Basal metatarsal osteotomy (opening wedge) for Hallux Valgus using the Arthrex LPS open wedge system
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The basal metatarsal osteotomy of the first ray is an operation for moderate to severe Hallux Valgus deformity which can be technically challenging.
The choice of an opening wedge osteotomy (as demonstrated in this technique) avoids the shortening of the 1st Ray which can occur with the use of a closing wedge osteotomy, but careful soft tissue balancing is required with the opening wedge.
Though the inter-metatarsal angle is well corrected (as long as an appropriately large size of open wedge plate is selected) inevitably the distal metatarsal articular angle (DMAA) is pushed into valgus which means almost always an Akin osteotomy is also required. This is also required to address pronation of the hallux which can be marked with larger deformities. Other procedures are always required to rebalance the soft tissues in particular a modified McBrides procedure and medial capsular plication and on occasion careful Z-lengthening of the extensor tendons to the Hallux.
Alternate operations for severe deformities are commonly either corrective first MTP fusions or a Lapidus procedure.
The Arthrex LPS open wedge plate is probably the lowest profile plate on the market and plate irritation is as a result rare. This version is non-locking and as such not well suited to softer bone (though a less low profile locking plate is available).
Author:Mark Herron FRCS.
Institution: The Wellington Hospital, London, UK.
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Question 1 of 14
Which one of the following factors will not potentially make on-table correction of a severe Hallux Valgus deformity more difficultCorrectIncorrect
Question 2 of 14
With a severe Hallux Valgus deformity and co-existing osteoarthritis which one of the following statements is true about the operative options ?CorrectIncorrect
Question 3 of 14
Which one of the following is not a recognised type of Basal metatarsal osteotomy?CorrectIncorrect
Question 4 of 14
In terms of the radiographic criteria used to classify Hallux valgus which one of the following would correspond to a severe deformity ?CorrectIncorrect
Question 5 of 14
Which one of the following procedures is not routinely required during a Basal osteotomy ?CorrectIncorrect
Question 6 of 14
The location of the bone cut for an opening wedge basal osteotomy is best determined by which one of the following ?CorrectIncorrect
Question 7 of 14
If the lateral cortex fractures whilst performing the osteotomy which one of the following steps is not appropriate ?CorrectIncorrect
Question 8 of 14
After an opening wedge osteotomy has been fixed which of one of the following statements is incorrect ?CorrectIncorrect
Question 9 of 14
Which one of the following steps is least helpful in distracting the osteotomy during plate insertion ?CorrectIncorrect
Question 10 of 14
Which one of the following statements is true of the bone gap produced by inserting an opening wedge plate ?CorrectIncorrect
Question 11 of 14
In the post-operative period which one of the following statements about management is correct ?CorrectIncorrect
Question 12 of 14
In a post-operative patient re-presenting at the 9 week stage with increasing lesser metatarsal pain and tenderness which one of the following is not an appropriate immediate step?CorrectIncorrect
Question 13 of 14
With respect to the published results of Basal metatarsal osteotomies which one of the following is incorrect?CorrectIncorrect
Question 14 of 14
With respect to the published results of Basal osteotomies which one of the following statements is incorrect ?CorrectIncorrect