Radiographic evaluation for AVN following distal metatarsal Stoffella bunion osteotomy.
BACKGROUND
Avascular necrosis of the metatarsal head, delayed bone healing and nonunion are complications that may occur after distal first metatarsal osteotomies. Intraoperative damage to the extraosseous blood supply, the location of the osteotomy and postoperative vasospasm have been cited as possible causes of such changes. We evaluated Stoffella's subcapital osteotomies which were performed at our department for the correction of moderate to severe hallux valgus deformities.


METHODS
Standardized radiographs of 300 feet, taken 6weeks, 3 months, and 6 months postoperatively and at the final followup were examined with regard to postoperative AVN or signs of delayed bone healing. Of 228 patients, 202 were women and 26 were men. The patients' mean age was 49 years, and the mean followup was 12 months.


RESULTS
In 278 cases the radiographs revealed an unremarkable first metatarsal head. Seventeen cases showed diffuse or localized osteopenia or small cysts in the subchondral bone. These changes fully resolved on subsequent radiographs. The X-rays of two patients revealed progressive narrowing of the joint space, irregular contours on the surface of the joint and an abnormal bone structure. The patients subsequently developed a characteristic picture of avascular necrosis, in one case combined with nonunion. Three patients had delayed bone healing, but ultimately healed successfully.


CONCLUSIONS
Ischemic changes in bone are known to occur after distal first metatarsal osteotomies. There is a very low incidence of postoperative perfusion problems after Stoffella;s technique, even with lateral soft tissue release.
Klein
Christian
C
Orthopedic Department, Deputy Orthopedic Department, Prof. Martin Hell Strasse 7-9, A-5422 Bad Dürrnberg, Austria. dr.klein@ortho-mondsee.at
Zembsch
Alexander
A
Dorn
Ulrich
U
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D005594:Fracture Fixation, Intramedullary / Q000009:adverse effects*; D006215:Hallux Valgus / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008682:Metatarsal Bones / Q000601:surgery*; D008875:Middle Aged; D010020:Osteonecrosis / Q000000981:diagnostic imaging* / Q000209:etiology* / Q000473:pathology; D010027:Osteotomy / Q000009:adverse effects*; D012189:Retrospective Studies; D013165:Splints; D014057:Tomography, X-Ray Computed; D017211:Treatment Failure; D055815:Young Adult