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Proximal Opening Wedge Osteotomy with Wedge-Plate Fixation Compared with Proximal Chevron Osteotomy for the Treatment of Hallux Valgus: A Prospective, Randomized Study

Glazebrook, Mark MSc, PhD, MD, FRCS(C); Copithorne, Peter MD, FRCS(C); Boyd, Gordon MD, FRCS(C); Daniels, Timothy MD, FRCS(C); Lalonde, Karl-André MD, FRCS(C); Francis, Patricia RN; Hickey, Michael MD, FRCS(C)

Journal of Bone & Joint Surgery - American Volume: 1 October 2014 - Volume 96 - Issue 19 - p 1585–1592
doi: 10.2106/JBJS.M.00231
Scientific Articles
Supplementary Content
Disclosures

Background: Hallux valgus with an increased intermetatarsal angle is usually treated with a proximal metatarsal osteotomy. The proximal chevron osteotomy is commonly used but is technically difficult. This study compares the proximal opening wedge osteotomy of the first metatarsal with the proximal chevron osteotomy for the treatment of hallux valgus with an increased intermetatarsal angle.

Methods: This prospective, randomized multicenter (three-center) study was based on the clinical outcome scores of the Short Form-36, the American Orthopaedic Foot & Ankle Society forefoot questionnaire, and the visual analog scale for pain, activity, and patient satisfaction. Subjects were assessed prior to surgery and at three, six, and twelve months postoperatively. Surgeon preference was evaluated based on questionnaires and the operative times required for each procedure.

Results: No significant differences were found for any of the patients’ clinical outcome measurements between the two procedures. The proximal opening wedge osteotomy was found to lengthen, and the proximal chevron osteotomy was found to shorten, the first metatarsal. The intermetatarsal angles improved (decreased) significantly, from 14.8° ± 3.2° to 9.1° ± 2.9 (mean and standard deviation) after a proximal opening wedge osteotomy and from 14.6° ± 3.9° to 11.3° ± 4.0° after a proximal chevron osteotomy (p < 0.05 for both). Operative time required for performing a proximal opening wedge osteotomy is similar to that required for performing a proximal chevron osteotomy (mean and standard deviation, 67.1 ± 16.5 minutes compared with 69.9 ± 18.6 minutes; p = 0.510).

Conclusions: Opening wedge and proximal chevron osteotomies have comparable radiographic outcomes and comparable clinical outcomes for pain, satisfaction, and function. The proximal opening wedge osteotomy lengthens, and the proximal chevron osteotomy shortens, the first metatarsal. The proximal opening wedge osteotomy was subjectively less technically demanding and was preferred by the orthopaedic surgeons in this study.

Level of Evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

1Halifax Infirmary, Queen Elizabeth II Health Sciences Center, 1796 Summer Street, Halifax, NS B3H3A7, Canada. E-mail address for P. Copithorne: pcopithorne@gmail.com. E-mail address for G. Boyd: gordonjboyd@gmail.com. E-mail address for P. Francis: francisp@cdha.nshealth.ca

2St. Michael’s Hospital, 800-55 Queen Street East, Toronto, ON M5C 1R6, Canada. E-mail address: danielst@smh.ca

3Division of Orthopaedic Surgery, Ottawa Hospital General Campus, 501 chemin Smyth, Ottawa, ON K1H 8L6, Canada. E-mail address: klalonde99@hotmail.com

441 Frederick Street, Orillia, ON L3V 5W6, Canada. E-mail address: hickey.ortho@gmail.com

Copyright 2014 by The Journal of Bone and Joint Surgery, Incorporated
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