title: Preventing delayed union after distal shortening oblique osteotomy of metatarsals in the rheumatoid forefoot.
abstract: OBJECTIVE
  The aim of this study is to evaluate the surgical methods to prevent delayed union after the distal shortening oblique osteotomy of the lesser metatarsals in the rheumatoid forefoot.
  
  
  METHODS
  This retrospective observational study included 107 patients. The patients were classified into the following four groups, each of which represented the addition of a surgical technique to reduce postoperative delayed union: 1st group: original surgical method; 2nd group: a normal saline was dripped on the oscillating saw; 3rd group: the incised periosteum was sutured; 4th group: the osteotomy sites were ligated. The frequencies of delayed union were assessed.
  
  
  RESULTS
  Delayed union occurred in 21 of the 127 metatarsals (16.5%) in the 1st group, 13 of the 99 metatarsals (13.1%) in the 2nd group, 5 of the 94 metatarsals (5.3%) in the 3rd group, and 6 of the 136 metatarsals (4.4%) in the 4th group. The frequency of delayed union decreased significantly with improved surgical procedures (p = 0.0003).
  
  
  CONCLUSIONS
  A combination of techniques that included dripping normal saline on the oscillating saw, ligating the osteotomy sites, and suturing the periosteum at the osteotomy sites decreased the frequency of delayed union after the distal shortening oblique osteotomy of the metatarsals in rheumatoid arthritis patients.
authors.affiliation: a Department of Orthopedic Surgery , Institute of Rheumatology, Tokyo Women's Medical University , Tokyo , Japan and.
authors.forename: Koichiro
authors.initials: K
authors.lastname: Yano
authors.affiliation: a Department of Orthopedic Surgery , Institute of Rheumatology, Tokyo Women's Medical University , Tokyo , Japan and.|b CREST, JST , Tokyo , Japan.
authors.forename: Katsunori
authors.initials: K
authors.lastname: Ikari
authors.affiliation: a Department of Orthopedic Surgery , Institute of Rheumatology, Tokyo Women's Medical University , Tokyo , Japan and.
authors.forename: Mina
authors.initials: M
authors.lastname: Ishibashi
authors.affiliation: a Department of Orthopedic Surgery , Institute of Rheumatology, Tokyo Women's Medical University , Tokyo , Japan and.
authors.forename: Shigeki
authors.initials: S
authors.lastname: Momohara
mesh_terms: D000368:Aged; D001172:Arthritis, Rheumatoid / Q000601:surgery*; D002146:Bony Callus / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008297:Male; D008682:Metatarsal Bones / Q000000981:diagnostic imaging / Q000601:surgery; D008875:Middle Aged; D010027:Osteotomy / Q000009:adverse effects / Q000379:methods; D011184:Postoperative Period; D012189:Retrospective Studies; D013536:Suture Techniques; D013997:Time Factors; D016896:Treatment Outcome
keywords: Delayed union; Forefoot surgery; Lesser metatarsals; Nonunion; Rheumatoid arthritis