title: Axial loading screw fixation for chevron type osteotomies of the distal first metatarsal: a retrospective outcomes analysis.
abstract: The distal chevron osteotomy is a widely accepted technique for the treatment of hallux abductovalgus deformity. Although the osteotomy is considered to be stable, displacements of the capital fragment has been described. We propose a new method for fixation of the osteotomy involving the axial loading screw (ALS) used in addition to single screw fixation. We believe this method will provide a more mechanically stable construct. We reviewed the charts of 46 patients in whom 52 feet underwent a distal chevron osteotomy that was fixated with either 1 screw or 2 screws that included the ALS. We hypothesized that the ALS group would have fewer displacements and would heal more quickly than the single screw fixation group. We found that the group with ALS fixation had healed at a mean of 6.5 weeks and that the group with single screw fixation had healed at 9.53 weeks (p = .001). Also, 8 cases occurred of displacement of the capital fragment in the single screw, control group compared with 2 cases of displacement in the ALS group. However, this finding was not statistically significant. The addition of the ALS to single screw fixation allowed the patients to heal approximately 3 weeks earlier than single screw fixation alone. The ALS is a fixation option for the surgeon to consider when osseous correction of hallux abducto valgus is performed.
authors.affiliation: Chief Resident, Submitted during Third Year Surgical Residency, Department of Podiatric Surgery, Oakwood Annapolis Hospital, Wayne, MI. Electronic address: docrmurph@gmail.com.
authors.forename: Ryan M
authors.initials: RM
authors.lastname: Murphy
authors.affiliation: Program Director, Podiatric Surgical Residency Program, Oakwood Annapolis Hospital, Wayne, MI.
authors.forename: Lawrence M
authors.initials: LM
authors.lastname: Fallat
authors.affiliation: Research Director, Curriculum and Evaluation Director, Medical Education, Oakwood Hospital and Medical Center, Dearborn, MI.
authors.forename: John P
authors.initials: JP
authors.lastname: Kish
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001863:Bone Screws; D005260:Female; D006215:Hallux Valgus / Q000601:surgery*; D006801:Humans; D008297:Male; D008682:Metatarsal Bones / Q000601:surgery*; D008875:Middle Aged; D010027:Osteotomy / Q000295:instrumentation* / Q000379:methods; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
keywords: 3; Austin bunionectomy; axial loading screw; bunion; fixation