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26 de agosto de 2016

Cirugía de preservación articular en hallux rígidus, cuánto importa el índice metatarsal?

J Foot Ankle Surg. 2016 Jul 27. pii: S1067-2516(16)30159-4. doi: 10.1053/j.jfas.2016.06.003. [Epub ahead of print]

Joint Preserving Procedure for Moderate Hallux Rigidus: Does the Metatarsal Index Really Matter?

Slullitel Gastón1, López Valeria1, Seletti M1, Calvi Juan P.1, Bartolucci C3, Pinton G3.

1 - Instituto de Ortopedia y Traumatología Dr. Jaime Slullitel - IJS - Rosario, Argentina

Abstract

Surgical treatment of moderate hallux rigidus remains controversial and the optimal surgical technique has yet to be defined. Decompressive metatarsal osteotomy is one of the procedures available; however, one of the potential drawbacks is the effect of the metatarsal shortening. We evaluated the global effect of the decompressive metatarsal osteotomy, accounting for the metatarsal index. We retrospectively evaluated 78 patients with stage II and III hallux rigidus who had undergone Youngswick osteotomy and analyzed their outcomes according to the metatarsal index. The candidates for inclusion underwent clinical and radiographic evaluation, including the visual analog scale foot and ankle score, first metatarsophalangeal joint range of motion, and first metatarsal protrusion distance to define the metatarsal index. Also, shortening of the first metatarsal was measured postoperatively, and the occurrence of metatarsalgia was considered a postoperative complication. The mean follow-up period was 53 ± 17 months. The groups stratified according to the metatarsal index (index plus, index plus minus, and index minus) presented with similar results (p ˃ .05). The average preoperative visual analog scale foot and ankle score of 56.4 ± 13.8 points improved significantly to 84.1 ± 5.5 points postoperatively (p < .0001). Also, the mean preoperative dorsiflexion of 20.4° ± 1.5° improved to 37.3° ± 1.6° postoperatively (p < .0001). Of the 78 patients, 97% would recommend the procedure to a family member or friend. Four patients (6%) experienced postoperative metatarsal pain. We found consistent results with this procedure. The reported functional score and dorsiflexion improvement provide evidence that good outcomes and high levels of patient satisfaction can be achieved, regardless of the metatarsal length.

          Fig. A) Rx preoperatoria, B) Rx Postoperatoria

Copyright © 2016 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

KEYWORDS:

decompressive osteotomy; first metatarsal length; forefoot disorders; hallux disorders; statistical analysis

Hallux valgus, hallux rígidus, osteotomía descompresiva, cirugía de preservación articular, metatarso

Link: http://www.jfas.org/article/S1067-2516(16)30159-4/abstract