The chevron osteotomy and avascular necrosis

Area of Science:

• Orthopedic surgery
• Podiatric medicine
• Surgical complications

Background:

• Avascular necrosis (AVN) of the first metatarsal head is a potential complication following the chevron procedure for hallux valgus correction.
• While widely reported in literature, its actual clinical incidence may be lower than suggested, potentially representing an overemphasized risk.
• Despite its infrequency, post-operative AVN can lead to severe consequences for affected patients.

Purpose of the Study:

• To provide a comprehensive overview of avascular necrosis (AVN) concerning the first metatarsal head.
• To review the vascular anatomy pertinent to the chevron osteotomy and lateral release technique.
• To discuss diagnostic imaging, management strategies, and revision surgery for AVN.

Main Methods:

• Literature review focusing on avascular necrosis (AVN) of the first metatarsal head.
• Analysis of the vascular supply of the first metatarsal in relation to the chevron osteotomy.
• Description of imaging modalities for AVN diagnosis.
• Review of current management and revision surgical options.

Main Results:

• The paper outlines the pathogenesis and classification systems for avascular necrosis (AVN).
• It details the specific vascular anatomy of the first metatarsal relevant to the chevron procedure.
• The review covers diagnostic imaging techniques and discusses treatment and revision strategies.

Conclusions:

• Avascular necrosis (AVN) is an infrequent but serious complication of the chevron procedure for hallux valgus.
• Understanding the vascular anatomy and employing appropriate imaging are crucial for diagnosis and management.
• This review synthesizes current knowledge to guide clinical practice regarding AVN after chevron osteotomy.