Radiographic analysis of the impact of internal fixation and dressing choice of distal chevron osteotomy: randomized control trial.
BACKGROUND
The aim of this study was to perform prospective, randomized comparison of two surgical techniques (fixation versus no fixation) and two postoperative regimens (soft cast versus elastic band) to determine if the head fragment displaces more or less with either technique.


METHODS
One hundred consecutive patients were included in the study. The osteotomy was fixed with an absorbable pin in 50 cases and no fixation in the other 50. Half of each group used a soft cast for 6 weeks postoperatively and half had a traditional elastic bandage. Weightbearing radiographs at 6 weeks, 6 months, 1 year, and mean of 7.9 years were evaluated.


RESULTS
A larger shift was found when fixation was used 3.9 (SD, 0.8) mm at 6 weeks versus 3.1 (SD, 0.9) mm in the no fixation group (p < 0.001). The two bandage types had no significant effect to the mean shift. Correction of the mean hallux valgus angle was worse overall when preoperative angles were over 30 degrees (p < 0.001).


CONCLUSIONS
There was a statistically higher shift in the fixation group, but the clinical significance of 0.7 mm difference and the type of postoperative bandaging did not influence outcome is questionable. The risk for recurrence of hallux valgus was higher when preoperative angles were over 30 degrees.
Ilkka Tapani
IT
Pentikäinen
Risto
R
Ojala
Pasi
P
Ohtonen
Jouni
J
Piippo
Juhana Ilmari
JI
Leppilahti
D020341:Absorbable Implants; D000328:Adult; D001858:Bone Nails; D002370:Casts, Surgical; D058128:Compression Bandages; D005260:Female; D006215:Hallux Valgus / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D008682:Metatarsal Bones / Q000000981:diagnostic imaging* / Q000601:surgery; D008875:Middle Aged; D010027:Osteotomy / Q000295:instrumentation* / Q000379:methods; D011446:Prospective Studies; D011859:Radiography; D055815:Young Adult