Journal List > J Korean Foot Ankle Soc > v.19(2) > 1043373

Bae, Lee, and Chung: The Impact of the Amount of Displacement of Percutaneous Osteotomy on the Clinical Result in Bunionette

Abstract

Purpose:

The purpose of this study was to report impacts of the amount of displacement of percutaneous osteotomy on the clinical and radiologic results in the treatment of bunionette deformities.

Materials and Methods:

We retrospectively reviewed 36 cases of bunionette deformities treated with percutaneous modified Kramer osteotomies from 2009 to 2013. We measured amounts of displacement on anteroposterior and lateral plain radiographs as well as multiple parameters which represent degrees of the bunionette deformities. We also recorded radiological healing time, clinical healing time, residual symptoms, and the time of returning to daily activity.

Results:

No meaningful correlation was found between severity of preoperative deformity and amount of displacement of the osteotomy. The amount of displacement on a horizontal plane did not affect the healing time, duration of symptoms, or time of returning to daily activity. However, large sagittal displacement was related to duration of postoperative symptoms.

Conclusion:

Findings of this study suggest that the displacement in percutaneous osteotomy for bunionette deformity does not affect clinical results and healing time. We believe that we do not need to be excessively cautious about how large the displacement we make during the percutaneous modified Kramer osteotomy for the bunionette deformity.

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Figure 1.
Metatarsal angle line was defined by the line (white dotted line) from the center of the metatarsal head (white arrow) to the point (black arrow) on which proximal diaphyseal dissecting line (black dotted line) cross the proximal joint.
jkfas-19-63f1.tif
Figure 2.
In this case we made big sagittal displacement during the procedure (A) and vague pain was persisted until 16 weeks after the surgery (B).
jkfas-19-63f2.tif
Figure 3.
In this case we made huge amount of displacement of metatarsal osteotomy in horizontal plane (A) but not in sagittal plane (B). Follow-up radiograph shows that such a big displacement did not affect bone healing (C).
jkfas-19-63f3.tif
Table 1.
Amount of Displacement in Each Fallat Type of Bunionette Deformity
Fallat type Mean value of displacement (%)
Horizontal Sagittal
I 57.2 31.9
II 54.6 31.2
III 54.8 30.4
IV 56.6 31.5
Table 2.
Parameters Represent Degrees of Bunionette Deformity
Parameter Preoperative Postoperative Last follow-up
2nd∼5th IMA (°) 20.48±0.89 8.75±1.46 12.93±0.74
4th∼5th IMA (°) 10.85±0.47 3.53±0.43 4.68±0.44
5th MTPA (°) 14.92±0.89 10.16±0.76 4.55±0.60

Values are presented as mean±standard deviation. IMA: inter-metatarsal angle, MTPA: metatarso-phalangeal angle.

Table 3.
Correlation between Amount of Displacement in Each Plane and Degrees of Deformity
Plane of displacement Preoperative 2nd~5th IMA Preoperative 4th~5th IMA Preoperative 5th MTPA
Pearson coefficient p-value Pearson coefficient p-value Pearson coefficient p-value
Horizontal 0.103 0.550 -0.268 0.114 -0.039 0.819
Sagittal -0.070 0.687 -0.081 0.637 -0.180 0.295

IMA: inter-metatarsal angle, MTPA: metatarso-phalangeal angle.

Table 4.
Correlation between Amount of Displacement in Each Plane and Clinical Parameters
Plane of displacement Radiologic healing time Duration of symptom Time of returning to normal activity
Pearson coefficient p-value Pearson coefficient p-value Pearson coefficient p-value
Horizontal -0.223 0.192 -0.258 0.128 0.033 0.850
Sagittal 0.180 0.293 0.387 0.020* 0.224 0.189

* Significant correlation with p-value<0.05.

Table 5.
Comparing Parameters between Delayed Union Group and Normal Union Group by Independent t-test
Parameter Delayed union group Normal union group p-value
Dispacement in horizontal plane (%) 49.0±26.0 60.0±14.4 0.283
Displacement in sagittal plane (%) 35.4±31.4 23.0±20.0 0.185
Duration of symptom (wk) 8.2±3.8 4.5±1.9 0.031*
Time of returning to normal activity (wk) 6.9±1.5 5.7±1.3 0.030 *

Values are presented as mean±standard deviation. *Significant difference with p-value<0.05.

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