A new "tension side" locking plate for Hallux Valgus: A prospective multicentre case series.
BACKGROUND
Proximal osteotomy of the first metatarsal is often indicated for Hallux Valgus correction. Previously recognised complications however, include transfer metatarsalgia, first metatarsophalangeal joint stiffness, problems with fixation and prominence of metalware.


METHODS
We report on one year follow up of an international prospective series between June 2009 and October 2012 involving three centres, including 91 feet (58 patients) that underwent proximal osteotomy, using a new locking plate applied to the plantar surface of the metatarsal.


RESULTS
Mean Hallux Valgus angle improved from 27.9 (±13.1)° to 12.4 (±8.2)° while mean Intermetatarsal angle improved from 12.5 (±8.4) to 7.1 (±3.4) and there was a statistically significant improvement in both mean AOFAS-HMI score 54.2 (±13.9) to 94.0 (±9.5) and Visual Analogue Pain Scale 4.7 (±1.5) to 0.6 (±1.3). 70% of patients were back at their preoperative employment at five weeks. Mean surgical time was 56min and the plate was generally well tolerated. There were five implant related complications.


CONCLUSIONS
Locked fixation from the tension side of the construct encourages early weight bearing with a low risk of implant prominence. Our radiological, functional and clinical parameters are comparable with similar series and we therefore recommend this technique.
Robert Jones Agnes Hunt Orthopaedic Hospital (Foot and Ankle Department), Oswestry SY10 7AG, United Kingdom. Electronic address: goldbloom.daniel@gmail.com.
Daniel
D
Goldbloom
Wrexham Maelor Hospital, Croesnewydd Road, Wrexham LL13 7TD, United Kingdom. Electronic address: nilesh@bhanu.freeserve.co.uk.
Nilesh
N
Makwana
Wrexham Maelor Hospital, Croesnewydd Road, Wrexham LL13 7TD, United Kingdom.
Patrick
P
Laing
Polyclinique de Bordeaux-Tondu, Service de chirurgie du pied et de la cheville, 143 rue du Tondu, 33082 Bordeaux Cedex, France.
Eric
E
Toullec
Groupe Hospitalier Diaconesses Croix saint Simon, 18, rue du Sergent Bauchat, 75018 Paris, France.
Wilfrid
W
Graff
Centre Hospitalier universitaire Notre Dame de secours, Boite Postale 3 - Jbeil, Byblos, Lebanon.
Antoine
A
Charbel
D000328:Adult; D001860:Bone Plates; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000295:instrumentation*; D006215:Hallux Valgus / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010027:Osteotomy; D011446:Prospective Studies; D016896:Treatment Outcome
Basal Osteotomy; Hallux Valgus; Locking plate; Opening wedge