Lateral Soft-Tissue Release with Medial Transarticular or Dorsal First Web-Space Approach Combined...

23
Lateral Soft-Tissue Release with Medial Transarticular or Dorsal First Web-Space Approach Combined with Distal Chevron Osteotomy for Moderate-to-Severe Hallux Valgus by Yu-Bok Park, Keun-Bae Lee, Sung-Kyu Kim, Jong-Keun Seon, and Jun-Young Lee JBJS Essent Surg Tech Volume 4(4):e24 December 24, 2014 ©2014 by The Journal of Bone and Joint Surgery, Inc.

Transcript of Lateral Soft-Tissue Release with Medial Transarticular or Dorsal First Web-Space Approach Combined...

Page 1: Lateral Soft-Tissue Release with Medial Transarticular or Dorsal First Web-Space Approach Combined with Distal Chevron Osteotomy for Moderate-to-Severe.

Lateral Soft-Tissue Release with Medial Transarticular or Dorsal First Web-Space Approach Combined with Distal

Chevron Osteotomy for Moderate-to-Severe Hallux Valgus

by Yu-Bok Park, Keun-Bae Lee, Sung-Kyu Kim, Jong-Keun Seon, and Jun-Young Lee

JBJS Essent Surg TechVolume 4(4):e24

December 24, 2014

©2014 by The Journal of Bone and Joint Surgery, Inc.

Page 2: Lateral Soft-Tissue Release with Medial Transarticular or Dorsal First Web-Space Approach Combined with Distal Chevron Osteotomy for Moderate-to-Severe.

A medial longitudinal skin incision.

Yu-Bok Park et al. JBJS Essent Surg Tech 2014;4:e24

©2014 by The Journal of Bone and Joint Surgery, Inc.

Page 3: Lateral Soft-Tissue Release with Medial Transarticular or Dorsal First Web-Space Approach Combined with Distal Chevron Osteotomy for Moderate-to-Severe.

A longitudinal midline capsulotomy.

Yu-Bok Park et al. JBJS Essent Surg Tech 2014;4:e24

©2014 by The Journal of Bone and Joint Surgery, Inc.

Page 4: Lateral Soft-Tissue Release with Medial Transarticular or Dorsal First Web-Space Approach Combined with Distal Chevron Osteotomy for Moderate-to-Severe.

The first metatarsophalangeal joint is distracted distally with use of two vein retractors and application of manual traction to the great toe to allow clear visualization of the lateral soft-tissue

structures.

Yu-Bok Park et al. JBJS Essent Surg Tech 2014;4:e24

©2014 by The Journal of Bone and Joint Surgery, Inc.

Page 5: Lateral Soft-Tissue Release with Medial Transarticular or Dorsal First Web-Space Approach Combined with Distal Chevron Osteotomy for Moderate-to-Severe.

The lateral joint capsule (arrow) is visualized through the metatarsophalangeal joint, which is distracted with use of a mosquito clamp.

Yu-Bok Park et al. JBJS Essent Surg Tech 2014;4:e24

©2014 by The Journal of Bone and Joint Surgery, Inc.

Page 6: Lateral Soft-Tissue Release with Medial Transarticular or Dorsal First Web-Space Approach Combined with Distal Chevron Osteotomy for Moderate-to-Severe.

After the lateral joint capsule is released with use of a number-15 blade, the adductor hallucis tendon (arrow) is observed.

Yu-Bok Park et al. JBJS Essent Surg Tech 2014;4:e24

©2014 by The Journal of Bone and Joint Surgery, Inc.

Page 7: Lateral Soft-Tissue Release with Medial Transarticular or Dorsal First Web-Space Approach Combined with Distal Chevron Osteotomy for Moderate-to-Severe.

The adductor hallucis tendon is released completely.

Yu-Bok Park et al. JBJS Essent Surg Tech 2014;4:e24

©2014 by The Journal of Bone and Joint Surgery, Inc.

Page 8: Lateral Soft-Tissue Release with Medial Transarticular or Dorsal First Web-Space Approach Combined with Distal Chevron Osteotomy for Moderate-to-Severe.

Illustration showing the conjoined tendon of the adductor hallucis tendon transected from its insertion into the base of the proximal phalanx.

Yu-Bok Park et al. JBJS Essent Surg Tech 2014;4:e24

©2014 by The Journal of Bone and Joint Surgery, Inc.

Page 9: Lateral Soft-Tissue Release with Medial Transarticular or Dorsal First Web-Space Approach Combined with Distal Chevron Osteotomy for Moderate-to-Severe.

Varus stress is applied to the first metatarsophalangeal joint to complete the release of the adductor hallucis tendon at the proximal phalanx.

Yu-Bok Park et al. JBJS Essent Surg Tech 2014;4:e24

©2014 by The Journal of Bone and Joint Surgery, Inc.

Page 10: Lateral Soft-Tissue Release with Medial Transarticular or Dorsal First Web-Space Approach Combined with Distal Chevron Osteotomy for Moderate-to-Severe.

A 60° v-osteotomy is created and centered in the first metatarsal head.

Yu-Bok Park et al. JBJS Essent Surg Tech 2014;4:e24

©2014 by The Journal of Bone and Joint Surgery, Inc.

Page 11: Lateral Soft-Tissue Release with Medial Transarticular or Dorsal First Web-Space Approach Combined with Distal Chevron Osteotomy for Moderate-to-Severe.

The capital fragment is translated about 7 mm laterally and manually impacted onto the shaft to obtain a stable reduction.

Yu-Bok Park et al. JBJS Essent Surg Tech 2014;4:e24

©2014 by The Journal of Bone and Joint Surgery, Inc.

Page 12: Lateral Soft-Tissue Release with Medial Transarticular or Dorsal First Web-Space Approach Combined with Distal Chevron Osteotomy for Moderate-to-Severe.

Yu-Bok Park et al. JBJS Essent Surg Tech 2014;4:e24

©2014 by The Journal of Bone and Joint Surgery, Inc.

Page 13: Lateral Soft-Tissue Release with Medial Transarticular or Dorsal First Web-Space Approach Combined with Distal Chevron Osteotomy for Moderate-to-Severe.

Yu-Bok Park et al. JBJS Essent Surg Tech 2014;4:e24

©2014 by The Journal of Bone and Joint Surgery, Inc.

Page 14: Lateral Soft-Tissue Release with Medial Transarticular or Dorsal First Web-Space Approach Combined with Distal Chevron Osteotomy for Moderate-to-Severe.

Postoperative shoe.

Yu-Bok Park et al. JBJS Essent Surg Tech 2014;4:e24

©2014 by The Journal of Bone and Joint Surgery, Inc.

Page 15: Lateral Soft-Tissue Release with Medial Transarticular or Dorsal First Web-Space Approach Combined with Distal Chevron Osteotomy for Moderate-to-Severe.

The adductor hallucis tendon is identified with use of a mosquito clamp.

Yu-Bok Park et al. JBJS Essent Surg Tech 2014;4:e24

©2014 by The Journal of Bone and Joint Surgery, Inc.

Page 16: Lateral Soft-Tissue Release with Medial Transarticular or Dorsal First Web-Space Approach Combined with Distal Chevron Osteotomy for Moderate-to-Severe.

The adductor hallucis tendon (arrow) has been released from its insertion at the base of the proximal phalanx of the great toe.

Yu-Bok Park et al. JBJS Essent Surg Tech 2014;4:e24

©2014 by The Journal of Bone and Joint Surgery, Inc.

Page 17: Lateral Soft-Tissue Release with Medial Transarticular or Dorsal First Web-Space Approach Combined with Distal Chevron Osteotomy for Moderate-to-Severe.

After the fibular sesamoid-metatarsal ligament is released, the fibular sesamoid (arrow) can be observed.

Yu-Bok Park et al. JBJS Essent Surg Tech 2014;4:e24

©2014 by The Journal of Bone and Joint Surgery, Inc.

Page 18: Lateral Soft-Tissue Release with Medial Transarticular or Dorsal First Web-Space Approach Combined with Distal Chevron Osteotomy for Moderate-to-Severe.

The transverse metatarsal ligament (arrow) has been identified and transected.

Yu-Bok Park et al. JBJS Essent Surg Tech 2014;4:e24

©2014 by The Journal of Bone and Joint Surgery, Inc.

Page 19: Lateral Soft-Tissue Release with Medial Transarticular or Dorsal First Web-Space Approach Combined with Distal Chevron Osteotomy for Moderate-to-Severe.

The preoperative hallux valgus angle was 38°, the first-second intermetatarsal angle was 19°, and the tibial sesamoid position was grade 3.

Yu-Bok Park et al. JBJS Essent Surg Tech 2014;4:e24

©2014 by The Journal of Bone and Joint Surgery, Inc.

Page 20: Lateral Soft-Tissue Release with Medial Transarticular or Dorsal First Web-Space Approach Combined with Distal Chevron Osteotomy for Moderate-to-Severe.

Preoperative clinical photograph.

Yu-Bok Park et al. JBJS Essent Surg Tech 2014;4:e24

©2014 by The Journal of Bone and Joint Surgery, Inc.

Page 21: Lateral Soft-Tissue Release with Medial Transarticular or Dorsal First Web-Space Approach Combined with Distal Chevron Osteotomy for Moderate-to-Severe.

Postoperative anteroposterior radiograph.

Yu-Bok Park et al. JBJS Essent Surg Tech 2014;4:e24

©2014 by The Journal of Bone and Joint Surgery, Inc.

Page 22: Lateral Soft-Tissue Release with Medial Transarticular or Dorsal First Web-Space Approach Combined with Distal Chevron Osteotomy for Moderate-to-Severe.

The hallux valgus angle was 10°, the first-second intermetatarsal angle was 9°, and the tibial sesamoid position was grade 2 at the time of final follow-up.

Yu-Bok Park et al. JBJS Essent Surg Tech 2014;4:e24

©2014 by The Journal of Bone and Joint Surgery, Inc.

Page 23: Lateral Soft-Tissue Release with Medial Transarticular or Dorsal First Web-Space Approach Combined with Distal Chevron Osteotomy for Moderate-to-Severe.

Clinical photograph at the time of final follow-up.

Yu-Bok Park et al. JBJS Essent Surg Tech 2014;4:e24

©2014 by The Journal of Bone and Joint Surgery, Inc.