title: Proximal metatarsal osteotomy for hallux valgus: an audit of radiologic outcome after single screw fixation and full postoperative weightbearing.
abstract: BACKGROUND
  Proximal metatarsal osteotomy combined with a distal soft-tissue procedure is a common treatment for moderate to severe hallux valgus. Secure stabilisation of the metatarsal osteotomy is necessary to avoid complications such as delayed union, nonunion or malunion as well as loss of correction. The aim of this study was to report our results using a single screw for stabilisation of the osteotomy.
  
  
  METHODS
  We retrospectively reviewed 151 patients with severe hallux valgus who were treated by the above mentioned way with full postoperative weightbearing in a stiff soled shoe. Mean age of patients at time of surgery was 54 years, 19 patients were male and 132 female. Assessment of clinical and radiographic results was performed after 2 days and 6 weeks. Results were also correlated to the experience of the performing surgeon.
  
  
  RESULTS
  Mean preoperative HVA (hallux valgus angle) was 36.4 degrees, and then 3.5 degrees 2 days and 13.4 degrees 6 weeks after the procedure (p < 0.001). Mean preoperative IMA (intermetarsal angle) was 16.8 degrees, and then 6.4 degrees after 2 days and 9.8 degrees after 6 weeks (p < 0.001). Mean preoperative first metatarsal length of 56.4 mm decreased to 53.6 mm after 6 weeks. Possible non-union of the osteotomy was observed in 4 patients (2.6%) after 6 weeks. Performing residents (n = 40) operated in 65 minutes and attending surgeons (n = 111) in 45 minutes, with no significant differences in radiographic measurements between both groups.
  
  
  CONCLUSIONS
  Single screw stabilisation of proximal chevron osteotomy is a reliable method for treating severe hallux valgus deformities with satisfactory results.
authors.affiliation: Department of Orthopaedics, University Hospital Tuebingen, Hoppe-Seyler-Strasse 3, 72076 Tuebingen Germany.
authors.forename: Falk
authors.initials: F
authors.lastname: Mittag
authors.affiliation: Department of Orthopaedics, University Hospital Tuebingen, Hoppe-Seyler-Strasse 3, 72076 Tuebingen Germany.
authors.forename: Ulf
authors.initials: U
authors.lastname: Leichtle
authors.affiliation: Department of Medical Biometry, University Tuebingen, Westbahnhofstrasse 55, 72070 Tuebingen, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Meisner
authors.affiliation: Department of Orthopaedics, University Hospital Tuebingen, Hoppe-Seyler-Strasse 3, 72076 Tuebingen Germany.
authors.forename: Ingmar
authors.initials: I
authors.lastname: Ipach
authors.affiliation: Department of Orthopaedics, University Hospital Tuebingen, Hoppe-Seyler-Strasse 3, 72076 Tuebingen Germany.
authors.forename: Nikolaus
authors.initials: N
authors.lastname: Wülker
authors.affiliation: Department of Orthopaedics, University Hospital Tuebingen, Hoppe-Seyler-Strasse 3, 72076 Tuebingen Germany.
authors.forename: Markus
authors.initials: M
authors.lastname: Wünschel
keywords: Full weightbearing; Hallux valgus; Proximal metatarsal osteotomy; Single screw fixation