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Metatarsus adductus setting in adult patients: Results of a treatment algorithm with shortening arthrodesis tarsometatarsal joints two and three
Foot and Ankle Surgery ( IF 2.5 ) Pub Date : 2022-06-26 , DOI: 10.1016/j.fas.2022.06.008
Werner Pauli 1 , Kai Dopke 2 , Christof Straehl 3 , Filippo Schiapparelli 4 , Enrique Adrian Testa 5
Affiliation  

Background

This study proposes a treatment algorithm based on the correction of symptomatic metatarsus adductus (MA) associated with hallux abducto-valgo (HAV) through tarsometatarsal joint 2–3 (TMTJ) shortening arthrodesis. Our hypothesis is that the proposed algorithm leads to realignment of the forefoot rays from two to five and reduction of the talonavicular coverage angle (TNCA) with good clinical and radiographic results.

Methods

Clinical and radiographic evaluations were performed before and after surgery at 1-year follow-up on forty-six consecutive adult patients with MA, midfoot pain, HAV and osteoarthritis and/or instability of the TMTJ 2–3 in whom shortening of the 2nd and 3rd TMT joints according to MAA and treatment of the HV according to deformity was undertaken.

Results

Talus-first metatarsal angle (TFMA) was the only parameter which did not statistically significantly postoperatively change. All other clinical (AOFAS score) and radiological outcomes significantly improved postoperatively.

Conclusion

Although further studies are needed to confirm the proposed data, it would seems that the shortening arthrodesis of rays two and three has consequences on the forefoot and hindfoot by realigning the longitudinal axis of the foot. The consequent application of the algorithm and adequate correction of the HAV allow good clinical and radiographic results to be obtained.

Level of evidence

IV prospective cases series.



中文翻译:

成人患者的跖骨内收设置:缩短关节固定术跗跖关节 2 和 3 的治疗算法的结果

背景

本研究提出了一种治疗算法,该算法基于通过跗跖关节2-3 (TMTJ) 缩短关节固定术矫正与拇外展外翻 (HAV) 相关的症状性跖内收肌 (MA)。我们的假设是,所提出的算法导致前足射线从 2 条重新调整为 5 条,并减少距舟覆盖角 (TNCA),具有良好的临床和影像学结果。

方法

对 46 名患有 MA、中足疼痛、HAV 和骨关节炎和/或 TMTJ 2-3 不稳定的成年患者进行了为期 1 年的随访,在手术前后进行了临床和影像学评估,其中第 2 和根据 MA​​A 进行第 3 次 TMT 关节治疗,并根据畸形对 HV 进行治疗。

结果

距骨-第一跖骨角 (TFMA) 是唯一在术后没有统计学显着变化的参数。术后所有其他临床(AOFAS 评分)和放射学结果均显着改善。

结论

虽然需要进一步的研究来确认所提出的数据,但似乎通过重新对齐脚的纵轴,缩短射线 2 和 3 的关节融合术对前足和后足产生了影响。算法的后续应用和 HAV 的充分校正可以获得良好的临床和影像学结果。

证据等级

四、前瞻性病例系列。

更新日期:2022-06-26
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