title: Correlation of Postoperative Position of the Sesamoids After Chevron Osteotomy With Outcome.
abstract: BACKGROUND
  Postoperative incomplete reduction of the sesamoids has been identified as a potential risk factor for hallux valgus recurrence after proximal osteotomy. However, it is not known whether the postoperative sesamoid position is a risk factor in hallux valgus correction via distal chevron osteotomy with or without dorsal webspace release (DWSR).
  
  
  METHODS
  In this retrospective study, 169 patients who underwent distal chevron osteotomy with or without DWSR were reviewed. Preoperative and postoperative (6 weeks, 6 months, 12 months) weightbearing radiographs were evaluated. Functional hallux valgus angle (HVA), intermetatarsal angle (IMA), and the position of the tibial sesamoid were graded using the center of head method. Seventy-six radiographs were available for review at the 12-month follow-up. Of these, 41 patients underwent DWSR procedure and 35 did not.
  
  
  RESULTS
  In both groups, correction of all 3 parameters (HVA, IMA, tibial sesamoid position) were significant at the 12-month follow-up. Comparison of the postoperative results of the 2 groups showed no statistically significant differences. Four feet demonstrated displaced sesamoid position at the 12-month follow-up, with radiographic evidence of recurrence in just one. No significant relationship was found between postoperative sesamoid position and hallux valgus recurrence that occurred in 4 feet.
  
  
  CONCLUSIONS
  Combining DWSR with a distal chevron osteotomy did not delay healing or increase risk of avascular necrosis, but it did not significantly improve angular measurements or sesamoid position. The concept that postoperative sesamoid position can be used to predict hallux valgus recurrence was not supported by our results when looking at distal chevron correction.
  
  
  METHODS
  Level III, retrospective comparative study.
authors.affiliation: Department of Orthopaedic Surgery, Mayo Clinic, Jacksonville, FL, USA.
authors.forename: Glenn G
authors.initials: GG
authors.lastname: Shi
authors.affiliation: Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: Peter
authors.initials: P
authors.lastname: Henning
authors.affiliation: Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, WI, USA rmarks@mcw.edu.
authors.forename: Richard M
authors.initials: RM
authors.lastname: Marks
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006215:Hallux Valgus / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010027:Osteotomy / Q000379:methods*; D011184:Postoperative Period; D012008:Recurrence; D012189:Retrospective Studies; D012716:Sesamoid Bones / Q000000981:diagnostic imaging*; D055815:Young Adult
keywords: distal chevron osteotomy; distal soft tissue procedure; dorsal webspace release; hallux valgus; radiography; sesamoid