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

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Presentation transcript:

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

Yu-Bok Park et al. JBJS Essent Surg Tech 2014;4:e24 ©2014 by The Journal of Bone and Joint Surgery, Inc.

Yu-Bok Park et al. JBJS Essent Surg Tech 2014;4:e24 ©2014 by The Journal of Bone and Joint Surgery, Inc.

Postoperative shoe. Yu-Bok Park et al. JBJS Essent Surg Tech 2014;4:e24 ©2014 by The Journal of Bone and Joint Surgery, Inc.

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.

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.

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.

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.

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.

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.

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.

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.

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.