112.
Distraction osteogenesis after failed arthrodesis surgery on the first
metatarso-phalangeal joint
Jens Kurt Johansen, Jens Wester, Tune Ipsen
Section of foot and ankle surgery Odense University Hospital; Section of foot
and ankle surgery, Odense University Hospital; Section of hand surgery,
Odense University Hospital
Background:
Very little literature have been published regarding the salvage
of shortening and dorsalflexion of the 1. ray after failed arthrodesis surgery.
Significant shortening of the first metatarsal disrupts the normal weight
transfer mechanism, and can result in overload of the adjacent metatarsals with
metatarsalgia and forefoot pain
Purpose / Aim of Study:
To investigate the use of distraction osteogenesis
after failed arthrodesis surgery on the first metatarsophalangeal joint.
Materials and Methods:
The patient is a 50 year old woman who had prior
surgery on the FMPJ. The patient had had both sesamoids removed, and an
arthrodesis of the FMPJ was performed on her left foot.The patient had
developed metatarsalgia under the second ray, and a cock-up deformity of the
1.
toe. The arthrodesis line was cut and suplemented with the removal of a
plantarly based wedge thus correcting the alignment of the first toe. Two pins
was inserted in the first metatarsal bone and 2 pins was inserted in the first
proximal phalanx. A mini Orthofix apparatus was mounted. A 1,6 mm K-wire
was placed transfixing the FMTP and IP joints, in order to gain extension of
the extensor tendon. Twelve days after the mounting of the external fixator the
distraction fase was begun.The distraction rate was 4 times 0,25 mm/daily. A
distraction of approximately 13 mm was achieved, with uneventfull healing at
the osteotomy sites.
Findings / Results:
Pre-operative AOFAS hallux metatarsophalangeal-
interphalangeal Score was 17. Postoperative score was 82. The patient was
able to wear conventional footwear, and had only mild restrictions regarding
runníng activities. The toe was painfree doing everyday activities.
Conclusions:
Distraction Osteogenesis after failed arthrodesis surgery on the
FMPJ can be a satisfactory way of dealing with the shortening of the first ray
and metatarsalgia.
