Distal linear osteotomy compared to oblique diaphyseal osteotomy in moderate to severe hallux valgus.
BACKGROUND
There are no comparative studies of proximal and distal osteotomy for treatment of moderate to severe hallux valgus. Our purpose was to compare the surgical outcomes of modified proximal Ludloff (oblique diaphyseal) osteotomy with modified distal Bösch (distal linear) osteotomy by a single surgeon in moderate to severe hallux valgus.


METHODS
This retrospective study included feet with a hallux valgus angle greater than 30 degrees. A total of 30 feet (average age, 64.5 years) underwent Ludloff and 32 feet (average age, 61.1 years) underwent Bösch osteotomy. Both osteotomies were combined with distal soft tissue procedure. Clinical outcomes including AOFAS score and satisfaction rate were compared and radiographic parameters analyzed at 2~years of followup.


RESULTS
AOFAS scores were equivalent (p=0.483), with comparable satisfaction rates in both groups (p=0.418). The radiographic results including hallux valgus angle (p=0.026), intermetatarsal angle 1-2 (p<0.001), sesamoid position (p=0.008), correction of intermetatarsal angle 1-2 (p<0.001), and change of sesamoid position (p<0.001) were significantly better in the Bösch group. Correction of hallux valgus angle (p=0.308) and shortening of the first metatarsal (p=0.086) were insignificant with the numbers available. Recurrence developed in eight feet of the Ludloff group and two of the Bösch group (p=0.040). Dorsiflexion malunion occurred in four feet in the Bösch group, as compared with one in the Ludloff group.


CONCLUSIONS
Our study found that distal linear osteotomy was a more reliable reconstruction with equivalent function outcomes than an oblique diaphyseal osteotomy. Additional fixation may be necessary to decrease sagittal malunion in distal Bösch osteotomy.
Department of Orthopaedics & Traumatology, Taipei Veterans General Hospital, and Department of Surgery, School of Medicine, National Yang-Ming University, 201, Sec.2, Shih-Pai Rd., Taipei 112, Taiwan, Republic of China. chiangcc@vghtpe.gov.tw
Chao-Ching
CC
Chiang
Chien-Fu Jeff
CF
Lin
Yun-Hsuan
YH
Tzeng
Ching-Kuei
CK
Huang
Wei-Ming
WM
Chen
Chien-Lin
CL
Liu
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006215:Hallux Valgus / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D017746:Joint Capsule / Q000601:surgery; D008297:Male; D008682:Metatarsal Bones / Q000000981:diagnostic imaging / Q000601:surgery; D008683:Metatarsophalangeal Joint / Q000000981:diagnostic imaging / Q000601:surgery; D008875:Middle Aged; D010027:Osteotomy / Q000379:methods*; D017060:Patient Satisfaction; D011183:Postoperative Complications; D011859:Radiography; D012189:Retrospective Studies; D012720:Severity of Illness Index