:Adolescent; D000328:Adult; D001858:Bone Nails; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008682:Metatarsal Bones / Q000601:surgery*; D008875:Middle Aged; D010020:Osteonecrosis / Q000601:surgery*; D010027:Osteotomy / Q000295:instrumentation / Q000379:methods*