Short-term efficacy of transverse osteotomy of the first metatarsal and fixation with two Kirschner wires for mild to moderate hallux valgus
10.3760/cma.j.cn121113-20240401-00187
- VernacularTitle:第一跖骨横行截骨克氏针固定治疗轻中度 外翻的早期临床疗效
- Author:
Lin SHEN
1
;
Ning JIANG
;
Jia WANG
;
Xiantie ZENG
Author Information
1. 天津大学天津医院足踝二病区，天津 300211
- Publication Type:Journal Article
- Keywords:
Hallux valgus;
Osteotomy;
Kirschner wires;
Minimally invasive surgical procedures
- From:
Chinese Journal of Orthopaedics
2025;45(3):144-150
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the short-term efficacy of transverse osteotomy of the first metatarsal and fixation with Kirschner wires for mild to moderate hallux valgus (HV).Methods:This was a retrospective cohort study. A total of 44 patients (55 feet) with HV who underwent surgical treatment in the Foot and Ankle Ward Two, Tianjin Hospital, Tianjin University from March 2022 to June 2023 were enrolled, including 41 females and 3 males. Based on the different surgical methods, they were divided into a transverse osteotomy group and Scarf group. The transverse osteotomy group was treated with transverse osteotomy of the first metatarsal and fixation with two Kirschner wires, and the Scarf group was treated with "Z" osteotomy and screw fixation. The transverse osteotomy group consisted of 20 patients (25 feet), all female, with an average age of 54.56±3.13 years (range, 50-62 years), including 12 left feet and 13 right feet. Among them, 7 feet had mild HV, and 18 feet had moderate HV. The Scarf osteotomy group included 24 patients (30 feet), 3 males and 21 females, with an average age of 52.43±5.46 years (range, 39-60 years), including 15 left feet and 15 right feet. Among them, 3 feet had mild HV and 27 feet had moderate HV. Observation indicators: (1) The imaging indicators of the two groups were compared before operation and at the last follow-up. These indicators included hallux valgus angle (HVA), intermetatarsal angle (IMA). (2) The clinical efficacy of the two groups was compared, including American Orthopaedic Foot and Ankle Society (AOFAS) forefoot score and visual analogue scale (VAS), as well as postoperative complications. (3) The operation time of the two groups was recorded respectively.Results:Both groups were followed up for an average duration of 6-18 months (13.28±4.42 months). There were no significant differences in preoperative baseline characteristics between the transverse osteotomy group and the Scarf group ( P>0.05). The mean operation time was 28.96±4.10 min for the transverse osteotomy group and 45.37±4.72 min for the Scarf group, with a statistically significant difference ( t=13.612, P<0.001). In the transverse osteotomy, the preoperative HVA was 32.48°±3.9°and decreased to 8.59°±3.06° at the last follow-up, while IMA reduced from 14.53°±1.89° before surgery to 5.07°±1.74° at the last follow-up with statistical significance ( P<0.05). Similarly, in the Scarf group, preoperative HVA was 32.83°±2.33° and decreased to 9.87°±2.66° at the last follow-up, whereas IMA decreased from 13.7°±2.03° before surgery to 5.73°±1.74° at the last follow-up with statistical significance ( P<0.05). There was no significant difference in HVA and IMA between the two groups before surgery and the last follow-up ( P>0.05). In the transverse osteotomy, the preoperative VAS score was 6.0(5.5, 7.0), and at the last follow-up, it improved to 2.0(1.0, 2.0). The preoperative AOFAS score was 48.40±6.04 and increased significantly to 87.36±5.02 at the last follow-up ( P<0.05). In the Scarf group, the preoperative VAS score was 6.0(5.0, 6.0), which decreased to 2.0(2.0, 2.0) at the last follow-up assessment. The preoperative AOFAS score was 50.70±7.31 and showed a significant improvement with a mean of 84.43±3.45 at the final evaluation ( P<0.05). There were no significant differences in preoperative VAS scores between the two groups; however, at the last follow-up assessment, patients in the transverse osteotomy group had higher scores compared to those in the Scarf group, indicating better outcomes ( t=2.610, P=0.012). Postoperatively, only 1 foot in the transverse osteotomy group developed metastatic metatarsal pain, with a complication rate of 4% (1/25). In the Scarf osteotomy group, 1 foot developed superficial wound infection, 1 foot developed metastatic metatarsal pain, and 6 feet experienced joint stiffness, with a complication rate of 27%(8/30). Conclusions:Transverse osteotomy of the first metatarsal and fixation with Kirschner wires is simple, effective, and fast. It can effectively relieve pain, quickly restore function, shorten operation time, reduce soft tissue trauma, and minimize complications, demonstrating good clinical efficacy in the short term.
