title: Role of Fixation and Postoperative Regimens in the Long-Term Outcomes of Distal Chevron Osteotomy: A Randomized Controlled Two-by-Two Factorial Trial of 100 Patients.
abstract: The necessity of chevron osteotomy fixation is controversial and evidence for the effectiveness of postoperative regimens is limited. In a prospective, randomized study, we compared the long-term results of 2 operative techniques (osteotomy fixation versus no fixation) and 2 postoperative regimens (a soft cast versus an elastic bandage) in 100 patients who underwent surgery for hallux valgus. Clinical evaluations with the American Orthopaedic Foot and Ankle Society (AOFAS) scale scoring were performed at baseline and 6 weeks, 6 months, 1 year, and a mean of 7.9 years postoperatively. The mean AOFAS function score were better in the group treated without osteotomy fixation and with an elastic bandage at 6 weeks postoperatively, but the differences then disappeared. The total AOFAS scores improved significantly in all 4 subgroups during the first 12 months; however, in the long term, some deterioration occurred. In the AOFAS scores, the average function, alignment, and total points were significantly worse when the preoperative hallux valgus angles exceeded 30°. The incidence of complication was low (1%); there was 1 superficial wound infection. The AOFAS score did not differ statistically among the groups in our population. An elastic bandage for postoperative treatment is recommended. The risk of recurrence is greater and functional result worse if the preoperative hallux valgus angle exceeds 30°.
authors.affiliation: Orthopaedic Surgeon, Division of Orthopaedic and Trauma Surgery, Department of Surgery, Oulu University Hospital, Oulu, Finland.
authors.forename: Ilkka
authors.initials: I
authors.lastname: Pentikäinen
authors.affiliation: Specializing Physician, Division of Orthopaedic and Trauma Surgery, Department of Surgery, Oulu University Hospital, Oulu, Finland.
authors.forename: Jouni
authors.initials: J
authors.lastname: Piippo
authors.affiliation: Statistician, Division of Orthopaedic and Trauma Surgery, Department of Surgery, Oulu University Hospital, Oulu, Finland.
authors.forename: Pasi
authors.initials: P
authors.lastname: Ohtonen
authors.affiliation: Orthopaedic Surgeon, Division of Orthopaedic and Trauma Surgery, Department of Surgery, Oulu University Hospital, Oulu, Finland.
authors.forename: Juhani
authors.initials: J
authors.lastname: Junila
authors.affiliation: Chief of Orthopaedic and Trauma Surgery and Professor, Oulu University Hospital, Oulu, Finland. Electronic address: juhana.leppilahti@ppshp.fi.
authors.forename: Juhana
authors.initials: J
authors.lastname: Leppilahti
mesh_terms: D000328:Adult; D002370:Casts, Surgical; D005260:Female; D006215:Hallux Valgus / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010027:Osteotomy / Q000379:methods*; D011182:Postoperative Care / Q000379:methods*; D011446:Prospective Studies; D012149:Restraint, Physical; D053828:Stockings, Compression
keywords: Austin bunionectomy; bunion surgery; chevron osteotomy; fixation; hallux valgus