Quantitative Analysis of the Degree of Frontal Rotation Required to Anatomically Align the First Metatarsal Phalangeal Joint During Modified Tarsal-Metatarsal Arthrodesis Without Capsular Balancing.
The data from 35 consecutive patients with hallux valgus undergoing triplane arthrodesis at the first tarsal metatarsal joint were studied to determine the amount of first metatarsal frontal plane rotation (supination) needed to anatomically align the first metatarsal phalangeal joint on an anterior posterior radiograph without soft tissue balancing at the first metatarsal phalangeal joint. Radiographs were measured both pre- and postoperatively to assess the 1-2 intermetatarsal angle, hallux abductus angle, and tibial sesamoid position (TSP). The mean amount of varus (supination) rotation performed during correction was 22.1° ± 5.2° and the mean amount of intermetatarsal angle reduction achieved after completion of the procedure was 6.9° ± 3.0°. The TSP changed by a mean of 3.3° ± 1.2°. A series of univariate linear regression analyses was performed to analyze the relationship between the frontal plane rotation of the first metatarsal performed during the operation and the preoperative intermetatarsal angle, hallux abductus angle, and TSP. Greater preoperative TSP scores were associated with greater intraoperative varus (supination) rotation required for joint alignment. Direct observation of the alignment changes at the first metatarsal phalangeal joint after metatarsal rotation without distal procedures strengthened the notion that the frontal plane rotational position plays an important role in the bunion deformity.
Residency Director, UnityPoint Health, Trinity Regional Medical Center, Fort Dodge, IA; Assistant Professor, Des Moines University College of Podiatric Medicine and Surgery, Fort Dodge, IA. Electronic address: daytonp@me.com.
Paul
P
Dayton
Resident, UnityPoint Health, Trinity Regional Medical Center, Fort Dodge, IA.
Merrell
M
Kauwe
Director, Fellowship Training, Youngstown, OH; and Adjunct Professor, Kent State University College of Podiatric Medicine, Independence, OH.
Lawrence
L
DiDomenico
Assistant Professor, Des Moines University College of Podiatric Medicine and Surgery, Des Moines, IA.
Mindi
M
Feilmeier
Associate Professor, Chairperson, and Program Director, Des Moines University, Des Moines, IA.
Rachel
R
Reimer
D001174:Arthrodesis / Q000379:methods*; D017760:Bone Malalignment / Q000000981:diagnostic imaging / Q000517:prevention & control*; D005260:Female; D006215:Hallux Valgus / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D017746:Joint Capsule / Q000601:surgery*; D008297:Male; D008682:Metatarsal Bones / Q000000981:diagnostic imaging / Q000601:surgery*; D008683:Metatarsophalangeal Joint / Q000000981:diagnostic imaging / Q000601:surgery*; D012189:Retrospective Studies; D012399:Rotation
Lapidus arthrodesis; hallux abducto valgus; metatarsal pronation; metatarsus primus adducto valgus; tibial sesamoid position