title: Serious sequellae of the hallux valgus surgery: More options for its surgical treatment.
abstract: OBJECTIVE
  The purpose of this study is to present a method for treating the serious consequences that result from failure of corrective techniques used for hallux valgus, which produces severe shortening of the first ray, and makes it difficult to perform the third rocker.
  
  
  METHODS
  In this study, conducted in 2 hospitals in Madrid and Barcelona, an assessment was made of the clinical and radiological results of 40 cases, of which 97.5% were female. Technically it involves making a metatarsophalangeal arthrodesis after bone distraction with an external mini-fixation, and then inserting an iliac crest bone graft, stabilising it with a plate or the mini-fixator.
  
  
  RESULTS
  The pre-operative shortening was 2.5cm. and elongation obtained was between 1.5 and 3.0cm. Clinical and radiological bone graft integration was achieved at 2-4 months, although full integration occurred after one year. Falliner and Blauth criteria were used to evaluate the results at 6 and 12 months follow-up, and using Visual Analogue Scale (VAS score/pain, scale 1-10), being favourable in 80%, and not changing over time. The failure rate was 7.5%, which included the non-integration of the graft and infection, requiring additional surgery.
  
  
  CONCLUSIONS
  There are not many publications on the number and type of complication for hallux valgus surgery, or guidelines established, only the treatment by conventional fusion. The problem arises when the patient presents a severe shortening of the ray, and direct fusion would aggravate the insufficiency of the first ray and the transference metatarsalgia. In these cases, these procedures would be indicated.
authors.affiliation: Servicio de Cirugía Ortopédica y Traumatología, Hospital Virgen del Mar, Madrid, España. Electronic address: mnusamp1@nunezsamper.com.
authors.forename: M
authors.initials: M
authors.lastname: Núñez-Samper
authors.affiliation: Servicio de Cirugía Ortopédica y Traumatología, Clínica Tres Torres, Barcelona, España.
authors.forename: R
authors.initials: R
authors.lastname: Viladot
authors.affiliation: Servicio de Cirugía Ortopédica y Traumatología, Clínica Tres Torres, Barcelona, España.
authors.forename: S J
authors.initials: SJ
authors.lastname: Ponce
authors.affiliation: Servicio de Cirugía Ortopédica y Traumatología, Hospital Virgen del Mar, Madrid, España.
authors.forename: E
authors.initials: E
authors.lastname: Lao
authors.affiliation: Felow C.O.T. Instituto Nacional de Rehabilitación, Ciudad de México, México.
authors.forename: F
authors.initials: F
authors.lastname: Souki
mesh_terms: D000328:Adult; D000368:Aged; D001174:Arthrodesis / Q000295:instrumentation / Q000379:methods*; D001860:Bone Plates; D016025:Bone Transplantation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006215:Hallux Valgus / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D007085:Ilium / Q000637:transplantation*; D008297:Male; D008875:Middle Aged; D019857:Osteogenesis, Distraction; D012086:Reoperation / Q000379:methods; D016879:Salvage Therapy / Q000379:methods*; D016896:Treatment Outcome
keywords: Artrodesis metatarsofalángica; Grave insuficiencia del primer radio; Hallux valgus sequelae; Metatarsophalangeal arthrodesis; Secuelas cirugía de hallux valgus; Severe first ray deficiency