RU2257174C1 - Method for operative treatment of valgus deviation of the great toe of degree ii-iv and hammer-like deformation of the second toe - Google Patents

Abstract

FIELD: medicine, orthopedics.

SUBSTANCE: the method deals with an access to the caput and bottom of the 1^st metatarsal bone, removal of osseous-cartilaginous growth in area of metatarso-phalangeal joint, cut a fragment out of articular capsule with its bottom being on proximal phalanx, suturing a cut fragment at tension towards soft tissues in area of distal metaepiphysis of the 1^st metatarsal bone to withdraw the great toe out of defective position, resection of the bottom of proximal phalanx in a hammer-like toe, osteotomy of the bottom of the 1^st metatarsal bone, forming wedge-like autotransplants out of resected bottom of proximal phalanx of the second toe followed by their introduction into area of osteotomy of the bottom of the 1^st metatarsal bone to prevent the relapse of deformation.

EFFECT: higher efficiency of therapy.

2 dwg, 1 ex

Description

The present invention relates to medicine, in particular to orthopedics.

There is a method of surgical treatment of hallux valgus deviation of the first foot of the foot of the II-IV degree, which consists in resection of the first metatarsopharyngeal joint and performing transverse arch plastic with a tendon of the long extensor of the fourth toe of the foot, conducted through channels drilled in 1-5 metatarsal bones (Korzh A.A., Yaremenko D.A. To surgical treatment of lateral flattening of the foot and hallux valgus // Orthopedics, traumatology and prosthetics. - 1972. - No. 4. - P.36-41).

However, the use of this method causes malnutrition of the cartilage of the metatarsophalangeal joints. Unreliable fixation of the transverse arch leads to relapse. The relatively narrow diameter of the graft, the great tension experienced by it under load of the foot, and the relatively low coefficient of elasticity contributes to the emergence of patterns.

There is also known a method of surgical treatment of hallux valgus deviation of the first toe, which consists in resection of bone-cartilaginous growths in the head region of the first metatarsal bone, manufacturing a wedge-shaped autograft from resected material, introducing it into the osteotomy zone of the base of the first metatarsal bone and suturing between the heads of the first and second metatarsal bones (Bezhenutsa V.I. Reconstruction of the forefoot at hallux valgus // Orthopedics, traumatology and prosthetics. - No. 7. - 1979. - P.56-57.).

However, autografts are made of arthritic bone-cartilage overgrowth material in the region of the head of the first metatarsal bone, the tissue of which is subject to degenerative-dystrophic changes. As a result, after the bone autograft is introduced into the osteotomy zone of the base of the first metatarsal bone, the processes of bone consolidation are delayed. In addition, with cystic degeneration of the head of the first metatarsal bone, which is often the case with arthrosis of the first plus-nephalangeal joint and hallux valgus, the material of bone-cartilage proliferation is clearly not enough for the manufacture of a graft.

As a prototype, we selected a method for surgical treatment of hallux valgus of the first toe, which consists in accessing the head and base of the first metatarsal bone, removing bone-cartilaginous growths in the region of the first metatarsophalangeal joint, and cutting out the flap from the joint capsule with the base on the proximal phalanx of the first finger, removing the first finger from a vicious position, suturing the cut flap with tension to the soft tissues in the distal metaepiphysis of the first metatarsal bone, wedge ovoid resection of the distal and osteotomy of the base of the first metatarsal bone, the introduction of a resected bone wedge into the osteotomy of the base of the bone and suturing of the wound (Logroscino D. Iltrattamento chirurgico dellialuce valgo // Chir Organi Mov. -1948. - No. 32. - P.81-96 )

However, this method leads to a violation of the blood supply to the head of the first metatarsal bone and the development of arthrosis of the first metatarsophalangeal joint. When performing a two-level osteotomy, it is relatively difficult to manipulate bone fragments and perform osteosynthesis of fragments of the first metatarsal bone. In addition, the method does not involve the simultaneous elimination of the hammer-like deformation of the second finger.

The task of the invention is to provide simultaneous correction of the shape and position of the first metatarsal bone with hallux valgus II-IV degree and axis of the hammer finger.

The problem is solved due to the fact that a cut along the rear of the second finger provides access to the proximal phalanx, resects its base, removes the hammer-shaped finger from the vicious position, wedge-shaped autografts are made from the resected base of the proximal phalanx of the second finger and introduce them into the osteotomy zone of the first metatarsal bone .

The essence of the method of surgical treatment of hallux valgus deviation of the first toe of the II-IV degree and hammer-like deformation of the second toe is illustrated by drawings, in which Fig. 1 shows the first beam and the forefoot before surgery, in Fig.2 - after surgery.

The method is as follows:

Access the head and base of the first metatarsal bone, remove the bone-cartilaginous growths 1 in the metatarsophalangeal joint, cut a flap 2 from the joint capsule with the base on the proximal phalanx 3, remove the first finger 4 from the vicious position by stitching the cut out flap 2 with tension to soft tissues in the area of the distal metaepiphysis 5 of the first metatarsal bone. Then, a linear incision in the rear of the second finger provides access to its proximal phalanx, resection of the base 6 of the proximal phalanx of the hammer-like finger is performed, it is removed from the vicious position and the wound is sutured. After that, osteotomy 7 of the base of the first metatarsal bone is performed (Fig. 1). Wedge-shaped autografts 8 are made from the removed base 6 of the proximal phalanx of the second finger, for which articular cartilage is removed, and the remainder of the fragment is split lengthwise into two wedge-shaped parts 3-4 mm thick. Then, autotransplant grafts 8 are introduced into the osteotomy zone 7 (Fig. 2).

Clinical example.

Patient K., 57 L, № and / b 206371, was admitted to the NNIIITO with a diagnosis of bilateral hallux valgus II art. Previously, the patient was not treated. The disease is five years old. The patient walks with a limp without additional support. The pain occurs when walking for more than three hours. The movements in the first metatarsophalangeal joint in the sagittal and horizontal planes are moderately limited. The deformation of the first metatarsophalangeal joints, the violation of the axis of the first and second fingers are determined. The deflection angle of the first metatarsal bone is 20 °. The Friedland Cross Arch Index was 23%.

The patient underwent surgery: reconstruction of the forefoot of the right foot (removal of osteo-cartilaginous growths, corrective osteotomy of the first metatarsal bone with the introduction of wedge-shaped autografts into the osteotomy zone, made from the resected phalanx of the second hammer finger).

The postoperative period was uneventful. The anatomical, functional and cosmetic result is excellent. When viewed after six months, no complaints. The result of the operation is marked as excellent.

The method of surgical treatment of hallux valgus deviation of the first toe of the II-IV degree and hammer-like deformation of the second finger provides simultaneous correction of the shape and position of the first metatarsal bone, hammer-like toe.

Claims (1)

Method for surgical treatment of hallux valgus deviation of the first toe of the II-IV degree and hammer-like deformation of the second toe by accessing the head and base of the first metatarsal bone, removing bone-cartilaginous growths in the region of the first metatarsophalangeal joint, joint capsule plasty, removing the first finger from the vicious position and osteotomy the base of the first metatarsal bone, characterized in that by cutting along the rear of the second finger access to the proximal phalanx, perform a resection of its base, remove the milk a finger-like finger from a vicious position, wedge-shaped grafts are made from the resected base and inserted into the osteotomy zone of the first metatarsal bone.

Images