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Circulatory disturbance of the first metatarsal head after Chevron osteotomy as shown by bone scintigraphy
S Resch1, A Stenström, T Gustafson
1Department of Orthopaedics, University Hospital, Lund, Sweden.
Insights
Chevron osteotomy is a safe hallux valgus treatment. Combining it with adductor tenotomy does not increase the risk of circulatory issues or avascular necrosis in the metatarsal head.
Area of Science:
- Orthopedic surgery
- Foot and ankle surgery
- Surgical anatomy
Background:
- Distal osteotomies, like Chevron osteotomy, carry a risk of circulatory disturbance.
- Avascular necrosis risk is reportedly higher (up to 40%) when combined with adductor tenotomy.
- Recent studies suggest adductor tendon proximity to critical circulation is minimal.
Purpose of the Study:
- To prospectively evaluate the circulatory safety of Chevron osteotomy alone versus combined with adductor tenotomy.
- To assess the risk of avascular necrosis following these surgical procedures.
Main Methods:
- Prospective randomized study of 38 patients (41 feet).
- Patients randomized to Chevron osteotomy alone or with adductor tenotomy.
- Postoperative scintigraphy, X-rays, and clinical exams at 2-9 days; average 19-month follow-up.
Main Results:
- Four cases of circulatory defects identified (3 in osteotomy alone, 1 in combined group).
- No patients experienced symptoms of reduced metatarsal head circulation.
- All defects healed; radiographs showed no signs of necrosis.
Conclusions:
- Chevron osteotomy is a safe surgical option for hallux valgus.
- Combining Chevron osteotomy with adductor tenotomy does not elevate the risk of circulatory disturbance or avascular necrosis.
Abstract:
Distal osteotomies, such as Chevron osteotomies, have a potentially high risk for circulatory disturbance, since they transect part of the circulatory apparatus. An increased risk of up to 40% of avascular necrosis diagnosed radiographically has been reported when the osteotomy is combined with adductor tenotomy. On the other hand, new circulatory studies indicate that the circulation does not go in direct proximity to the adductor tendon. In this prospective study, 38 consecutive patients (41 feet) were randomized to Chevron osteotomy alone or Chevron osteotomy with adductor tenotomy. They were investigated 2 to 9 days postoperatively with 99mTc-methylene diphosphonate scintigraphy as well as x-rays and clinical examination. The average follow up was 19 months (range 12-48 months). Three defects were found in those operated with Chevron osteotomy alone, and one defect was found in a patient operated with Chevron osteotomy and adductor tenotomy. None of the patients had symptoms attributable to reduced circulation of the metatarsal head. Repeat scans showed healing in all four cases. Radiographs failed to show any signs of necrosis. Thus, Chevron osteotomy is a safe method in the treatment of hallux valgus which can be combined with adductor tenotomy without increasing the risk for circulatory disturbance.