Screw Versus Plate Fixation for Chevron Osteotomy: A Retrospective Study.
The chevron osteotomy is a popular procedure used for the correction of moderate hallux abducto valgus deformity. Fixation is typically accomplished with Kirschner wires or bone screws; however, in cystic or osteoporotic bone, these could be inadequate, resulting in displacement of the capital fragment. We propose using a locking plate and interfragmental screw for fixation of the chevron osteotomy that could reduce the healing time and decrease the incidence of displacement. We performed a retrospective cohort study for chevron osteotomies on 75 feet (73 patients). The control groups underwent fixation with 1 screw in 30 feet (40%) and 2 screws in 30 feet (40%). A total of 15 feet (20%) were included in the locking plate and interfragmental screw group. The patients were followed up until bone healing was achieved at a median of 7 (range 6 to 14) weeks. Our hypothesis was that those treated with the locking plate and interfragmental screw would have a faster healing time and fewer incidents of capital fragment displacement compared with the 1- or 2-screw groups. The corresponding mean intervals to healing for the 1-screw group was 7.71 ± 1.28 (range 6 to 10) weeks, for the 2-screw group was 7.27 ± 1.57 (range 6 to 14) weeks, and for the locking plate and interfragmental screw group was 7.01 ± 1.00 (range 6 to 9) weeks. One case of capital fragment displacement occurred in the single screw group and one in the 2-screw group. No displacement occurred in the locking plate and interfragmental screw group. Neither finding was statistically significant. However, we believe the locking plate and interfragmental screw could be a viable option in patients with osteoporotic and cystic bone changes for correction of hallux abducto valgus.
Submitted during Third Year Surgical Residency, Department of Podiatric Surgery, Oakwood Wayne Hospital, Wayne, MI.
Boyd J
BJ
Andrews
Program Director, Podiatric Surgical Residency Program, Beaumont Hospital-Wayne, Wayne, MI. Electronic address: lfallatdpm@aol.com.
Lawrence M
LM
Fallat
Research Director, Curriculum and Evaluation Director, Medical Education, Oakwood Hospital and Medical Center, Dearborn, MI.
John P
JP
Kish
D000293:Adolescent; D000328:Adult; D000368:Aged; D001860:Bone Plates; D001863:Bone Screws; D001864:Bone Wires; D005260:Female; D006215:Hallux Valgus / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D008682:Metatarsal Bones / Q000000981:diagnostic imaging / Q000601:surgery*; D008875:Middle Aged; D010027:Osteotomy / Q000379:methods*; D011859:Radiography; D012189:Retrospective Studies; D055815:Young Adult
Austin bunionectomy; displacement; hallux valgus; healing; metatarsal; osteoporotic; radiographic