title: [Modified Chevron osteotomy combined distal soft tissue reconstruction to treat high-grade bunionette deformity].
abstract: OBJECTIVE
  To explore the surgical method of using the modified chevron osteotomy combined distal soft tissue reconstruction to treat high-grade bunionette deformity.
  
  
  METHODS
  From June 2013 to June 2015, the modified chevron osteotomy combined distal soft tissue reconstruction was used for surgical treatment of high-grade bunionette deformity in the Department of Hand and Foot Microsurgery in Xuzhou Central Hospital.Twenty-six patients with 28 feet high-grade bunionette deformity were hospitalized for treatment, with 3 male (3 feet) and 23 female (25 feet) cases, aged 22-73 (mean 47.1) years old.The average fourth-fifth intermetatarsal angle, lateral deviation of the fifth metatarsal angle and metatarsophalangeal-fifth angle were measured on the pre-and post- operative anterior to posterior weight-beating X rays of treated feet.The American Orthopaedic Foot and Ankle Society (AOFAS) Lesser Toe Metatarsophalangeal-Interphalangeal Scale was used to evaluate the post-operative outcomes.
  
  
  RESULTS
  All of 26 patients were followed, with a mean 15.7 months (range 8-25 months). Primarily healing of the wound was achieved in all cases.No postoperative infection and nonunion on the osteotomy site was found during the follow-up time.The fracture healing time was 6-15 (mean 12.2) weeks.All the patients had satisfactory appearance and sensory function without callosum and metastatic metatarsalgia at the final follow-up.The post-operative fourth-fifth intermetatarsal angle, lateral deviation of the fifth metatarsal angle and metatarsophalangeal-fifth angle were significantly lesser than the pre-operative at the 6th week after operation, respectively [(5.5±1.7)°, (2.1±0.8)°, (5.7±2.6)°vs (16.4±4.2)°, (6.0±2.2)°, (10.5±7.4)°; all P<0.01]. The post-operative AOFAS score was significantly greater than the pre-operative [(87.1±6.7) vs (62.3±9.8) points, P<0.001].
  
  
  CONCLUSIONS
  The modified chevron osteotomy combined distal soft tissue reconstruction is a safe and easy treatment option for the high-grade bunionette deformity and provides patient satisfaction results.
authors.affiliation: The Hand and Foot Microsurgery Department, Xuzhou Central Hospital, Xuzhou 221009, China.
authors.forename: S M
authors.initials: SM
authors.lastname: Feng
authors.forename: A G
authors.initials: AG
authors.lastname: Wang
authors.forename: P
authors.initials: P
authors.lastname: Ding
authors.forename: Z Y
authors.initials: ZY
authors.lastname: Zhang
authors.forename: M M
authors.initials: MM
authors.lastname: Zhou
authors.forename: C K
authors.initials: CK
authors.lastname: Li
authors.forename: Q Q
authors.initials: QQ
authors.lastname: Sun
mesh_terms: D050489:Bunion, Tailor's / Q000601:surgery*; D005260:Female; D017102:Fracture Healing; D006215:Hallux Valgus / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D035002:Lower Extremity; D008297:Male; D008682:Metatarsal Bones / Q000000981:diagnostic imaging / Q000601:surgery*; D010027:Osteotomy / Q000379:methods*; D017060:Patient Satisfaction; D011183:Postoperative Complications; D011184:Postoperative Period; D011859:Radiography; D016896:Treatment Outcome