title: Short- and long-term outcomes following hallux-valgus correction: a modified Kramer osteotomy.
abstract: BACKGROUND
  Short- and long-term assessments were performed of a modification to the Kramer osteotomy that developed to stabilize the metatarsal head using an angular implant, the LINK(®) internal hallux fixator (Waldemar LINK GmbH & Co. KG, Hamburg, Germany).
  
  
  METHODS
  For this retrospective study, radiological assessments were used to measure outcomes in 72 feet with hallux valgus treated from 2006 to 2011. The hallux-valgus angle, the intermetatarsal angle between the first and second intermetarsal shaft axes, and the distal metatarsal articular angle were measured at short- and long-term intervals. Long-term clinical assessments included results of the Foot Function Index and the American Orthopedic Foot and Ankle Society Forefoot Score.
  
  
  RESULTS
  Of the 72 feet treated, 12 were done as bilateral operations. Fifty-five patients at a mean age of 52 years (±12; range 22-78) were included in short-term assessments. Significant improvements in angular measurements were made (p < 0.001) between baseline and 3 month assessments. Three postoperative complications occurred and 40 % (29/72) of the implants were eventually removed. Fifty-five of the 72 feet were available for long-term assessments at a median of 5 years postoperatively (IQR 5-7; range 3-9). No significant loss of correction was detected (p = 0.373). Clinical assessments indicated successful outcomes in 86 % (47/55) of the feet, with slightly better results in older patients (p = 0.033; OR 1.1, CI 95 % 1.01-1.15).
  
  
  CONCLUSIONS
  This technique can achieve normal angular configuration, even with severe deformities, without significant long-term loss of correction. Patients should be informed of potential discomfort necessitating hardware removal, although the likelihood of complications is low.
  
  
  METHODS
  Level III study.
authors.affiliation: Department of Orthopedics and Traumatology, Cantonal Hospital Frauenfeld, Frauenfeld, Switzerland.
authors.forename: Christoph
authors.initials: C
authors.lastname: Knoth
authors.affiliation: Department of Radiology, University Hospital Zürich, Zurich, Switzerland.
authors.forename: Leonie
authors.initials: L
authors.lastname: Carow
authors.affiliation: Department of Orthopedics and Traumatology, Cantonal Hospital Frauenfeld, Frauenfeld, Switzerland.
authors.forename: Ralph
authors.initials: R
authors.lastname: Zettl
authors.affiliation: Department of Orthopedics and Traumatology, Cantonal Hospital Frauenfeld, Frauenfeld, Switzerland.
authors.forename: JoEllen
authors.initials: J
authors.lastname: Welter
authors.affiliation: Department of Orthopedics and Traumatology, Cantonal Hospital Frauenfeld, Frauenfeld, Switzerland. Florian.Hess@stgag.ch.
authors.forename: Florian
authors.initials: F
authors.lastname: Hess
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006215:Hallux Valgus / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D016268:Internal Fixators; D008297:Male; D008682:Metatarsal Bones / Q000601:surgery*; D008875:Middle Aged; D010027:Osteotomy / Q000295:instrumentation / Q000379:methods*; D011859:Radiography; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: First metatarsal osteotomy; Forefoot surgery; Hallux valgus; Kramer osteotomy