Blood Supply to the First Metatarsal Head and Vessels at Risk with a Chevron Osteotomy
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J.J. George Malal, J. Shaw-Dunn and C. Senthil Kumar
The Journal of Bone and Joint Surgery (American). 2007;89:2018-2022.
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Re: Blood vessels at risk with a Chevron Osteotomy
0-20%! I believe the zero, 20% though?
I have done, literally, thousands of chevron (or Austin's) with not a single AVN of the head.
My best guestamation of why surgeons may have problems is that the apex of the osteotomy is too far distal and the angle to large.
Anyone else out there with no real problem with this procedure?
Steve -
Re: Blood vessels at risk with a Chevron Osteotomy
Increased displacement maximizes the utility of the distal chevron osteotomy for hallux valgus deformity correction.
Murawski DE, Beskin JL.
Foot Ankle Int. 2008 Feb;29(2):155-63.
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Re: Blood vessels at risk with a Chevron Osteotomy
If the surgeon runs as high a risk of AVN as 1:5 :confused: is it not fair to to critique the skills of the surgeon, perhaps more so than the procedure ? Any capital osteotomy can produce AVN but I have only ever seen a couple of cases, from another surgeon in 15 + years. My guess is you would need to be astonishingly aggressive and strip a lot of tissue away to produce AVN, as a rule.
The solution is quite simple, isn't it ? Know the anatomy, the principal vessels and avoid / protect.
Dieter -
Re: Blood vessels at risk with a Chevron Osteotomy
Modified chevron osteotomy fixed with stofella pin for hallux valgus.
Kürklü M, Demiralp B, Yurttaş Y, Ciçek EI, Ateşalp AS.
Foot Ankle Int. 2008 May;29(5):478-82
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Re: Blood vessels at risk with a Chevron Osteotomy
Mobility changes of the first ray after hallux valgus surgery: clinical results after proximal metatarsal chevron osteotomy and distal soft tissue procedure.
Kim JY, Park JS, Hwang SK, Young KW, Sung IH
Foot Ankle Int. 2008 May;29(5):468-72
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Re: Blood vessels at risk with a Chevron Osteotomy
Range of motion of the first metatarsophalangeal joint after chevron procedure reinforced by a modified capsuloperiosteal flap.
Ozkurt B, Aktekin CN, Altay M, Belhan O, Tabak Y.
Foot Ankle Int. 2008 Sep;29(9):903-9.
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Re: Blood vessels at risk with a Chevron Osteotomy
The risk of avascular necrosis following chevron osteotomy: a prospective study using bone scintigraphy.
Shariff R, Attar F, Osarumwene D, Siddique R, Attar GD.
Acta Orthop Belg. 2009 Apr;75(2):234-8.
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Re: Blood vessels at risk with a Chevron Osteotomy
No midterm benefit from low intensity pulsed ultrasound after chevron osteotomy for hallux valgus.
Zacherl M, Gruber G, Radl R, Rehak PH, Windhager R.
Ultrasound Med Biol. 2009 Aug;35(8):1290-7. -
Re: Blood vessels at risk with a Chevron Osteotomy
Ninety-degree chevron osteotomy for correction of hallux valgus deformity: clinical data and finite element analysis.
Matzaroglou C, Bougas P, Panagiotopoulos E, Saridis A, Karanikolas M, Kouzoudis D.
Open Orthop J. 2010 Apr 22;4:152-6.
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Re: Blood vessels at risk with a Chevron Osteotomy
The clinical efficacy of treatment on the cases of severe hallux valgus by the first metatarsal basal osteotomy combined with Chevron-Gerbert operation
Chen ZJ, Wang ZY, Wang QP, Zhu GY, Jiang J, Qi YZ, Zeng YF.
Zhonghua Wai Ke Za Zhi. 2010 Nov;48(21):1633-1636.
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Re: Blood vessels at risk with a Chevron Osteotomy
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Re: Blood vessels at risk with a Chevron Osteotomy
Plantar loading after chevron osteotomy combined with postoperative physical therapy.
Schuh R, Adams S, Hofstaetter SG, Krismer M, Trnka HJ.
Foot Ankle Int. 2010 Nov;31(11):980-6.
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Re: Blood vessels at risk with a Chevron Osteotomy
Stabilization of chevron bunionectomy with a capsuloperiosteal flap.
Guclu B, Kaya A, Akan B, Koken M, Kemal Us A.
Foot Ankle Int. 2011 Apr;32(4):414-8.
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Re: Blood vessels at risk with a Chevron Osteotomy
Distal metatarsal osteotomy for hallux varus following surgery for hallux valgus.
Choi KJ, Lee HS, Yoon YS, Park SS, Kim JS, Jeong JJ, Choi YR.
J Bone Joint Surg Br. 2011 Aug;93(8):1079-83.
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Minimally Invasive Chevron Osteotomy; Functional Outcome and Comparison with Open Chevron Osteotomy
Samer S. Morgan, Ibrahim Roushdi, Simon Palmer
Presented at the American Academy of Orthopaedic Surgeons 2012 Annual Meeting. Feb. 7-11. San Francisco.
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Randomized Controlled Trial of Halux Valgus Treated with Medial-opening vs. Chevron Metatarsal Osteotomy
Peter G. Copithorne, Karl Lalond, Timothy R. Daniels, Gordon Boyd, Mark Glazebrook,
Presented at the American Academy of Orthopaedic Surgeons 2012 Annual Meeting. Feb. 7-11. San Francisco.
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Scarf Versus Chevron Osteotomy for the Correction of 1–2 Intermetatarsal Angle in Hallux Valgus: A Systematic Review and Meta-analysis
Simon E. Smith, Karl B. Landorf, Paul A. Butterworth, Hylton B. Menz
Journal of Foot and Ankle Surgery; Article in Press
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Percutaneous distal metatarsal osteotomy versus distal chevron osteotomy for correction of mild-to-moderate hallux valgus deformity.
Radwan YA, Mansour AM.
Arch Orthop Trauma Surg. 2012 Jul 22.
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Comparing proximal and distal metatarsal osteotomy for moderate to severe hallux valgus.
Chuckpaiwong B.
Int Orthop. 2012 Sep 19.
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Outcomes of proximal chevron osteotomy for moderate versus severe hallux valgus deformities.
Moon JY, Lee KB, Seon JK, Moon ES, Jung ST.
Foot Ankle Int. 2012 Aug;33(8):637-43.
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MINIMALLY INVASIVE CHEVRON OSTEOTOMY; FUNCTIONAL OUTCOME AND COMPARISON WITH OPEN CHEVRON OSTEOTOMY
S. Morgan, I. Roushdi, R. Benerjee and S. Palmer
J Bone Joint Surg Br 2012 vol. 94-B no. SUPP XLIII 67
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Chevron Osteotomy of the First Metatarsal Stabilized With an Absorbable Pin
Our 5-year Experience
Alberto Morandi, Emanuele Ungaro, Andrea Fraccia, Valerio Sansone
Foot & Ankle International January 10, 2013 1071100712464956
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Modified chevron osteotomy with lateral release and screw fixation for treatment of severe hallux deformity.
Hofstaetter SG, Schuh R, Trieb K, Trnka HJ.
Z Orthop Unfall. 2012 Dec;150(6):594-600.
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Chevron Osteotomy of the First Metatarsal Stabilized With an Absorbable Pin
Our 5-year Experience
Alberto Morandi, Emanuele Ungaro, Andrea Fraccia, Valerio Sansone,
Foot & Ankle International January 10, 2013 1071100712464956
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Treatment for Hallux Valgus with Chevron Metatarsal Osteotomy in Patients over 60 Years Old.
Jeong BO, Lee SH.
J Korean Foot Ankle Soc. 2012 Dec;16(4):223-228. Korean.
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Plate fixation for proximal chevron osteotomy has greater risk for hallux valgus recurrence than Kirschner wire fixation.
Park CH, Ahn JY, Kim YM, Lee WC.
Int Orthop. 2013 Feb 20
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The chevron osteotomy and avascular necrosis
Matthew Rothwell, James Pickard
The Foot Volume 23, Issue 1 , Pages 34-38, March 2013
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Comparison of outcomes between proximal and distal chevron osteotomy, both with supplementary lateral soft-tissue release, for severe hallux valgus deformity
A prospective randomised controlled trial
H-W. Park et al
Bone Joint J April 2013 vol. 95-B no. 4 510-516
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Percutaneous Chevron; the union of classic stable fixed approach and percutaneous technique
Joel Vernois, David Redfern
Fuß & Sprunggelenk; Available online 4 April 2013
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A comparison of proximal and distal chevron osteotomy for the correction of moderate hallux valgus deformity
C-H. Park et al
Bone Joint J 2013;95-B:649–56
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Axial Loading Screw Fixation for Chevron Type Osteotomies of the Distal First Metatarsal: A Retrospective Outcomes Analysis
Ryan M. Murphy, Lawrence M. Fallat, John P. Kish
Journal of Foot and Ankle Surgery; Article in Press
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Comparison of open lateral release and transarticular lateral release in distal chevron metatarsal osteotomy for hallux valgus correction
Ji Yong Ahn, et al
International Orthopaedics; August 2013
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Comparative Study of Scarf and Extended Chevron Osteotomies for Correction of Hallux Valgus
Bryan G. Vopat, Craig R. Lareau, Julie Johnson, Steven E. Reinert, Christopher W. DiGiovanni
Foot Ankle Spec October 23, 2013
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Comparison of Distal Soft-Tissue Procedures Combined with a Distal Chevron Osteotomy for Moderate to Severe Hallux Valgus: First Web-Space Versus Transarticular Approach
Yu-Bok Park et al
The Journal of Bone & Joint Surgery, Volume 95, Issue 21 -
Long-term outcome of chevron-osteotomy in juvenile hallux valgus
Tanja KRAUS, Georg SINGER, Martin ŠVEHLÍK, Johannes KALTENBACH, Robert EBERL, Wolfgang LINHART
ACTA ORTHOPÆDICA BELGICA 2013, N° 5 (Vol. 79/5) p.552-558
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Long-term outcome of chevron-osteotomy in juvenile hallux valgus.
Kraus T, Singer G, Svehlík M, Kaltenbach J, Eberl R, Linhart W.
Acta Orthop Belg. 2013 Oct;79(5):552-8.
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The Clinical Results of the Proximal Opening Wedge Osteotomy Using a Low Profile Plate in Hallux Valgus: Comparison with Proximal Chevron Osteotomy Fixed with K-wires.
Seo ES, Bang TJ, Jeon SH.
J Korean Foot Ankle Soc. 2013 Dec;17(4):302-308
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Biomechanical analysis of two fixation methods for proximal chevron osteotomy of the first metatarsal
Reinhard Schuh, Jochen Gerhard Hofstaetter, Emir Benca, Madeleine Willegger, Gobert von Skrbensky, Shahin Zandieh, Axel Wanivenhaus, Johannes Holinka, Reinhard Windhager
International Orthopaedics; February 2014
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Clinical Outcomes after Chevron Procedure are Better than Pedobarographic Results
Radu Prejbeanu et al.,
2014, Key Engineering Materials, 601, 177
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