RESUMEN
This study reviewed the subjective, clinical and radiological outcome of 71 patients (84 feet) treated by scarf osteotomy for hallux valgus deformity at our institution from 1995 to 1998 with an average follow-up time of 22 months (range, 17 to 48 months). At the time of follow-up, 39% of the patients were very satisfied, 50% were satisfied and 11% were not satisfied. The mean AOFAS score raised significantly from 43 points (14-68) preoperatively to 82 points (39 to 100) at follow-up (p < 0.001). The radiological angles including M1-M2, M1-P1, M1-M5 and DMAA improved significantly (p < 0.001). Among the 16 complications recorded, seven (8%) were minor and nine (11%) required an additional procedure. The scarf osteotomy of the first metatarsal coupled with a lateral soft-tissue release and, in three-quarters of our cases, with a basal closing wedge varisation osteotomy of the first phalanx, resulted in overall high satisfaction rate as well as significant clinical and radiological improvements in our series. Nevertheless, the range of motion of the first MP joint remained low: 30 degrees to 74 degrees in 52 patients (62%) and <30 degrees in four patients (5%). Furthermore, the mobility of the first ray as well as the consequences of the procedure in the sagittal plane need to be assessed more accurately, and this may be achieved by incorporating measurement of the plantar pressures in the forefoot area into the global rating system.
Asunto(s)
Hallux Valgus/cirugía , Osteotomía/métodos , Adulto , Anciano , Femenino , Estudios de Seguimiento , Hallux Valgus/diagnóstico , Humanos , Masculino , Persona de Mediana Edad , Dimensión del Dolor , Satisfacción del Paciente , Probabilidad , Rango del Movimiento Articular/fisiología , Recuperación de la Función , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Resultado del TratamientoRESUMEN
The authors compared the long term follow-up (mean duration 19 years) of 96 patients operated on for hallux valgus, 52 by the McBride procedure, 46 by a Hohmann procedure. Clinical results considered 4 criteria: deformity, pain, mobility and satisfaction. Dorsoplantar weight bearing X-ray compared anatomical results. This study showed that patients were subjectively more satisfied after McBride operation (p = 0.0001) even if the deformity was radiologically better reduced by osteotomy (p = 0.006). This discrepancy between subjective and radiologic results was related to the fact that X-rays represent only the static morphologic reflect of a more complex pathologic entity: radiology can only partly explain the functional discomfort of the patients. The modified McBride procedure was better suited to patients presenting a painful HV. Osteotomy was more suited to bunions causing little pain. Indications for each of these procedures should be based more on patient's history and clinical examination than on X-rays.