title: Proximal opening wedge osteotomy with wedge-plate fixation compared with proximal chevron osteotomy for the treatment of hallux valgus: a prospective, randomized study.
abstract: BACKGROUND
  Hallux valgus with an increased intermetatarsal angle is usually treated with a proximal metatarsal osteotomy. The proximal chevron osteotomy is commonly used but is technically difficult. This study compares the proximal opening wedge osteotomy of the first metatarsal with the proximal chevron osteotomy for the treatment of hallux valgus with an increased intermetatarsal angle.
  
  
  METHODS
  This prospective, randomized multicenter (three-center) study was based on the clinical outcome scores of the Short Form-36, the American Orthopaedic Foot & Ankle Society forefoot questionnaire, and the visual analog scale for pain, activity, and patient satisfaction. Subjects were assessed prior to surgery and at three, six, and twelve months postoperatively. Surgeon preference was evaluated based on questionnaires and the operative times required for each procedure.
  
  
  RESULTS
  No significant differences were found for any of the patients' clinical outcome measurements between the two procedures. The proximal opening wedge osteotomy was found to lengthen, and the proximal chevron osteotomy was found to shorten, the first metatarsal. The intermetatarsal angles improved (decreased) significantly, from 14.8° ± 3.2° to 9.1° ± 2.9 (mean and standard deviation) after a proximal opening wedge osteotomy and from 14.6° ± 3.9° to 11.3° ± 4.0° after a proximal chevron osteotomy (p < 0.05 for both). Operative time required for performing a proximal opening wedge osteotomy is similar to that required for performing a proximal chevron osteotomy (mean and standard deviation, 67.1 ± 16.5 minutes compared with 69.9 ± 18.6 minutes; p = 0.510).
  
  
  CONCLUSIONS
  Opening wedge and proximal chevron osteotomies have comparable radiographic outcomes and comparable clinical outcomes for pain, satisfaction, and function. The proximal opening wedge osteotomy lengthens, and the proximal chevron osteotomy shortens, the first metatarsal. The proximal opening wedge osteotomy was subjectively less technically demanding and was preferred by the orthopaedic surgeons in this study.
  
  
  METHODS
  Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: Halifax Infirmary, Queen Elizabeth II Health Sciences Center, 1796 Summer Street, Halifax, NS B3H3A7, Canada. E-mail address for P. Copithorne: pcopithorne@gmail.com. E-mail address for G. Boyd: gordonjboyd@gmail.com. E-mail address for P. Francis: francisp@cdha.nshealth.ca.
authors.forename: Mark
authors.initials: M
authors.lastname: Glazebrook
authors.affiliation: Halifax Infirmary, Queen Elizabeth II Health Sciences Center, 1796 Summer Street, Halifax, NS B3H3A7, Canada. E-mail address for P. Copithorne: pcopithorne@gmail.com. E-mail address for G. Boyd: gordonjboyd@gmail.com. E-mail address for P. Francis: francisp@cdha.nshealth.ca.
authors.forename: Peter
authors.initials: P
authors.lastname: Copithorne
authors.affiliation: Halifax Infirmary, Queen Elizabeth II Health Sciences Center, 1796 Summer Street, Halifax, NS B3H3A7, Canada. E-mail address for P. Copithorne: pcopithorne@gmail.com. E-mail address for G. Boyd: gordonjboyd@gmail.com. E-mail address for P. Francis: francisp@cdha.nshealth.ca.
authors.forename: Gordon
authors.initials: G
authors.lastname: Boyd
authors.affiliation: St. Michael's Hospital, 800-55 Queen Street East, Toronto, ON M5C 1R6, Canada. E-mail address: danielst@smh.ca.
authors.forename: Timothy
authors.initials: T
authors.lastname: Daniels
authors.affiliation: Division of Orthopaedic Surgery, Ottawa Hospital General Campus, 501 chemin Smyth, Ottawa, ON K1H 8L6, Canada. E-mail address: klalonde99@hotmail.com.
authors.forename: Karl-André
authors.initials: KA
authors.lastname: Lalonde
authors.affiliation: Halifax Infirmary, Queen Elizabeth II Health Sciences Center, 1796 Summer Street, Halifax, NS B3H3A7, Canada. E-mail address for P. Copithorne: pcopithorne@gmail.com. E-mail address for G. Boyd: gordonjboyd@gmail.com. E-mail address for P. Francis: francisp@cdha.nshealth.ca.
authors.forename: Patricia
authors.initials: P
authors.lastname: Francis
authors.affiliation: 41 Frederick Street, Orillia, ON L3V 5W6, Canada. E-mail address: hickey.ortho@gmail.com.
authors.forename: Michael
authors.initials: M
authors.lastname: Hickey
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D006215:Hallux Valgus / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D008684:Metatarsus / Q000601:surgery*; D008875:Middle Aged; D061646:Operative Time; D010027:Osteotomy / Q000379:methods*; D010147:Pain Measurement; D017060:Patient Satisfaction; D011183:Postoperative Complications; D011446:Prospective Studies; D011859:Radiography; D011795:Surveys and Questionnaires; D016896:Treatment Outcome