Method for operative treatment of valgus deviation of the great toe of degree ii-iv and hammer-like deformation of the second toe

FIELD: medicine, orthopedics.

SUBSTANCE: the method deals with an access to the caput and bottom of the 1st metatarsal bone, removal of osseous-cartilaginous growth in area of metatarso-phalangeal joint, cut a fragment out of articular capsule with its bottom being on proximal phalanx, suturing a cut fragment at tension towards soft tissues in area of distal metaepiphysis of the 1st metatarsal bone to withdraw the great toe out of defective position, resection of the bottom of proximal phalanx in a hammer-like toe, osteotomy of the bottom of the 1st metatarsal bone, forming wedge-like autotransplants out of resected bottom of proximal phalanx of the second toe followed by their introduction into area of osteotomy of the bottom of the 1st metatarsal bone to prevent the relapse of deformation.

EFFECT: higher efficiency of therapy.

2 dwg, 1 ex

 

The present invention relates to medicine, in particular to orthopedics.

There is a method of surgical treatment of valgus deviation of the first plce foot II-IV degree, consisting of resection of the first planetinvader joint and perform plastic surgery transverse arch tendon of the long extensor of the fourth toe, conducted through channels drilled in 1-5 metatarsal bones (the cake A.A., Yaremenko D.A. TO the surgical treatment of lateral flatness of the foot and hallux valgus // Orthopaedics, traumatology and prosthetics. - 1972. No. 4. - P.36-41).

However, application of this method causes malnutrition cartilage metatarsophalangeal joints. Unreliable fixation transverse arch leads to relapse. A relatively narrow diameter of the graft, great tension, test them under load of the foot, and a relatively low coefficient of proteins contributes to ability.

There is also known a method of surgical treatment of valgus deviation of the first toe, consisting of resection of bone and cartilage growth in the area of the head of the first metatarsal bone, the manufacture of V-autograft from the resected material, the introduction of it in the area osteotomy of the first metatarsal bone and suturing between the heads of the first and second metatarsal to the STI (VI Bianaca Reconstruction of the forefoot with hallux valgus // Orthopaedics, traumatology and prosthetics. No. 7. - 1979. - P.56-57.).

However, autotransplants are made of a material arthritic bone and cartilage growth in the area of the head of the first metatarsal bone, the tissue which is susceptible to degenerative changes. Consequently, after the introduction of bone autograft in the area osteotomy of the first metatarsal bone the bone consolidation is delayed. In addition, in patients with cystic degeneration of the head of the first metatarsal bone, which happens often with arthrosis of the first plus-metalanguage joint and hallux valgus, material bone and cartilage growth is clearly insufficient for the manufacture of the graft.

As a prototype we have chosen the method of surgical treatment of valgus deviation of the first toe, which consists in accessing the head and the base of the first metatarsal bone, the destruction of bone and cartilage growth in the area of the first metatarsophalangeal joint, cutting out the flap of the joint capsule with the base at the proximal phalanx of the first finger, the removal of the first finger from the vicious position, podselenii cut the flap with the tension of the soft tissues in the region of the distal metapelite first metatarsal bone, wedge resection of the distal of the case and osteotomy of the first metatarsal bone, the introduction of the resected bone wedge zone osteotomy of the base of the bone and the wound closure (Logroscino D. Iltrattamento chirurgico dellialuce valgo // Chir Organi Mov. -1948. - No. 32. - P.81-96).

However, this method leads to disruption of blood supply to the head of the first metatarsal bone and the development of osteoarthritis of the first metatarsophalangeal joint. When performing duplex osteotomy relatively difficult to manipulate the bone fragments and to carry out the fixation of the fragments of the first metatarsal bone. Furthermore, the method does not involve removing corns, hammer deformation of the second finger.

The task of the invention is the provision of a one-stage correction of the shape and position of the first metatarsal bone with hallux valgus II-IV degree and axis, corns, hammer toe.

The problem is solved due to the fact that the slit on the rear of the second finger access to the proximal phalanx, perform the resection its Foundation, remove corns, hammer toe from the vicious provisions are made of resected base of the proximal phalanx of the second toe wedge autotransplants and implement them in the area osteotomy of the first metatarsal bone.

The method of surgical treatment of valgus deviation of the first toe II-IV degree, corns, hammer deformation of the second finger is illustrated by drawings, where the a figure 1 shows the first beam and the forefoot before surgery figure 2 - after the operation.

The method is as follows:

Access to the head and the base of the first metatarsal bone, remove bone and cartilage growth 1 in the area of the metatarsophalangeal joint, cut out the flap 2 of the joint capsule with the base at the proximal phalanx 3, remove the first finger 4 of the perverse position of podlivaniem cut flap 2 with the tension of the soft tissues in the region of the distal metapelite 5 of the first metatarsal bone. Then a linear incision across the back of the second finger access its proximal phalanx, perform the resection of the base 6 of the proximal phalanx, corns, hammer toe, remove it from the vicious position and sutured the wound. Then perform the osteotomy 7 the base of the first metatarsal bone (figure 1). From a remote base 6 of the proximal phalanx of the second finger is made wedge-shaped autotransplants 8, which removes the articular cartilage, and the rest of the fragment is split lengthwise into two wedge-shaped part of the thickness of the base 3-4 mm. Then Autotrans-plantati 8 implement in the area of the osteotomy 7 (figure 2).

Clinical example.

Patient K., 57 l, n and/b 206371, entered NIETO diagnosed with bilateral hallux valgus II century Earlier the patient was not treated. Disease duration is five years. The patient walks with a limp without additional funding support. Bo is occurs when walking for more than three hours. Motion in the first metatarsophalangeal joint in the sagittal and horizontal planes moderately limited. Is determined by the deformation of the first metatarsophalangeal joint, the violation of the axis of the first and second fingers. The angle of deviation of the first metatarsal bone 20°. The index of the transverse arch at Friedland was 23%.

The patient was executed operation: reconstruction of the anterior of the right foot (destruction of bone and cartilage growth, corrective osteotomy of the first metatarsal bone with the introduction in the area of the osteotomy klinovidnykh autotransplants made from resected phalanges of the second, corns, hammer toe).

The postoperative period was uneventful. Anatomical, functional and cosmetic result is excellent. When viewed within six months, no complaints. The result of the operation is marked as excellent.

Method of surgical treatment of valgus deviation of the first toe II-IV degree, corns, hammer deformation of the second finger provides an instantaneous correction of the shape and position of the first metatarsal bone, corns, hammer toe.

Method of surgical treatment of valgus deviation of the first toe II-IV degree, corns, hammer deformation of the second finger by accessing the head and the base of the first metatarsal bone, removal of bone and graseby the enlargement in the area of the first metatarsophalangeal joint, plastic joint capsule, removing the first finger from the vicious position and osteotomy of the first metatarsal bone, wherein the slit on the rear of the second finger access to the proximal phalanx, perform the resection its Foundation, remove corns, hammer toe from the vicious provisions are made of resected base wedge grafts and implement them in the area osteotomy of the first metatarsal bone.



 

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