Croatian rotatory oblique three-dimensional osteotomy (CROTO) - a modified Wilson's osteotomy for adult hallux valgus intended to prevent dorsal displacement of the distal fragment and to reduce shortening of the first metatarsal bone

Kolundžić, Robert and Mađarević, Mladen and Trkulja, Vladimir and Crnković, Tomislav and Šmigovec, Igor and Matek, Daniel (2017) Croatian rotatory oblique three-dimensional osteotomy (CROTO) - a modified Wilson's osteotomy for adult hallux valgus intended to prevent dorsal displacement of the distal fragment and to reduce shortening of the first metatarsal bone. Medicinski glasnik, 14 (2). pp. 250-256. ISSN 1840-0132

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Abstract

Aim: To evaluate biomechanical and clinical outcomes of a newly developed modification of the Wilson's osteotomy for hallux valgus: a three-dimensional subcaptial correction of the metatarsal head position with a simultaneous lateral and plantar shift with derotation intended to reduce displacement of the distal fragment and shortening of the first metatarsal bone. ----- Methods: Thirty four feet (28 female patients) underwent the new procedure and were evaluated before and 12 to 84 months (median=25.5) after the surgery. ----- Results: Plantar shift of the distal fragment was achieved in all feet. Shortening of the first metatarsal was moderate: ≤6 mm in 32/34 feet, 7 and 10 mm in the remaining two. Median difference in metatarsal index post- vs. pretreatment was -4.0. The hallux valgus angle, intermetatarsal and distal metatarsal articular angles were reduced in all feet. The American Orthopaedic Foot and Ankle Society score improved in all feet (median increase= 51.5). ----- Conclusion: The method allows for a lateral and plantar shift with derotation of the distal fragment and a mild/moderate shortening of the first metatarsal bone.

Abstract in Croatian

Cilj: Procijeniti biomehaničke i kliničke rezultate nove modifikacije Wilsonove osteotomije za liječenja haluks valgusa: trodimenzionalne subkapitalne korekcije položaja glave prve metatarzalne kosti s istodobnim lateralnim i plantarnim pomakom s derotacijom u svrhu prevencije pomaka distalnog ulomka i skrećenja prve metatarzalne kosti. ----- Metode: Novom su metodom operirana 34 stopala u 28 žena, a evaluirana su prije operacije i 12 do 84 mjeseca nakon operacije (medijan=25.5 tjedana). ----- Rezultati: Plantarni pomak distalnog fragmenta ostvaren je u svim stopalima pri čemu je skraćenje prve metatarzalne kosti bilo umjereno: ≤6 mm u 32/34 stopala i 7 i 10 mm u preostala dva. Medijan-razlika metatarzalnog indeksa, nakon zahvata u odnosu na stanje prije zahvata, iznosio je -4.0. Kut haluks valgusa, intermetatarzalni kut i kut distalnog metatarzalnog zgloba smanjeni su u svim stopalima. Skor Američkog društva za stopalo i skočni zglob povećan je u svim stupalima (medijan povećanja=51.5). ----- Zaključak: Metoda omogućuje plantarni i lateralni pomak distalnog ulomka, uz derotaciju i blago do umjereno skraćenje prve metatarzalne kosti.

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