Chevron Osteotomy

NewsBot · Nov 16, 2023

A Modified 90-Degree Distal Chevron Metatarsal Osteotomy for Correcting Moderate Hallux Valgus Deformity
Min Gyu Kyung et al
J Clin Med. 2023 Nov 2;12(21):6902.

Various modifications of distal chevron metatarsal osteotomy (DCMO) have been introduced for correcting moderate hallux valgus deformity; however, the amount of correction may be limited, and complications, such as the recurrence of the deformity and avascular necrosis of the metatarsal head, have been a problem. This study aimed to present a modified 90-degree DCMO technique that overcomes the previously reported shortcomings and to report a successful short-term radiographic outcome. Sixty-eight consecutive patients who underwent the operation with our modified DCMO technique and twenty-two consecutive patients with the conventional DCMO technique (control group) were retrospectively analyzed. The radiographic measurements were evaluated preoperatively, at two months post operation, and at the final follow-up. Both groups showed a significant correction of the hallux valgus angle, first-second intermetatarsal angle, distal metatarsal articular angle, and sesamoid position at the final follow-up, while the amount of correction was significantly greater in the modified DCMO group. In both groups, there were no cases of complications such as avascular necrosis of the metatarsal head, nonunion, and surgical site infection appearing throughout the follow-up period. Therefore, the modified 90-degree DCMO technique is effective and safe, which could serve as a favorable option to treat moderate hallux valgus deformity.
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NewsBot · Dec 26, 2023

Surgical Insights and Complications of Third-generation Minimally Invasive Chevron Akin Osteotomy for Hallux Valgus
McCann, Julia A. et al
Techniques in Foot & Ankle Surgery ():10.1097/BTF.0000000000000403, December 8, 2023. | DOI: 10.1097/BTF.0000000000000403

Minimally invasive bunion correction is an increasingly popular surgical technique to address hallux valgus deformity. Though some complications are decreased compared with open procedures, there are still notable preventable and unavoidable complications associated with these procedures. This paper serves as a review of complications and adverse events encountered with third-generation minimally invasive Chevron and Akin osteotomy procedures, as well as how to avoid and mitigate these adverse outcomes.
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NewsBot · Feb 11, 2024

Radiographic comparison of open and minimally invasive distal chevron metatarsal osteotomy in patients with Hallux valgus
Joohak Kim et al
January 26, 2024

This study aimed to compare radiographic outcomes of open and minimally invasive surgery (MIS) in patients with hallux valgus. We reviewed data of patients with hallux valgus who underwent open or minimally invasive distal chevron osteotomy at our institution. Radiographic assessment was completed preoperatively, immediate postoperatively, and one year postoperatively using eight weight bearing parameters . The classic distal chevron osteotomy method was used for open surgery and a modified method that added percutaneous K-wire fixation to the minimal invasive Chevron-Akin(third-generation MIS) was used for correction of the distal metatarsal articular angle(DMAA). A total of 65 feet (33 open surgeries and 32 MIS) were included. The HVA, IMA, and DMAA improved significantly following surgery regardless of surgical method (p<0.001). Other radiographic indicators showed no statistically significant differences after surgery. DMAA improved by 71.0±14.2% after surgery, and the open surgery group showed less significant reduction in DMAA (49.7±25.7%, p<0.001). Other parameters showed no difference between the two groups regarding relative postoperative changes. The MIS group showed shorter operation time(p<0.001) and hospitalization period(p=0.034) than did the open surgery group. Therefore, the MIS group is expected to be cost-effective. Radiographic measurements revealed comparable outcomes of MIS compared with open surgery. Additionally, adding percutaneous K-wire fixation during MIS had an advantage in correcting DMAA compared with open surgery. Furthermore, the correction of DMAA could reduce recurrence of valgus deformity of the hallux.
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NewsBot · Feb 26, 2024

Does the Presence of Asymptomatic Flatfoot Deformity Impact the Clinical and Radiographic Outcomes of the Minimally Invasive Chevron and Akin Bunionectomy?
Rami Mizher et al
Foot Ankle Int. 2024 Jan 28

Background: Flatfoot deformity is believed to play a role in hallux valgus development and recurrence. While symptomatic flatfoot deformity can be treated with separate procedures at the time of hallux valgus correction, the question remains whether the patient undergoing correction of a symptomatic hallux valgus deformity should have their asymptomatic flatfoot concurrently addressed. We aimed to investigate whether the presence of asymptomatic flatfoot influences patient-reported and radiographic outcomes of the minimally invasive chevron and Akin bunionectomy.

Methods: A total of 104 patients were included in this study. Forty-two asymptomatic patients met the radiographic criteria for flatfoot while 62 had a normal arch. Patient-reported outcomes were evaluated and compared between the two groups using validated PROMIS measures preoperatively and at a minimum one-year postoperatively. Radiographic outcomes including hallux valgus angle (HVA), intermetatarsal angle (IMA), Meary's angle, calcaneal pitch (CP), and talonavicular coverage angle (TNCA) were measured and compared preoperatively and minimum six-months postoperatively.

Results: Both groups demonstrated similar preoperative and postoperative PROMIS scores with significant improvements in physical function, pain interference, pain intensity, and global physical health. Preoperatively, HVA was similar between both groups, however the flatfoot group showed a greater IMA, Meary's angle, TNCA, and lower CP. Postoperatively, HVA and IMA were similar between groups, although patients in the flatfoot group retained a significantly greater Meary's angle, TNCA, and lower CP. Both groups showed significant improvements in HVA, IMA, and TNCA.

Conclusion: Our study indicates that the minimally invasive chevron and Akin bunionectomy leads to improved clinical and radiographic hallux valgus outcomes without adversely impacting radiographic flatfoot parameters. Therefore, the MIS bunionectomy may be an effective option for hallux valgus correction in patients with mild, asymptomatic flatfoot
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NewsBot · Mar 6, 2024

Improvement of Valgus Deviation of the Lesser Toes of Moderate to Severe Hallux Valgus After Proximal Chevron Metatarsal Osteotomy and Akin Osteotomy
Hwa Jun Kang et al
Foot Ankle Int. 2024 Feb 13

Background: This study examines the correction of lesser toe valgus deviation following proximal chevron metatarsal osteotomy (PCMO) and Akin osteotomy in moderate to severe hallux valgus patients, while identifying influencing factors.

Method: Among 89 patients (116 feet), those with moderate to severe hallux valgus underwent PCMO and Akin osteotomy. Radiologic assessments included preoperative metatarsus adductus angle (MAA), hallux valgus angle (HVA), intermetatarsal angle (IMA), valgus angles of the second to fourth metatarsophalangeal joints, and hallux valgus recurrence. Assessments included visual analog scale (VAS) pain scores, American Orthopaedic Foot & Ankle Society (AOFAS) scores, and patient satisfaction over an average follow-up of 30.6 ± 21.2 (range, 12-99) months.

Results: The mean preoperative HVA of 34.4 degrees decreased to 8.7 degrees at final follow-up. The valgus angles of the second, third, and fourth toes improved by 37.1%, 27%, and 44.5%, respectively. In metatarsus adductus patients, lesser toe valgus angles were significantly higher both preoperatively and at final follow-up. Hallux valgus recurrence patients had higher preoperative and final follow-up IMA and valgus angles in the second and third toes. Nonrecurrence patients showed greater decreases in these angles. A larger HVA correction corresponded to a greater decrease in lesser toe valgus deviation. VAS and AOFAS scores improved significantly at the last follow-up.

Conclusion: The study found a significant reduction in the valgus angle of the second, third, and fourth toes after PCMO and Akin osteotomy in moderate to severe hallux valgus cases, without additional surgeries on lesser toes. The lesser toe angular reductions were less pronounced in patients with metatarsus adductus or with hallux valgus recurrence.
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NewsBot · May 23, 2024

MICA Procedure vs Open Chevron Osteotomy for Hallux Valgus Correction: A Prospective Cohort Study
Vinay V. Balesar et al
Source

Background:
Currently, more than 150 surgical techniques have been described for the treatment of hallux valgus. The abundance of techniques indicates that there is no technique that has been designated as a gold standard. In recent years, a particular interest in the use of minimally invasive techniques has grown. The aim of this study was to prospectively compare clinical, radiologic, and postoperative outcomes between the MICA technique and open chevron technique over a 1-year follow-up period.
Methods:
Between January 2016 and August 2020, data were prospectively collected from consecutive patients preoperatively and at 6 weeks, 3 months, and 12 months following minimally invasive chevron and Akin (MICA) or open chevron osteotomies. Radiographic outcomes were measured using weightbearing radiographs preoperatively and at 3 and 12 months postoperatively. Clinical outcomes were measured using the American Orthopaedic Foot & Ankle Society (AOFAS), Manchester-Oxford Foot Questionnaire (MOXFQ), VAS (visual analog scale), Foot Function Index (FFI), Foot and Ankle Outcome Score (FAOS), and Euro-QoL-5D (EQ5D) questionnaires.
Results:
Of the 68 patients, 42 patients (62%) underwent a MICA surgery and 26 patients (38%) underwent open chevron osteotomy. Both groups showed significant improvement in HVA, IMA, and DMAA at the 1-year follow-up. Our findings show that both clinical and radiologic outcomes of the MICA technique are comparable to the conventional open technique. No significant differences were found in clinical outcomes (VAS, AOFAS, MOXFQ, FFI, and FAOS), complication rate, and operative times.
Conclusion:
These results show that MICA is a safe alternative for chevron osteotomy. The clinical and radiologic outcomes of these 2 techniques by 12 months are comparable.
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NewsBot · Jun 8, 2024

Percutaneous distal chevron osteotomy is associated with lower immediate postoperative pain and a greater range of motion than the open technique: A prospective randomized study
Hangseob Yoon et al
Int Orthop. 2024 Jun 5

Purpose: The results of past studies comparing percutaneous techniques with traditional open techniques for hallux valgus are controversial. Therefore, this study aimed to compare the radiologic and clinical outcomes of percutaneous and open distal chevron osteotomies.

Methods: Seventy-one patients with mild to severe hallux valgus deformity were randomized to undergo percutaneous distal chevron osteotomy (percutaneous group, n = 36) or open distal chevron osteotomy (open group, n = 35) between October 2019 and September 2020. Radiological and clinical outcomes were assessed preoperatively and postoperatively. Outcome measures included the foot and ankle outcome score, foot functional index, visual analogue scale (VAS) scores for pain, range of motion (ROM) of the first metatarsophalangeal (MTP) joint, hallux valgus angle, intermetatarsal angle, and first metatarsal shortening. Additionally, the first metatarsal declination angle was measured to evaluate sagittal malunion.

Results: The mean first metatarsal declination angle decreased significantly at 12 months postoperatively in both groups (p = 0.021 and p < 0.001 in the percutaneous and open groups, respectively), and the decrement was significantly greater in the open group (p = 0.033). The mean VAS score for pain on postoperative day one was 4.2 ± 1.9 and 5.3 ± 1.7 in the percutaneous and open groups, respectively (p = 0.019). The mean ROM of the first MTP joint did not change significantly after surgery, from 72.5 ± 7.5 preoperatively to 71.0 ± 9.5 at 12 months postoperatively in the percutaneous group (p = 0.215); however, it decreased significantly from 70.6 ± 7.3 preoperatively to 63.4 ± 10.4 at 12 months postoperatively in the open group (p < 0.001). There were no significant differences between the groups regarding other clinical outcomes.

Conclusion: The percutaneous group showed a lower immediate pain level at postoperative day 1 and better ROM of the first MTP joint at 12 months postoperatively.
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NewsBot · Sep 23, 2024

Chevron osteotomy and scarf osteotomy for hallux valgus angle and intermetatarsal angle correction: a systematic review and meta-analysis of randomized controlled trials
Yu-Ning Peng et al
J Orthop Surg Res. 2024 Sep 14;19(1):566

Background: This systematic review and meta-analysis aimed to investigate the differences in hallux valgus angle (HVA), intermetatarsal angle (IMA), American Orthopedic Foot and Ankle Society (AOFAS) scores, and complication rates between chevron osteotomy and scarf osteotomy for correcting hallux valgus.

Methods: Two investigators independently searched for randomized controlled trials (RCTs) published from 2007 to 2018 on PubMed, Web of Science, and Cochrane Library databases. Next, chevron and scarf osteotomies were compared for their postoperative outcomes using HVA, IMA, and AOFAS scores and their complication rates. Meta-analysis was performed using Review Manager (version 5.3).

Results: Six RCTs-comprising 507 feet, of which 261 and 246 underwent chevron and scarf osteotomies, respectively-were included. The meta-analysis revealed that chevron osteotomy led to significantly smaller postoperative HVAs than scarf osteotomy (weighted mean difference [WMD] = -1.94, 95% CI = - 2.65 to - 1.29, P < .00001). However, the differences in postoperative IMA (WMD = - 0.44, 95% CI = - 1.10 to 0.22, P = .19), postoperative AOFAS scores (WMD = 0.75; 95% CI = - 5.32 to 6.82; P = .81), and complication rates (risk ratio = 1.22, 95% CI = 0.65-2.27, P = .53) between feet that underwent chevron and scarf osteotomies were nonsignificant.

Conclusions: Compared with scarf osteotomy, chevron osteotomy had significantly more favorable postoperative outcomes in terms of HVA correction, but not in terms of IMA, AOFAS scores, or complication rates.
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NewsBot · Sep 28, 2024

Minimally invasive chevron and Akin osteotomy may be effective for hallux valgus deformity

NewsBot · Sep 30, 2024

Early effectiveness of modified minimally invasive Chevron-Akin osteotomy for moderate to severe hallux valgus
Songbai Wang et al
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2024 Sep 15;38(9):1047-1054

Objective: To explore early effectiveness of modified minimally invasive Chevron-Akin (MICA) osteotomy in the treatment of moderate to severe hallux valgus.

Methods: A clinical data of 49 patients (61 feet) with moderate to severe hallux valgus, who met the selection criteria between December 2019 and October 2022, was retrospectively analyzed. There were 7 males (8 feet) and 42 females (53 feet) with an average age of 38.0 years (range, 15-59 years), including 37 of unilateral foot and 12 of bilateral feet. There were 41 feet of moderate hallux valgus [hallux valgus angle (HVA) 20°-40°] and 10 feet of severe hallux valgus (HVA>40°). All patients underwent modified MICA osteotomy. A transverse osteotomy on the distal end of the first metatarsal bone was performed to replaced the traditional Chevron osteotomy, and three Kirschner wires were used to assist in three-dimensional correction. The other treatments were the same as traditional MICA osteotomy. The HVA, inter metatarsal angle (IMA), Hardy score of the sesamoid, and American Orthopaedic Foot and Ankle Society (AOFAS) score of 61 feet before operation and at last follow-up were recorded, and the results were compared between the various severity of hallux valgus.

Results: All patients were followed up 6-24 months with an average of 12.0 months. After operation, the redness and swelling around the incision occurred in 1 foot; limited mobility of the metatarsophalangeal joint occurred in 2 feet; mild numbness of the skin occurred in 5 feet; mild inversion of the great toe occurred in 2 feet. No complication such as tendon injury was found. X-ray films showed no abnormal healing, nonunion, or necrosis of the metatarsal head after osteotomy. The healing time of osteotomy ranged from 3 to 4 months, with an average of 3.2 months. At last follow-up, the HVA, IMA, Hardy score of sesamoid, and AOFAS scores all significantly improved when compared with preoperative levels ( P<0.05). The AOFAS scores were excellent in 45 feet, good in 15 feet, and fair in 1 foot, with an excellent and good rate of 98.4%. The above indicators for moderate or severe hallux valgus patients were significantly improved when compared with preoperative levels ( P<0.05). The changes between pre- and post-operation in HVA, IMA, and Hardy scores of severe hallux valgus were all greater than those of moderate hallux valgus, with significant difference in HVA change between groups ( P<0.05), while there was no significant difference in the other two changes ( P>0.05).

Conclusion: Modified MICA osteotomy can achieve good orthopedic effects and early functional improvement in the treatment of moderate to severe hallux valgus.
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NewsBot · Oct 17, 2024

Radiological results of Johnson’s modified chevron osteotomy to address hallux valgus
J.E. Martínez Jiménez, et al
Source

Purpose. The purpose of this study was to asses the radiological results obtained further to chevron osteotomy of the first metatarsal for the treatment of hallux valgus. Materials and methods. The sample consists of 24 consecutive patients (27 feet) of whom 21 were female and 3 male, with a mean age of 44.4 years. In all cases weight-bearing radiographs were made on which the following angles were measured both preoperatively and at the end of follow-up: metatarsal-phalangeal (MTP), intermetatarsal (M1-M2), the M1-M5 angle and the distal metatarsal articular angle (DMAA). Likewise, the relative length of the first metatarsal and the position of the sesamoid bones were measured by means of standardized methods. Results. There were not any significant complications. Average follow-up was 3 months (range: 6-50). The procedure managed to improve all angles considerably (p= 0.01). Shortening of the first metatarsal was 0.018 (1.8%). As regards sesamoid displacement, a substantial improvement was obtained vis-à-vis the preoperative situation, with 96.2% of results in the G-0 and G-1 range (displacement 0%-50%). Conclusions. Chevron osteotomy has shown to be an effective method to correct hallux valgus-associated angle deformities in the mid-moderate range, including DMAA angle, which a minimal shortening of the first metatarsal.
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NewsBot · Oct 19, 2024

A Systematic Review of Osteotomies to Correct Hallux Valgus in the First Metatarsal
M. Santos et al
Appl. Sci. 2024, 14(7), 3043; https://doi.org/10.3390/app14073043

Hallux valgus is one of the most common deformities of the forefoot. When addressing hallux valgus, surgical management plays a central role, with the majority of techniques consisting of cutting (osteotomy) and reshaping the overall anatomy of the metatarsal and phalanx. Understanding and analyzing the results of many osteotomies to treat hallux valgus is essential. This systematic review aims to summarize a structure of the different practices used through osteotomies to correct hallux valgus in the metatarsal, the results obtained, and the methodologies used to provide a follow-up. This systematic search was carried out using three databases: the National Library of Medicine, Science Direct, and Sage Journals. This research mainly focused on analyzing the outcomes and post-operative results of the various osteotomies of the first metatarsal manuscripts that addressed more than just the procedure analysis or its results, which were excluded, as in the case of combined pathologies. Fifteen manuscripts were included for full-text analysis based on comparative/explanatory studies of surgical procedures for hallux valgus metatarsal osteotomies and their clinical outcomes. The clinical results were analyzed in two aspects: the dimensional analysis of the metatarsal before and after the surgical procedure and the technologies used to obtain the follow-up. This review will guide future research into the more comprehensive use of the metatarsal osteotomy process and where engineering can and should intervene and make the procedures more precise and straightforward.
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NewsBot · Oct 29, 2024

Comparison of third-generation minimally invasive surgery, split-drill osteotomy, and triplanar chevron osteotomy for treating mild to moderate hallux valgus with metatarsalgia in middle-aged women: An observational study
Jianming Cao et al
Medicine (Baltimore). 2024 Oct 11;103(41)

This retrospective study compared the clinical efficacy of third-generation minimally invasive surgery (3rd-MIS) split-drill osteotomy with soft tissue release to that of triplanar chevron osteotomy (TCO) for treating mild to moderate hallux valgus (HV) with metatarsalgia in middle-aged women. This study compared the efficacy of 3rd-MIS using split-drill osteotomy to that of TCO in treating mild to moderate HV with metatarsalgia in 52 middle-aged women from March 2022 to June 2023. Retrospectively analyzing a total of 52 patients (26 patients per group), we employed 2 distinct surgical methods across 2 groups in this study: the TCO group received a traditional TCO accompanied by soft tissue release, whereas the MIS group underwent a split-drill osteotomy with soft tissue release. The study compared the operation time, onset of weight-bearing, osteotomy healing, blood loss, pre- and postsurgery X-ray measurements, metatarsalgia, and foot function scores. In the TCO group, complications included peri-incisional numbness, elevation of the first metatarsal head with metatarsalgia, and bone hyperplasia with stiffness at the MTPJ in one patient each. In the MIS group, bunions were successfully corrected without significant complications like bone nonunion or avascular necrosis of the metatarsal head, and the metatarsal length was preserved. Significant differences in operation time, weight-bearing onset, healing, and blood loss were detected between groups (P < .05). Preoperatively, there were no significant differences in hallux valgus angle, 1-2 intermetatarsal angle, or distal metatarsal articular angle among the groups (P > .05). Nonetheless, notable postoperative differences were observed (P < .05). Foot function and pain scores, assessed by the American Orthopaedic Foot & Ankle Society and the Visual Analogue Scale, showed significant improvements in both groups following surgery. Both surgical techniques effectively corrected the HV angle without significant changes in the first metatarsal length. The MIS group experienced significantly less pain on the second day postsurgery, as indicated by lower Visual Analogue Scale scores (P < .05). Both techniques were similarly effective in treating metatarsalgia. 3rd-MIS split-drill osteotomy with soft tissue release offers several advantages over TCO techniques for treating mild to moderate HV with metatarsalgia in middle-aged women, such as reduced trauma, quicker healing, smaller scars, and less pain after surgery.
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NewsBot · Nov 16, 2024

Complication Rates of Minimally Invasive Chevron Osteotomy for Correction of Hallux Abductovalgus: A Systematic Review
Chalen Yang et al
J Am Podiatr Med Assoc. 2024 Sep-Oct;114(5):22-067

Background: Recent advancements in minimally invasive surgery for correction of hallux abductovalgus has increased the popularity of this technique. To date, the incidence of complications with this updated technique has not been evaluated.

Methods: The purpose of this systematic review was to determine the incidence of complications of third-generation minimally invasive chevron osteotomy, with or without an Akin osteotomy, for the correction of hallux abductovalgus. We conducted a systematic review of electronic databases and relevant peer-reviewed sources as outlined by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for the preparation of systematic reviews. Studies that reported hallux abductovalgus deformities corrected with minimally invasive surgery and fixated with one or two screws, provided detailed descriptions of all complications, and had mean follow-up of 12 months or more were included.

Results: Of 80 studies identified, nine (11.25%) met the inclusion criteria (N = 766 feet). Three of these studies were prospective and involved 426 feet. The weighted mean age for the entire cohort was 50.88 years (17-87 years), and the weighted mean follow-up was 27.65 months (12-66 months). The total incidence of complications was 21.28% (163 of 766 feet). Among the most reported complications were reoperation, postoperative infection, reoccurrence of hallux abductovalgus, and nerve injury.

Conclusions: This systematic review revealed that this updated minimally invasive surgery technique provides a safe and reproducible surgical option to correct hallux abductovalgus deformities, with an incidence of complications comparable with that of open correction for this forefoot deformity.
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NewsBot · Nov 29, 2024

Anatomical and Micro-CT Assessment of the First Metatarsal Head Vascularization and Soft Tissue Envelope Following Minimally Invasive Chevron Osteotomy for Hallux Valgus Deformity
Kepler Alencar Mendes de Carvalho et al
Foot Ankle Int. 2024 Nov 29

Background: Minimally invasive surgical (MIS) chevron-type osteotomy for hallux valgus (HV) treatment offers a surgical alternative to open surgery with minimal surgical dissection and a hypothetical decreased risk for soft tissue complications. The objectives of this study were to assess the incidence of injuries to the soft tissue envelope and to the blood supply of the first metatarsal head through gross dissection and, using micro-computed tomography (micro-CT), to identify the safe position to perform the MIS chevron-type osteotomy of the first metatarsal head based on the anatomical data.

Methods: Twenty cadaveric specimens with HV were used for the study. Seven specimens were perfused with a low-viscosity radiopaque polymer preoperatively. All specimens underwent MIS chevron-type osteotomy executed using a 20 × 2-mm Shannon burr at the metatarsal neck's flare. Anatomical dissection of all specimens was then performed to assess macroscopic injury to the first metatarsal head complex soft tissue structures and blood supply. The 7 specimens that were preinjected then underwent micro-CT assessment to assess the first metatarsal head blood supply.

Results: Two soft tissue injuries in 2 cadavers were identified, including a 2-mm injury to the flexor hallucis brevis in one specimen and a 1-mm injury to the dorsomedial nerve. No arterial injuries were identified in either the gross dissection or micro-CT imaging. Micro-CT has pinpointed a secure location to complete the chevron-type osteotomy. We found that finalizing the dorsal arm of the MIS chevron-type osteotomy at a median distance of 25.6 mm, and the plantar arm at 23.9 mm from the most distal point of the first metatarsal head, ensured safety in the specimens we used.

Conclusion: As tested in this cadaveric study on 20 specimens, the MIS chevron-type osteotomy procedure preserved the soft tissue envelope of the first metatarsal head complex and the blood supply of the first metatarsal head, with a low number of injuries. Completing the dorsal arm of the MIS chevron-type osteotomy at a median distance of 25.6 mm, and the plantar arm at 23.9 mm from the furthest point of the first metatarsal head, while ensuring the Shannon burr does not exceed 3.9 mm dorsolaterally and 4.0 mm plantar-laterally from the cortical bone exit point, appeared crucial to avoid vascular damage.
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NewsBot · Dec 2, 2024 at 2:31 AM

Comparative analysis of triplanar Chevron osteotomy (TCO) and Chevron osteotomy (CO) for treating mild to moderate hallux valgus via computer simulation and 3D printing: An observational study
Cao, Jianming MD et al
Medicine 103(48)e40643, November 29, 2024.

Hallux valgus (HV) deformity, which is characterized by lateral deviation and pronation of the metatarsophalangeal joint, demonstrates complex 3-dimensional challenges, thus prompting the development of various surgical approaches, including traditional Chevron osteotomy (CO) and novel triplanar Chevron osteotomy (TCO). The objective of this study is to determine TCO at various tilt angles by employing 3D printing for ex vivo osteotomy angle simulations and computer modeling to correct deformities across 3 planes, thus aiming to enhance surgical outcomes by preserving or even increasing the length of the first metatarsal and thereby overcoming the limitations of CO. In this study, we collected and analyzed non-weight-bearing CT data from 55 patients (61 feet) with mild-to-moderate hallux valgus, plantar callosities and metatarsalgia from June 2019 to June 2020. The study utilized Mimics software for 3D digital reconstructions and simulation osteotomy of both TCO and CO. For both procedures, the apex was centered at the first metatarsal head, with CO specifically oriented towards the fourth metatarsal head at a 60° angle. The plantar-oblique Chevron osteotomy (POCO) was defined by a 15° plantar tilt, whereas TCO involved a further 9° tilt towards the metatarsal head. The key metrics that were measured included the hallux valgus angle (HVA), 1–2 intermetatarsal angle (IMA), distal metatarsal articular angle (DMAA) and first metatarsal length (FML). Our study aged between 30 and 71 years, with an average age of 47.37 years. Postoperative assessments using Mimics software showed significant improvements in reducing the HVA, IMA, and DMAA after CO and TCO. However, when comparing both techniques, their corrective capacities were roughly equivalent, with no significant differences observed in these metrics. Notably, compared with CO, TCO significantly increased the FML (P < .001), thus suggesting that TCO has greater potential to effectively prevent transfer metatarsalgia. This study underscores the ability of TCO to significantly extend the first metatarsal, with precise adjustments to its distal tilt to tailor deformity corrections. In computational simulation experiments, TCO offers a superior alternative to CO for treating hallux valgus by addressing 3-dimensional deformities and preserving or even increasing FML, thereby preventing transfer metatarsalgia
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Chevron Osteotomy

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Blood Clots after Chevron Osteotomy

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Bunionectomy - Chevron procedure

'MoAkin' biplanar proximal phalanx closing wedge osteotomy

Training Program for Orthopedic Residents in Forefoot Osteotomy Skills:

Bosch osteotomy

Pain developed 4 month after Calcaneal Osteotomy

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Chevron Osteotomy

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Blood Clots after Chevron Osteotomy

Chevron Osteotomy- Bunion Surgery

Bunionectomy - Chevron procedure

'MoAkin' biplanar proximal phalanx closing wedge osteotomy

Training Program for Orthopedic Residents in Forefoot Osteotomy Skills:

Bosch osteotomy

Pain developed 4 month after Calcaneal Osteotomy

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