Sesamoid problems.

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Abstract

[Indexed for MEDLINE] 5. Oper Orthop Traumatol. 2018 Jun;30(3):161-170. doi: 10.1007/s00064-018-0543-y. Epub 2018 Apr 25. [Minimally invasive cheilectomy]. [Article in German] Walther M(1), Chomej P(2), Kriegelstein S(3), Altenberger S(3), Röser A(3). Author information: (1)Zentrum für Fuß- und Sprunggelenkchirurgie, Schön Klinik München Harlaching - FIFA Medical Centre, Harlachinger Straße 51, 81547, München, Deutschland. mwalther@schoen-kliniken.de. (2)St. Elisabeth-Krankenhaus Leipzig, Leipzig, Deutschland. (3)Zentrum für Fuß- und Sprunggelenkchirurgie, Schön Klinik München Harlaching - FIFA Medical Centre, Harlachinger Straße 51, 81547, München, Deutschland. OBJECTIVES: Treatment of hallux rigidus by minimally invasive resection of the dorsal osteophytes, synovectomy and resection of the dorsal part of the metatarsal head. INDICATIONS: Hallux rigidus grades II and III CONTRAINDICATIONS: End-stage osteoarthritis of the first metatarsophalangeal joint with beginning ankylosis. SURGICAL TECHNIQUE: Osteophytes around the metatarsophalangeal joint are removed using a 1 cm incision dorsomedial, approximately 3 cm proximal of the joint space. The dorsal third of the metatarsal head is resected with a burr to improve dorsiflexion. The extent of bone resection is checked with an image intensifier. Loose bone fragments removed with a rangeur. An arthroscopy can be performed to check the completeness of bone resection, the irrigation of the joint and, if needed, to extend the synovectomy. POSTOPERATIVE MANAGEMENT: Removal of the sutures after 2 weeks. Depending on pain, the patient can change from the postoperative shoe to a normal soft, comfortable and wide shoe after 1-2 weeks. Nonsteroidal drugs can be prescribed as needed. Active and passive mobilization of the metatarsophalangeal joint is also recommended. RESULTS: The technique allows a soft-tissue-preserving resection of the osteophytes and a partial resection of the metatarsal head. The main advantages are limited soft-tissue trauma and rapid rehabilitation. In all, 21 women and 17 men with hallux rigidus stages II and III (Vanore) underwent surgery. Minimum follow-up was 12 months. In 1 patient, injury of the extensor hallucis longus tendon was observed. Two patients underwent revision surgery. One patient was converted to a metatarsophalangeal fusion, while another patient received a resection arthroplasty. At the latest follow-up, the AOFAS (American Orthopaedic Foot & Ankle Society) score averaged 88.7 points. DOI: 10.1007/s00064-018-0543-y