Long-term Follow-up of Dorsal Wedge Osteotomy for Pediatric Freiberg Disease.
BACKGROUND
Treatment for Freiberg disease has been largely conservative despite availability of various operative options for severe or refractory cases. The aim of this study was to evaluate the long-term results of pediatric patients with symptomatic Freiberg disease treated with intra-articular dorsal wedge osteotomy.


METHODS
Pediatric patients treated for Freiberg disease with surgery between January 1982 and 1999 were identified and selected for long-term clinical evaluation. Patients were evaluated regarding operative satisfaction and clinical outcome, performed according to the American Orthopaedic Foot & Ankle Society (AOFAS) lesser toe metatarsophalangeal-interphalangeal scale and range of motion (ROM) of metatarsophalangeal (MTP) joint. Patients had radiographic assessment of degenerative joint status with anteroposterior and oblique foot x-ray. Twenty patients (18 female, 2 male; mean age 15.2 years; range 12-17 years) were identified. The mean follow-up period was 23.4 (range 15-32) years.


RESULTS
The clinical outcomes of our patients were classified as excellent in 16 (80%) and good in 4 (20%). The AOFAS mean score was 96.8 (range 91-100) points at the last clinical appointment. A negative correlation between AOFAS score and time of follow-up (r's = -0.61, P < .001) was found. Also, a strong negative correlation was found between Smillie classification and AOFAS final score (r's = -0.88, P < .001).


CONCLUSIONS
The patients were very satisfied with pain and quality of life at a mean follow-up time of 23.4 years. To our knowledge, this is the first long-term follow-up report supporting the procedure described by Gauthier and Elbaz as a good option for operative treatment of Freiberg disease.


METHODS
Level IV, retrospective case series.
Orthopedic Surgery Department, Hospital de Braga, Braga, Portugal pereira.bac@gmail.com.
Bruno S
BS
Pereira
Orthopedic Surgery Department, Hospital de Braga, Braga, Portugal Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal.
Tiago
T
Frada
Orthopedic Surgery Department, Hospital de Braga, Braga, Portugal.
Daniel
D
Freitas
Orthopedic Surgery Department, Hospital de Braga, Braga, Portugal.
Pedro
P
Varanda
Orthopedic Surgery Department, Hospital de Braga, Braga, Portugal.
Manuel
M
Vieira-Silva
Orthopedic Surgery Department, Clínica Ntra. Sra. Del Remei, Carrer de l'Escorial, Barcelona, Espanha Facultad de Medicina, University of Barcelona, Casanova, Barcelona, Espanha.
Xavier Martin
XM
Oliva
Orthopedic Surgery Department, Hospital de Braga, Braga, Portugal Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal ICVS/3Bs - PT Government Associate Laboratory, Braga/Guimarães, Portugal.
Rui M
RM
Duarte
D000293:Adolescent; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008682:Metatarsal Bones / Q000000981:diagnostic imaging / Q000601:surgery*; D008683:Metatarsophalangeal Joint / Q000000981:diagnostic imaging / Q000601:surgery; D008684:Metatarsus / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000601:surgery; D010007:Osteochondritis / Q000151:congenital* / Q000000981:diagnostic imaging / Q000601:surgery; D010027:Osteotomy / Q000379:methods*; D017060:Patient Satisfaction; D011859:Radiography; D012189:Retrospective Studies
Freiberg disease; Gauthier and Elbaz; dorsal wedge osteotomy; forefoot disorders; metatarsal heads