title: Distraction osteogenesis for complex foot deformities: Gigli saw midfoot osteotomy with external fixation.
abstract: Open midfoot wedge osteotomy correction can cause neurovascular compromise, requires extensive exposure, sacrifices normal joints, and shortens the foot. We used a minimally invasive technique to treat complex foot deformities by combining percutaneous Gigli saw midfoot osteotomy, circular external fixation, and acute, gradual, or gradual with acute manipulation correction. The medical records of 23 patients (26 feet) with complex foot deformities (congenital, 18 feet; neuromuscular, 4 feet; post-traumatic, 3 feet; malunion, 1 foot) who had undergone treatment within an 18-year period (1990 through 2007) were retrospectively reviewed. We also performed the procedure on 10 cadaveric limbs to determine whether anatomic structures were at risk. Correction was achieved in all feet. The mean duration of external fixation treatment was 4.2 (range 3 to 7) months. The mean follow-up duration was 4.7 (range 2 to 18) years. A significant difference was observed in the pre- and postoperative, lateral view, talar-first metatarsal angle (p = .001). Minor complications (4 feet) consisted of bony exostoses. Major complications included recurrent deformity in 3 feet and sural nerve entrapment in 1 foot. Two patients had mild and one moderate foot pain. Three patients had impaired gait function; the remaining patients had functional gait. The mean interval until wearing regular shoes after external fixation removal was 2.3 (range 1 to 4) months. All but 1 of the patients were satisfied with the final results. We observed no cadaveric neurovascular injury. Our results have shown that percutaneous Gigli saw midfoot osteotomy can be performed without neurovascular injury and is capable of successfully correcting complex foot deformities.
authors.affiliation: Head of Foot and Ankle Surgery and Director, Foot and Ankle Deformity Correction Fellowship, International Center for Limb Lengthening, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, MD. Electronic address: blamm@lifebridgehealth.org.
authors.forename: Bradley M
authors.initials: BM
authors.lastname: Lamm
authors.affiliation: Chief of Podiatry, Department of Orthopaedics, Walter Reed National Military Medical Center, Bethesda, MD.
authors.forename: Monique C
authors.initials: MC
authors.lastname: Gourdine-Shaw
authors.affiliation: Lecturer of Orthopedics, Orthopedics Department, Benha University, Benha, Egypt.
authors.forename: Ahmed M
authors.initials: AM
authors.lastname: Thabet
authors.affiliation: Unit Head, Department of Orthopaedics, Pushpanjali Crosslay Hospital, Ghaziabad, Uttar Pradesh, India.
authors.forename: Gaurav
authors.initials: G
authors.lastname: Jindal
authors.affiliation: Director, International Center for Limb Lengthening, Rubin Institute for Advanced Orthopedics and Director, Pediatric Orthopedics, Sinai Hospital of Baltimore, Baltimore, MD; and Clinical Professor, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD.
authors.forename: John E
authors.initials: JE
authors.lastname: Herzenberg
authors.affiliation: Orthopaedic Surgeon, Endoklinik Hamburg, Hamburg, Germany.
authors.forename: Rolf D
authors.initials: RD
authors.lastname: Burghardt
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002102:Cadaver; D002648:Child; D002675:Child, Preschool; D016267:External Fixators; D005260:Female; D005528:Foot / Q000033:anatomy & histology; D005530:Foot Deformities / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D019857:Osteogenesis, Distraction / Q000009:adverse effects; D010027:Osteotomy / Q000379:methods*; D059348:Peripheral Nerve Injuries / Q000209:etiology / Q000517:prevention & control; D011859:Radiography; D012189:Retrospective Studies; D057772:Vascular System Injuries / Q000209:etiology / Q000517:prevention & control; D055815:Young Adult
keywords: center of rotation of angulation; deformity; midfoot correction; minimally invasive; subperiosteal dissection