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Syndesmosis Procedure for Hallux Valgus and Bunion Deformities Correction

Discussion in 'Foot Surgery' started by danielywu, Jan 15, 2014.

  1. Dieter Fellner

    Dieter Fellner Well-Known Member

    Re: Syndesmosis Procedure


    Daniel: I'm confused. Yes the procedure is described in outline in articles, I'm well aware of that. I am interested to know from you any pearls and pitfalls, and any other technique tips. Since you are well versed in the procedure you have much to contribute. Thanks.
     
  2. danielywu

    danielywu Active Member

    Re: Syndesmosis Procedure

    Dear Dieter:

    I am humbled by your asking.

    If I may I would like to be remembered one day as the devil’s advocate who tried his hardest in the Podiatry Forum to advocate non-osteotomy and syndesmosis concepts and preservation of adductor hallucis tendon and lateral sesamoid. Some of these are the differences between Irwin’s and my surgical techniques that you should easily notice when you go through these articles again carefully. Technical issue is mechanical and easy. It is only guided by surgical concepts and principles which are really the key to a physiological approach and reasonable outcome.

    We as surgeons should always remind ourselves the surgical doctrine of “Do No Harm”!

    Daniel
     
  3. drsarbes

    drsarbes Well-Known Member

    Re: Syndesmosis Procedure

    Hi DR. Wu

    I think we are proving that we are, in fact, open to new ideas, since we are still discussing the procedure.

    Perhaps one point you may be missing is that, speaking for myself at least, I have no problems with the osteotomy procedures. They are very successful, they heal fairly quickly, they are not painful when post operative protocols are followed and I have very very few complications.

    I'll give you a comparison.....Heel Spur Surgery. There are many many procedures out there for dealing with this condition. I perform a heel spur/fasciotomy procedure with the aid of fluoroscopy which is very successful. When I read of a newer procedure, perhaps with different modalities at their core, but I see the healing time is longer, the success rate is lower and the complication rate is higher...then why would I want to switch to this procedure?

    When you have a surgeon performing a certain set of procedures and someone comes in and tells you these procedures are fundamentally wrong and there is a better way, then certainly the burden of proof is on you.

    I do have a question that I have asked several times but have failed to see the answer...What is your post operative protocol? Are these patients ambulatory immediately post op? When, on average, are they back into regular shoes? Activity?

    Thank you

    Steve
     
    Last edited: Feb 13, 2014
  4. danielywu

    danielywu Active Member

    Re: Syndesmosis Procedure

    [I]“Recovery

    Since there is no bone-breaking involved, there is usually relatively little. Walking is allowed and possible any time after surgery. How, crutches are recommended for the first month after surgery for protection.
    Protective footwear is also worn for walking for the first 3 months until the syndesmosis connection bridge is mostly completed. During the same period walking is not a problem but needs to be restricted to less than 6,000 steps a day and a slower pace.”
    [/I]
    This is directly downloaded from my website www.bunioncenter.com under its Treatment section. Perhaps, what I can still add to it for you is that the protective foot wear is the Orthowedge by Darco and the second 3-month period is still restricted to normal walking in regular comfortable shoes. Unrestricted and unlimited activities and shoes (hi-heels and hi-fashion shoes included) are only permitted as tolerated after a total of 6 months. For more information, please visit my website first.

    Syndesmosis procedure is not be-all and end-all. That's why it is out for discussion. Also, we can only offer our best by doing whatever our own hands can do best, not other’s. But syndesmosis procedure does need other surgeons to help validate it.

    Daniel
     
  5. Dieter Fellner

    Dieter Fellner Well-Known Member

    Re: Syndesmosis Procedure

    The recovery part bothers me, a little. Daniel says there isn't much in the way of recovery because there is no bone breaking. He then goes on to say the patient is confined to the Darco shoe for three months and restricted footwear for a further three months. That's comparable to osteotomy procedures and more time in recovery than some osteotomy procedures. Compare this to a stable Scarf when the patient can be introduced to a sneaker after two weeks.
     
  6. drsarbes

    drsarbes Well-Known Member

    Re: Syndesmosis Procedure

    HI
    I agree with Dr. Fellner.
    Your recuperative period is quite a bit longer than what I normally see for my "bone Breaking" procedures.

    I perform a lot of neck osteotomies and these patients are back into an athletic shoe in 2 1/2 to 3 weeks. I have runners slowly jogging at 4 1/2 to 5 weeks. I would expect even the slowest of healers to be active at 8.

    I would like to comment on the "bone Breaking" nomenclature as well.

    Obviously this is being used as a marketing phrase, but it really has no place here. These are osteotomies. Obviously a fixated surgical osteotomy is quite different than a broken bone, which congers up an image of some type of traumatic fracture.

    Perhaps there is some way to accelerate the fibro-osseous bridge.
    If this is indeed what is giving you long term stability I would think that utilizing a simple graft would speed things up. You could possibly insert a bone graft after you "rough up" the cortices and simply pin this with an absorbable pin product. Or better yet, place your cerclage suture through the graft to keep it in place.

    Food for thought

    Steve
     
  7. danielywu

    danielywu Active Member

    Re: Syndesmosis Procedure

    Dear Dieter:
    It is indeed a ground-breaking speedy recovery for patients to go back to sneakers in two weeks, after bilateral procedures? without crutches and protection? unrestricted or activities as tolerated? It is quite different from what my patients have told me after their osteotomy procedures. What is your protocol after Chevron osteotomy, Steve?

    I thank Steve for his bone-graft suggestion but it seems to go against his comment of “Why is it flawed? Does the first ray not move independently from the second?” in the “Syndesmosis surgery for bunions” thread on May 8, 2012. Now, I am really confused.

    I suggest that we should substantiate our inexpensive talks with evidence. Since Steve has done thousands of Chevron procedure alone by 2007 and probably tens of thousands by now and Dieter has also ready access to thousands of cases from his teaching institution, instead of wasting any more time on free-for-all claims we have no excuse not to do a comparative study for Chevron, Scarf and Syndesmosis procedures for a landmark publication.

    What do you say about that? Please, no ifs and buts. I am sure we can do it if it has been done before without today’s technology. We can open ourselves for ideas and help from the Forum.

    Daniel
     
  8. drsarbes

    drsarbes Well-Known Member

    Re: Syndesmosis Procedure

    Hi Dan
    Not sure what you are asking for. I have nothing to prove nor am I going to perform some type of retrospective study.

    I'm not sure my patients do much better than any one else's (although my ego would like to think they do) - We have always had patients out of their post operative shoe (now short CAM boot) by three weeks. Again, a fixated osteotomy, particularly ones through cancellous bone (like an Austin) heal fairly quickly. These are not "broken bones"…..

    The point here is you have a procedure that you feel has some advantages over osteotomies. I am not entirely convinced but am open minded. I merely informed you, given my 3 decades of performing osteotomies, what my post operative course normally is.
    Pretty plain and simple.

    I never perform bilateral procedures since this would transform a rather simple, relatively non painful post op course into somewhat of an ordeal (IMHO).

    I understand the ambiguity in the argument for a procedure that is "functional" and allowing for regaining normal biomechanics and at the same time stating there is a bridge between the first and second metatarsals and also that this somehow allows normal first ray function but also holds the metatarsals together…….it gets a bit contradictory. My graft was only a suggestion for a shorter recovery.

    If the syndesmosis procedure does, in fact, have a longer more restrictive post operative protocol then I would not use the "non bone breaking" argument for its use since this gives the impression of a less "involved" quicker healing procedure.

    All this being said, I continue to be impressed with your initial radiographs and post operative photos.


    Steve
     
  9. danielywu

    danielywu Active Member

    Re: Syndesmosis Procedure

    Dear Steve:

    I appreciate your thoughts and enjoyed our discussion.

    Daniel
     
  10. drsarbes

    drsarbes Well-Known Member

  11. danielywu

    danielywu Active Member

    Re: Syndesmosis Procedure

    Dear Steve:

    To facilitate syndesmosis synthesis I have been using Platelet Rich Fibrin as biological scaffold. But it is difficult to assess its benefits. Thanks for the information on Thornier material.

    Daniel
     
  12. Dieter Fellner

    Dieter Fellner Well-Known Member

    Re: Syndesmosis Procedure

    Daniel: following the modified Scarf patients can be allowed back in sneakers after a bilateral procedure. Why? Because the osteotomy is engineered to withstand the weight-bearing stress. The osteotomy is compressed each time the patient bears weight.

    Of course this will not be unrestricted activity. As an orthopedist you wil be as familiar as anyone with the biological fracture healing mechanisms and time frame. Activity will need to be moderated, in much the same way as this needs to be moderated for the syndesmosis procedure, but over a time frame half of that for the syndesmosis. By the way, I have access to my own experience, not that of my institution (not sure which institution you refer to) where the modified scarf is not practiced, and especially not in the way that I like to perform the procedure.

    I am unclear how we can conduct a comparative study since you have told me in the past you have problems getting patients to return to your clinic for follow up appointments.

    One way, perhaps, to realize your clinical study suggestion will be to conduct a comparative, randomized blind, prospective clinical trial. Invite me over for a few months and you can do the syndesmosis and I will do the scarfs and we can figure it out.

    The problem with assigning a patient to a surgical shoe for three months: I am in New York City, in the middle of winter. How do you propose a patient can manage to dredge through a foot of snow and ice in a surgical shoe? For three months?!

    Just my 2c ....
     
  13. danielywu

    danielywu Active Member

    Re: Syndesmosis Procedure

    Dear Dieter:

    Now ... finally I understand why syndesmosis procedure is not suitable for NYC after all. What a shame!

    Unfortunately, a major problem with your suggestion is that I have patients coming to me from around the world specifically for syndesmosis procedure. It may be difficult to convince them to participate in a randomized study that will involve an osteotomy procedure.

    Daniel
     
  14. Dieter Fellner

    Dieter Fellner Well-Known Member

    Re: Syndesmosis Procedure

    Daniel: when I was working in England I also had patients from all over the world. I can spend 15 minutes counselling, and presenting the facts, and a patient will be happy to consent.

    That aside, of course, my suggestion will be a difficult proposition to realize. And it was made 'tongue-in-cheek'. Putting aside levity, for a moment, it will require a structured trial to know if there is a real difference in outcomes. Putting aside treatment philosophy and marketing spin, can a patient hope for a superior outcome following the syndesmosis. I have no reason to doubt your conviction and claims. But, when all is said and done, is this simply a case of surgeon preference? Can the syndesmosis withstand scientific scrutiny and analysis when evaluated using a robust patient outcome measurement tool. I am in no way suggesting it cannot, but as of now, we simply do not have this information.

    Lastly, the DARCO post-op shoe is not the only solution, inclement climate notwithstanding.

    Steve: do you have any experience with Tornier?

    DJF
     
  15. danielywu

    danielywu Active Member

    Re: Syndesmosis Procedure

    Dear Dieter:

    Darco is what I have also said a case of surgeon’s preference.

    I look forward to also hearing your Scarf patients agreeable to syndesmosis procedure one day in NYC for the study.

    I am so glad that you could also prove with Scarf that patients will travel the world for better results.

    I hope one day you will be able to contribute in scrutinizing syndesmosis procedure with action.

    Daniel
     
  16. Dieter Fellner

    Dieter Fellner Well-Known Member

    Re: Syndesmosis Procedure

    Daniel: Perchance yesterday I found your you tube videos. All, except, one are in Chinese but in any case, the women interviewed all seem very young.

    That made me wonder. What is the age / sex profile of your patients?

    Also, how did you get those animations done? Would love to know.

    Dieter
     
  17. danielywu

    danielywu Active Member

    Re: Syndesmosis Procedure

    Dear Dieter:

    Youth does attract more attention, didn't it. But I am still disappointed by your failure to notice that the same video is also available on my website www.bunioncenter.com. Hope you did not miss other important information. BTW, I designed its content and local IT did the animation.

    Daniel
     
  18. Dieter Fellner

    Dieter Fellner Well-Known Member

    Re: Syndesmosis Procedure

    Daniel: I am disappointed you did not offer more than 'youth does attract more attention'. Do you keep any activity audits on your case list? If the predominance of your patients are young this will explain your fondness of syndesmosis. The older patient with a chronic HAV will have significant adaptive changes in bone, cartilage and soft tissue. I posit the syndesmosis will be suboptimal in that category.

    By the way, why would you assume that I missed anything 'important'. The video is an infomercial, hardly important. The cartoons are cute though.

    Dieter
     
  19. danielywu

    danielywu Active Member

    Re: Syndesmosis Procedure

    Dear Dieter:

    I am bowing out for having nothing more want to say and feeling exhausted.
    Let time and action tell the rest

    Daniel
     
  20. Dieter Fellner

    Dieter Fellner Well-Known Member

    Re: Syndesmosis Procedure

    Daniel: get some rest and when you feel re-freshed hopefully you can return and provide answers to the very reasonable questions. I think it is a pity that you consistently evade specific questions and must assume you have no answer. Facts and figures will go quite some way to assist your quest to help popularize the syndesmosis, and will be essential if you truly desire to steer the global foot surgery community away from the well established gold standard treatment of the osteotomy.

    There are perhaps 10 or so useful osteotomies simply because, in the eyes of some foot surgeons, the severity of the deformity requires an adjustment in the approach. Of the 10 there is redundancy driven by surgeon preference. Some like the Austin others prefer the Reverdin-Green-Laird--Todd combinations. Some surgeons like basal wedge osteotomy for higher IMA angles others prefer Lapidus. Much of it has to do with training and experience in a particular procedure and this explains also why you are drawn to the syndesmosis - you have no personal experience of the osteotomy and rely on the information provided to you by your patients. This is selection bias.

    Personally I happen to think 2-3 suffice and for the most part the Scarf is an excellent choice for 99% of HAV. I remain open minded and yes, I will be evaluating the syndesmosis in due course. Watch this space. Good night!
     
  21. drsarbes

    drsarbes Well-Known Member

    Re: Syndesmosis Procedure

    "Steve: do you have any experience with Tornier? "

    Yes. I use some of their products. Toe Implant, anchors.....
    Why do you ask?

    Steve
     
  22. Dieter Fellner

    Dieter Fellner Well-Known Member

    Re: Syndesmosis Procedure

    Steve: curious about their absorbable suture, to know how this might compare with PDS 0/0 x 2, as might be used in a syndesmosis, and what is the cost comparison. Does hands-on experience correlate with the marketing claims?
     
  23. drsarbes

    drsarbes Well-Known Member

    Re: Syndesmosis Procedure

    Medical equipment marketing and claims probably right up there with weight loss products.
    I've used the Phantom Fiber on achilles but nothing else. I don't recall any problems with it. They have a knotless anchor technique that I used.

    Steve
     
  24. Dieter Fellner

    Dieter Fellner Well-Known Member

    Re: Syndesmosis Procedure

    To help clarify technical components of Dr Wu's procedure I would like to invite answers for the following questions:

    1. What size drill bit for the first metatarsal holes?
    2. After drilling the first metatarsal holes, how do you pass the suture
    across the second metatarsal? For example, do you use a suture passer, and
    is the suture passed over the second interspace intrinsic muscles, or deep,
    via a pocket to encircle only the bone? Or perhaps it doesn't make a
    difference.
    3. Where do you tie the suture?
    4. Are you using bone reduction forceps to hold the reduction while tying?
    5. Are you using fluoroscopy to confirm the position before tying?
    6. How is the forefoot offloading shoe working out?
    7. In your recent article you mention the exact nature of the tissue formed
    by periosteal elevation needs to be determined. Do you have any thoughts how this might be approached?
    8. A picture is worth a thousand words. There are very few active proponents of this operation to learn from. An intra-operative video will be invaluable!

    Many thanks!
     
  25. danielywu

    danielywu Active Member

    Re: Syndesmosis Procedure

    Dear Dieter:

    I am more than happy to answer your technical questions and thank you for posting them on a forum for others who may or may not have the same questions. I hope my experience can be helpful to you.

    1. I use a 2mm drill bit
    2. I use free needles to pass the sutures. A straight one through the first metatarsal holes and a curved one around the second metatarsal. Interroseus muscle is partly resected and the rest is displaced plantarward by the suture.
    3. The intermemtarsal cerclage sutures are tied dorsally.
    4. Nurse's hand squeezing on the forefoot is always good enough.
    5. Yes, I always check the correction with an AP view x-ray intra-operatively.
    6. Orthowedge by Darco is working out very well.
    7. The best approach is an animal study. So that it can be sacrificed for histology examination.
    8. Unfortunately, the hospital where I worked did not approve professional filming in the operating room.

    Daniel
     
  26. Dieter Fellner

    Dieter Fellner Well-Known Member

    Re: Syndesmosis Procedure

    Daniel,

    Thank you for this prompt and helpful response. Perhaps there can be an opportunity at some time for a cadaveric filmed presentation.
     
  27. Dieter Fellner

    Dieter Fellner Well-Known Member

    Re: Syndesmosis Procedure

    Daniel:

    couple more questions, if you please:

    1. Since you first started, have you changed your incisional approach? Can you please describe your preferred incision.
    2. Is there any subperiosteal dissection or do you leave the metatarsal periosteum intact save for the fish scaling elevation.
    3. Apart from the lateral 1st MTPJ release, neither capsule is violated. Correct?
    4. Do you ever violate the deep transverse Intermetatarsal ligament?
    5. Currently for how long are you keeping the patient in the Darco shoe?
    6. Any updates on orthobiologic products to enhance the process?
    7. Are there opportunities to visit to see the operation performed?

    Many thanks,
     
  28. danielywu

    danielywu Active Member

    Re: Syndesmosis Procedure

    To help clarify technical components of Dr Wu's procedure I would like to invite answers for the following questions:

    1. What size drill bit for the first metatarsal holes?
    2. After drilling the first metatarsal holes, how do you pass the suture
    across the second metatarsal? For example, do you use a suture passer, and
    is the suture passed over the second interspace intrinsic muscles, or deep,
    via a pocket to encircle only the bone? Or perhaps it doesn't make a
    difference.
    3. Where do you tie the suture?
    4. Are you using bone reduction forceps to hold the reduction while tying?
    5. Are you using fluoroscopy to confirm the position before tying?
    6. How is the forefoot offloading shoe working out?
    7. In your recent article you mention the exact nature of the tissue formed
    by periosteal elevation needs to be determined. Do you have any thoughts how this might be approached?
    8. A picture is worth a thousand words. There are very few active proponents of this operation to learn from. An intra-operative video will be invaluable!

    Many thanks!

    __________________

    Dr. DJ Fellner DPM



    Dear Dieter:

    I am more than happy to answer your technical questions and thank you for posting them on a forum for others who may or may not have the same questions to learn more about the "syndesmosis procedure". I hope my experience can be helpful to you.

    1. I use a 2mm drill bit
    2. I use free needles to pass the sutures. A straight one through the first metatarsal holes and a curved one around the second metatarsal. Interroseus muscle is partly resected and the rest is displaced plantarward by the suture.
    3. The intermemtarsal cerclage sutures are tied dorsally.
    4. Nurse's hand squeezing on the forefoot is always good enough.
    5. Yes, I always check the correction with an AP view x-ray intra-operatively.
    6. Orthowedge by Darco is working out very well.
    7. The best approach is an animal study. So that it can be sacrificed for histology examination.
    8. Unfortunately, the hospital where I worked did not approve professional filming in the operating room.

    Daniel



    Daniel,

    Thank you for this prompt and helpful response. Perhaps there can be an opportunity at some time for a cadaveric filmed presentation.

    __________________

    Dr. DJ Fellner DPM


    Dear Dieter:

    I wish I had access to a cadaver for just one foot. Hopefully, teaching institutions will one day pick up my trail. I do have a very simple animation to illustrate the essence of syndesmosis procedure. You can find it on my website www.bunioncenter.com or Youtube.

    Daniel




    Daniel:

    couple more questions, if you please:

    1. Since you first started, have you changed your incisional approach? Can you please describe your preferred incision.
    2. Is there any subperiosteal dissection or do you leave the metatarsal periosteum intact save for the fish scaling elevation.
    3. Apart from the lateral 1st MTPJ release, neither capsule is violated. Correct?
    4. Do you ever violate the deep transverse Intermetatarsal ligament?
    5. Currently for how long are you keeping the patient in the Darco shoe?
    6. Any updates on orthobiologic products to enhance the process?
    7. Are there opportunities to visit to see the operation performed?

    Many thanks,

    __________________

    Dr. DJ Fellner DPM



    Dear Dieter:
    I am glad that your program director has finally approved your research project proposal on the syndesmosis procedure and as my post of Jan 26 you are still welcome to spend any time with me in Hong Kong. Following are answers to your further questioning.
    1. My incisions are still the same as described by Pagella. I believe you have his article.
    2. Yes, subperiosteally. Details in my FAI article.
    3. Correct. Also detailed in the same.
    4. No.
    5. Three months.
    6. I have tried both PRP and PRF (Platelet Rich Fibrin) with no conclusive data for or against them.
    7. To maximize your experience, I would recommend the following readings to help you understand why hallux valgus is a soft tissue issue? what has gone wrong? why bones are mostly innocent, and ponder the reasons why plantar pressure studies have demonstrated that most osteotomy procedures could not restore hallux function?
    a. Stainsby GD. Pathological anatomy and dynamic effect of the displaced plantar plate and the importance of the integrity of the plantar plate-deep transverse metatarsal ligament tie-bar. Ann R Coll Surg Engl. 1997;79:58-68.
    b. Irwin LR, Cape J. Intermetatarsal osteodesis: a fresh approach to hallux valgus. Foot. 1999;9:93-98.
    c. Wu DY. Syndesmosis procedure: a non-osteotomy approach to metatarsus primus varus correction. Foot Ankle Int. 2007;28:1000-1006.
    d. Dhukaram V, Hullin MG, Senthil Kumar C. The Mitchell and Scarf osteotomies for hallux valgus correction: a retrospective, comparative analysis using plantar pressures. J Foot Ankle Surg 2006;45-6:400-9
    e. Kernozek TW, Sterriker SA. Chevron (Austin) distal metatarsal osteotomy for hallux valgus: comparison of pre- and post-surgical characteristics. Foot Ankle Int 2002;23-6:503-8.
    f. Syndesmosis procedure for the treatment of hallux valgus
    Good clinical and radiological results two years post-operatively
    D. W. C. Wong, D. Y. Wu, MD, H. S. Man, A. K. L. Leung
    Bone Joint J 2014 Apr;96-B (4):502–7.
    g. My website: www.bunioncenter.com

    Daniel
     
  29. danielywu

    danielywu Active Member

    Re: Syndesmosis Procedure

    Dear Dieter:
    I hope you don’t mind that I have moved our current conversation to my own thread under the same title of “Syndesmosis Procedure” where we had much discussion of bunion surgery and exchange of opinions with Steve. It contains so much more information and material for others to learn about the “syndesmosis procedure” and hopefully also benefit from. Let’s carry on there instead, please.
    Daniel
     
  30. Dieter Fellner

    Dieter Fellner Well-Known Member

    Re: Syndesmosis Procedure

    Daniel:

    Thank you for sharing and confirming my understanding. I have previously reviewed the articles. The listing is useful for those interested in following up. There is a relative paucity of available material. I feel that I now have a reasonably comprehensive grasp of the principles and technique.

    I recently had the opportunity to present my project during Grand Rounds.
    The proposal was met with interest and enthusiasm. My next objective is to accept your generous invitation and arrange a visit.

    Cordially,
     
  31. danielywu

    danielywu Active Member

    Re: Syndesmosis Procedure

    Dieter:

    Good, let me know whenever you can come over.

    Daniel
     
  32. Dieter Fellner

    Dieter Fellner Well-Known Member

    Re: Syndesmosis Procedure

    Daniel:

    I am ready, please see e-mail for travel itinerary

    Dieter
     
  33. danielywu

    danielywu Active Member

    Re: Syndesmosis Procedure

    Hi, Dieter:

    I look forward to meeting you in October. My office and staff are at your disposal for any help to make your visit most productive.

    Daniel
     
  34. Dieter Fellner

    Dieter Fellner Well-Known Member

    Re: Syndesmosis Procedure

    Daniel:

    Thank you for your gracious invitation. The flight is booked. I am looking forward to the occasion.

    Dieter
     
  35. drsarbes

    drsarbes Well-Known Member

    Re: Syndesmosis Procedure

    3 months in the Darco shoe?
    That seems a bit long for a post operative period, don't you think?
     
  36. Dieter Fellner

    Dieter Fellner Well-Known Member

    Re: Syndesmosis Procedure

    Steve,

    It does seem a little long, NYminute! It is a deviation from those original articles cited above. However, Dr. Wu mentions that it is difficult to predict objectively when the syndesmosis has "matured". A patient may do well over much shorter time frame. Possibly Dr Wu is erring on the side of caution. Also, perhaps there is room to discover bio-adjuvants to expedite the syndesmosis synthesis more predictably.

    Dieter
     
  37. danielywu

    danielywu Active Member

    Re: Syndesmosis Procedure

    Indeed, 3 months is not short and it has turned off many patients and surgeons alike. But if considering everything is relative, it is actually a bargain for what it can deliver.
    Gratefully, Dieter will be able to give us his objective opinions of two vastly different approaches soon.

    Daniel
     
  38. Dieter Fellner

    Dieter Fellner Well-Known Member

    Re: Syndesmosis Procedure

    I have discussed and debated with Dr. Wu, for more than two years. The time for talk is over. Airborn for 15+ hours, Flight CX 899, Cathay Pacific touched down on Hong Kong Soil on Wednesday October 22, 2014.

    Next morning, Thursday, I make my way from the hotel to Leighton Center. The building itself a few minutes from Hong Kong's Times Square. A short 10 minute walk. I find Dr. Wu's office on the 8th floor where I am greeted enthusiastically by his staff. I am a little early. This provides an opportunity for a tour of the facility. The suite is pleasant and light. In addition to the waiting room there is the consulting room, another office, a Physical Therapy room, a treatment room, a digital XR room, and a gait lab with treadmill and F-scan.

    Rachel, Dr. Wu's registered nurse, kindly offers a glass of water. A welcome refreshment. It's still a balmy 80 degrees and humid. I am provided a white coat, complete with name tag.

    Soon the waiting room begins to fill with patients. After a short while, Dr. Wu arrives. I arise from my chair and we shake hands. First impressions count. Dr. Wu is a genuinly warm, affable human being. Sincere, passionate about his work, and unwavering in his belief. I expected no less, after our extensive discussions. The time has come to see for myself. As they say: " the proof of the pudding is in the eating"
     
  39. Dieter Fellner

    Dieter Fellner Well-Known Member

    Re: Syndesmosis Procedure

    At this time, I would draw the reader's attention to the most recent peer reviewed publication by Dr. Wu:

    Osteodesis for Hallux Valgus Correction: Is it Effective?
    Wu DY, Lam KF.
    Clin Orthop Relat Res. 2014 Oct 28


    The terms 'syndesmosis' and 'osteodesis' are used interchangeably.

    I will be posting further updates on my 'Hong Kong' experience, next week,after my return from HK, to New York city.
     
  40. danielywu

    danielywu Active Member

    Re: Syndesmosis Procedure

    Osteodesis is the original name of the procedure given by its Italian authors more than 50 years ago. I have renamed it to “syndesmosis” procedure to better reflect the fundamental concept of this procedure which is to create a new syndesmosis-like fibrous bonding/connection between the first and second metatarsals and so to specifically provide a means to help stabilize the first metatarsus and prevent metatarsus primus varus recurrence.
    This double-goal approach of first metatarsal re-alignment (deformity correction) and re-stabilization (recurrence prevention) is not new or different from the Lapidus procedure, but without sacrificing a normal metatarsocuneiform joint.
    Can syndesmosis procedure deliver such an ideal scenario? Dieter will tell in due course from his observations in Hong Kong.
    Discussion with like-minded Dieter was truly a pleasure. His endeavor to look for truth was enviable. I hope his trip was valuable and worthwhile. May more inquisitive minds join him.
    Dr. Daniel Wu
     
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