RU2310414C1 - Method for surgical rehabilitation in patients with valgus deviation of the first toe - Google Patents

Abstract

FIELD: medicine, traumatology, orthopedics.

SUBSTANCE: osteotomy of the 1^st metatarsal bone should be carried out at the bottom of exostosis at the angle towards the axis of the 1^st metatarsal bone being equal to the angle of deviation of the axis of the first toe against the axis of the 1^st metatarsal bone; one should replace a distal fragment laterally till coincidence of the axis of the first toe and that of the proximal fragment of the 1^st metatarsal bone to fixed then. The innovation prevents articular arthrosis.

EFFECT: higher efficiency.

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Description

The invention relates to medicine, in particular to traumatology and orthopedics, and can be used to treat hallux valgus deviation of the 1st toe, as well as to restore limb functions.

Known methods for the treatment of hallux valgus 1st toe [Egorov MF Orthopedic cosmetology. Correction of the foot. / M.F.Egorov, K.V. Gunin, O.G. Teterin // M .: Publishing house of RAMS. - 2003. - 28-29 pp.] By resection of exostosis of the 1st metatarsal bone, osteotomy of the 1st metatarsal bone and fixation of the foot with a plaster cast.

Closest to the proposed method is the following [RF Patent No. 2259174, publ. 08/27/2005]. An arcuate incision is made along the medial surface of the foot in the projection of the 1st metatarsophalangeal joint. Separate the capsule of the 1st metatarsophalangeal joint. Then an exostosis is resected along the lateral surface of the head of the 1st metatarsal bone (Schede operation) and the saw surface is treated to prevent exostosis recurrence. A wedge-shaped resection of the distal 1st metatarsal bone is performed with the formation of a wedge with the base open inside. Using an oscillatory saw from an additional section of the base region of the 1st metatarsal bone, a transverse osteotomy of the proximal part of the 1st metatarsal bone is performed without crossing the lateral plate of the cortical substance. A wedge formed from the resected distal portion of the 1st metatarsal bone is inserted into the bone cleavage between the fragments. The base of the wedge should be facing outward, thereby restoring the correct axis of the 1st metatarsophalangeal joint.

Stable intraarticular fixation is carried out by introducing cantilever knitting needles from the back of the foot into the proximal phalanx of the big toe, the 1st metatarsal bone at the level of the head, middle third of the diaphysis and the base, which are fixed with washers with a slot in the outer multi-hole plates from apparatus G. A.Ilizarova. Planks are interconnected by threaded ties.

The disadvantages of this prototype:

1) osteotomy of the 1st metatarsal bone at 2 levels is a traumatic manipulation;

2) the transposition of fragments of the 1st metatarsal bone and their fixation in relation to each other are technically difficult manipulation;

3) the movement of a bone autograft can lead to its lysis;

4) resection of exostosis leads to damage to the articular surface of the head of the 1st metatarsal bone and the development of early deforming arthrosis;

5) immobilization of the 1st metatarsophalangeal joint leads to the development of persistent contractures.

We first proposed:

a) perform lateralizing osteotomy of the 1st metatarsal bone taking into account the angle of deviation of the 1st toe.

The method is as follows.

Subcutaneously, on the medial surface of the 1st toe, a Kirchner needle is introduced paraossally along the edge of the exostosis to the level of the joint space of the 1st metatarsophalangeal joint.

A 3 cm incision is made along the medial surface in the projection of the distal third of the 1st metatarsal bone. Using an oscillatory saw at the base of the exostosis, an osteotomy of the 1st metatarsal bone is performed at an angle equal to the angle of deviation of the 1st toe, from top to bottom, from the inside out. The distal fragment of the 1st metatarsal bone is moved laterally, i.e. lateralization of the 1st toe. The 1st finger and the proximal fragment of the 1st metatarsal bone are fixed with a previously installed Kirschner spoke. The wound is sutured with interrupted sutures.

Stable fixation is carried out by introducing cantilever knitting needles from the dorsum of the foot, perpendicular to the long axis of the 1st metatarsal bone, from top to bottom from the outside, inside and outside, at an angle of 90 ° to each other, into the proximal and distal fragments of the 1st metatarsal bones, which are fixed with washers with a slot in the outer multi-hole plates from the apparatus of G.A. Ilizarov. Planks are interconnected by threaded ties. By moving the nuts along the screeds, respectively the planks, compression or distraction is carried out depending on the degree of deformation.

Example. Patient K., 26 years old. The diagnosis of Hallux valgus of both feet, more pronounced on the right. Figure 1 presents the x-ray of the right foot in direct projection before surgery.

The surgical field is processed in the usual way. A Kirchner needle was inserted subcutaneously on the medial surface of the 1st toe of the right foot to the level of the joint space of the 1st metatarsophalangeal joint. An osteotomy, lateralization of the 1st toe of the right foot, fixation of the finger and proximal fragment of the 1st metatarsal bone with an installed spoke were performed from a 3 cm incision in a projection of the distal third of the 1st metatarsal bone with a fixed needle — clinically corrected. Toilet wounds. The wound is sutured with interrupted sutures through all layers. 2 cantilever spoke retainers were inserted into the proximal and distal fragments of the 1st metatarsal bone, which are fixed in the outer many-hole bars connected by threaded ties. Figure 2 presents the x-ray of the right foot in direct projection during treatment. Figure 3 presents the x-ray of the right foot in lateral projection during treatment.

The location of the apparatus from the dorsum of the foot and stable fixation made it possible to carry out the load from 1 day after the operation.

The device is dismantled after 4 weeks. The deformation is eliminated, the correct axis of the joint is restored, pain is not determined. Figure 4 presents the x-ray of the right foot in direct projection after treatment.

Technical result:

1) surgery is less traumatic by maintaining the integrity of the articular surfaces of the 1st metatarsophalangeal joint, exostosis and performing an osteotomy of the 1st metatarsal bone at level 1;

2) technically easier transposition of bone fragments of the 1st metatarsal bone, and therefore, restoration of the axis of the 1st toe due to the direction of the osteotomy (taking into account the angle of deviation of the 1st toe);

3) prevention of deforming arthrosis by preserving the articular surface of the head of the 1st metatarsal bone;

4) prevention of contractures in the 1st metatarsophalangeal joint due to the lack of immobilization of the 1st metatarsophalangeal joint.

Claims (1)

A method of surgical rehabilitation of patients with hallux valgus of the 1st toe, including osteotomy of the first metatarsal bone, fixation of fragments of the first metatarsal bone by an external fixation device, characterized in that the osteotomy is performed at the base of exostosis at an angle to the axis of the first metatarsal bone, equal to the angle of deviation of the axis of the first finger from the axis of the first metatarsal bone, move the distal fragment laterally until the axis of the first finger and the axis of the proximal fragment of the first metatarsal bone coincide.

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