Araştırma Makalesi
Extra-articular dorsal closing-wedge osteotomy in the treatment of late-stage Freiberg disease: clinical outcomes
Öz
Purpose: The aim of this study was to evaluate the results of dorsal close wedge osteotomy in addition to the debridement application on Freiberg disease in terms of functional recovery and pain relief.
Material and Methods: Sixteen patients diagnosed with Freiberg disease (11 female,5 male) were included in the study and their articular surfaces were evaluated using direct roentgenogram and magnetic resonance imaging following the physical examination. The evaluation of the patients’ articular surface was based on Smilie Classification. The cases were evaluated previous to surgery and in the 12th week of the postoperative period using visual analogue scale (VAS) to determine pain levels and using American Orthopaedic Foot and Ankle Society score (AOFAS) score to assess their functional recovery.
Results: According to Smilie Classification, two cases were grade 2, six cases were grade 3, seven cases were grade 4 and one case was grade 5. The average dorsiflexion amount of the patients was 22 degrees (between 0 and 38) in preoperative period. It increased to 42 degrees on average (between 20 and 70) in the 12th week after the operation. The enlargement in arthroses and the swelling in metatarsophalangeal arthrosis due tosynovitis improved aesthetically in the 12th week after the operation.
Conclusion: The application of dorsal close wedge osteotomy in addition to debridement in the case of Freiberg disease is effective in the adjustment of the articular surface, in maintaining metatarsal length, in increasing the articular’s functionality.
Anahtar Kelimeler
Kaynakça
- 1. Smilie IS. Treatment of Freiberg’s infraction. Proc R Soc Med. 1967;60:29–31. 2. Gauthier G, Elbaz R. Freiberg’s infraction: a subchondral bone fatigue fracture. A new surgical treatment. Clin Orthop Relat Res. 1979;142:93-5.
- 3. Kinnard P, Lirette R. Freiberg's disease and dorsiflexion osteotomy. J Bone Joint Surg Br. 1991;73:864-5.
- 4. Edmondson MC, Sherry KR, Afolyan J, Armitage AR, Skyrme AD. Case series of 17 modified Weil's osteotomies for Freiberg's and Köhler's II AVN, with AOFAS scoring pre-and post-operatively. Foot Ankle Surg. 2011:17:19-24.
- 5. Nagura I, Fujioka H, Kokubu T, Kurosaka M. Autologous osteochondral plug transplantation for osteochondrosis of the second metatarsal head: a case report. J Med Case Reports. 2011;13:308.
- 6. Lee SK, Chung MS, Baek GH, Oh JH, Lee YH, Gong, HS. Treatment of Freiberg disease with intra-articular dorsal wedge osteotomy and absorbable pin fixation. Foot Ankle Int. 2007;28:43-8.
- 7. Du Vries JG, Amiot RA, Cummings P, Sockrider N. Freiberg's disease of the second metatarsal treated with autologous ostechondral transplantation and external fixation. Foot Ankle Surg. 2008;47:565-70.
- 8. Tsujii M, Hasegawa M, Hirata H, Uchida A. Subchondral insufficiency fracture of the second metatarsal head in an elderly woman treated with autologous ostechondral transplantation. Arch Orthop Trauma Surg. 2008;128:689-93.
- 9. Lee, HJ, Kim JW, Min WK. Operative treatment of Freiberg disease using extra-articular dorsal closing-wedge osteotomy technical tip and clinical outcomes in 13 patients. Foot Ankle Int. 2013;34:111-6.
- 10. Capar B, Kutluay E, Müjde S. Dorsal closing-wedge osteotomy in the treatment of Freiberg's disease. Acta Orthop Traumatol Turc. 2006;41:136-9.
- 11. Chao KH, Lee CH, Lin LC. Surgery for symptomatic Freiberg’s disease: extraarticular dorsal closing wedge osteotomy in 13 patients followed for 2-4 years. Acta Orthop Scand. 1999;70:483-6.
- 12. Ikoma K, Maki M, Kido M, Imai K, Arai Y, Fujiwara H et al.. Extra-articular dorsal closing-wedge osteotomy to treat late-stage Freiberg disease using polyblend sutures: technical tips and clinical results. Int Orthop. 2014;38:1401-5.
- 13. Ibrahim T, Beiri A, Azzabi M, Best AJ, Taylor GJ, Menon DK. Reliability and validity of the subjective component of the American Orthopaedic Foot and Ankle Society clinical rating scales. J Foot Ankle Surg. 2007;46:65-74.
- 14. Lee SK, Chung MS, Baek GH, Oh JH, Lee YH, Gong HS. Treatment of Freiberg disease with intra-articular dorsal wedge osteotomy and absorbable pin fixation. Foot Ankle Int. 2007;28:43-8.
- 15. Jacob HA, Zolinger H, Georgiev S. Biomechanics of the metatarsophalangeal joints. Z Orthop. Ihre Grenzgeb. 1985;123:929-38.
- 16. Smith TW, Stanley D, Rowley DI. Treatment of Freiberg's disease. a new operative technique. J Bone Joint Surg Br. 1991;73:129-30.
- 17. Scartozzi G, Schram A, Janigian J. Freiberg’s infraction of the second metatarsal head with formation of multiple loose bodies. J Foot Surg. 1989;28:195-9.
- 18. Shih AT, Quint RE, Armstrong DG, Nixon BP. Treatment of Freiberg's infarction with the titanium hemi-implant. J Am Podiatr Med Assoc. 2004;94:590-3.
- 19. Hoskinson J. Freiberg’s Disease: a review of the long-term results. Proc R Soc Med. 1974;67:10-1.
- 20. Gu W, Shi Z, Chai Y, Zeng B. Effect evaluation of Freiberg’s disease with dorsal wedge osteotomy and absorbable pin fixation. Zhongguo Xiu Fu Chong Jian Ke Za Zhi. 2009;23:651-3.
Yıl 2017,
Cilt: 42 Sayı: 3, 507 - 512, 30.09.2017
Öz
Amaç: Bu çalışmanın amacı Freiberg hastalığında debridman uygulamasına ek olarak dorsal kapalı kama osteotomisinin sonuçlarını fonksiyonel iyileşme ve ağrı açısından değerlendirmektir.
Gereç ve Yöntem: Freiberg hastalığı teşhisi konulan 16 hasta (11 kadın, 5 erkek) çalışmaya dahil edildi. Hastaların fizik muayene sonrasında direk röntgenogram ve manyetik resonans görüntüleme ile eklem yüzeyleri değerlendirildi. Hastaların eklem yüzeyi değerlendirilmelerinde Smilie sınıflaması kullanıldı. Olguların ameliyat öncesi, ameliyat sonrası 12. haftada vizüel analog skalası (VAS) ile ağrı açısından ve American Orthopaedic Foot and Ankle Society (AOFAS) skoru ile fonksiyonel açıdan değerlendirmesi yapıldı.
Bulgular: Yapılan değerlendirmede Smilie sınıflamasına göre 2 olgu evre 2, 6 olgu evre 3, 7 olgu evre 4 ve 1 olgu ise evre 5 idi. Hastaların ameliyat öncesi ortalama dorsifleksiyon miktarları 22 derece (0 – 38 derece arası) iken ameliyat sonrası 12. haftada ortalama dorsifleksiyon miktarları 42 derece (20–70 derece arası) idi. Metatarsofalageal eklemdeki sinovite bağlı şişlik ve eklemdeki genişlemede ameliyat sonrası 12. haftada kozmetik açıdan düzelme saptandı.
Sonuç: Freiberg hastalığında eklem debridmanı ile birlikte uygulanan dorsal kapalı kama osteotomisi eklem yüzeyinin uyumunun yeniden sağlanması ve metatars uzunluğunun korunması ile semptomların azaltılması ve eklem fonksiyonunun arttırılmasında etkili bir yöntemdir.
Anahtar Kelimeler
Debridman Freiberg hastalığı kapalı kama osteotomi osteokondrosiz
Kaynakça
- 1. Smilie IS. Treatment of Freiberg’s infraction. Proc R Soc Med. 1967;60:29–31. 2. Gauthier G, Elbaz R. Freiberg’s infraction: a subchondral bone fatigue fracture. A new surgical treatment. Clin Orthop Relat Res. 1979;142:93-5.
- 3. Kinnard P, Lirette R. Freiberg's disease and dorsiflexion osteotomy. J Bone Joint Surg Br. 1991;73:864-5.
- 4. Edmondson MC, Sherry KR, Afolyan J, Armitage AR, Skyrme AD. Case series of 17 modified Weil's osteotomies for Freiberg's and Köhler's II AVN, with AOFAS scoring pre-and post-operatively. Foot Ankle Surg. 2011:17:19-24.
- 5. Nagura I, Fujioka H, Kokubu T, Kurosaka M. Autologous osteochondral plug transplantation for osteochondrosis of the second metatarsal head: a case report. J Med Case Reports. 2011;13:308.
- 6. Lee SK, Chung MS, Baek GH, Oh JH, Lee YH, Gong, HS. Treatment of Freiberg disease with intra-articular dorsal wedge osteotomy and absorbable pin fixation. Foot Ankle Int. 2007;28:43-8.
- 7. Du Vries JG, Amiot RA, Cummings P, Sockrider N. Freiberg's disease of the second metatarsal treated with autologous ostechondral transplantation and external fixation. Foot Ankle Surg. 2008;47:565-70.
- 8. Tsujii M, Hasegawa M, Hirata H, Uchida A. Subchondral insufficiency fracture of the second metatarsal head in an elderly woman treated with autologous ostechondral transplantation. Arch Orthop Trauma Surg. 2008;128:689-93.
- 9. Lee, HJ, Kim JW, Min WK. Operative treatment of Freiberg disease using extra-articular dorsal closing-wedge osteotomy technical tip and clinical outcomes in 13 patients. Foot Ankle Int. 2013;34:111-6.
- 10. Capar B, Kutluay E, Müjde S. Dorsal closing-wedge osteotomy in the treatment of Freiberg's disease. Acta Orthop Traumatol Turc. 2006;41:136-9.
- 11. Chao KH, Lee CH, Lin LC. Surgery for symptomatic Freiberg’s disease: extraarticular dorsal closing wedge osteotomy in 13 patients followed for 2-4 years. Acta Orthop Scand. 1999;70:483-6.
- 12. Ikoma K, Maki M, Kido M, Imai K, Arai Y, Fujiwara H et al.. Extra-articular dorsal closing-wedge osteotomy to treat late-stage Freiberg disease using polyblend sutures: technical tips and clinical results. Int Orthop. 2014;38:1401-5.
- 13. Ibrahim T, Beiri A, Azzabi M, Best AJ, Taylor GJ, Menon DK. Reliability and validity of the subjective component of the American Orthopaedic Foot and Ankle Society clinical rating scales. J Foot Ankle Surg. 2007;46:65-74.
- 14. Lee SK, Chung MS, Baek GH, Oh JH, Lee YH, Gong HS. Treatment of Freiberg disease with intra-articular dorsal wedge osteotomy and absorbable pin fixation. Foot Ankle Int. 2007;28:43-8.
- 15. Jacob HA, Zolinger H, Georgiev S. Biomechanics of the metatarsophalangeal joints. Z Orthop. Ihre Grenzgeb. 1985;123:929-38.
- 16. Smith TW, Stanley D, Rowley DI. Treatment of Freiberg's disease. a new operative technique. J Bone Joint Surg Br. 1991;73:129-30.
- 17. Scartozzi G, Schram A, Janigian J. Freiberg’s infraction of the second metatarsal head with formation of multiple loose bodies. J Foot Surg. 1989;28:195-9.
- 18. Shih AT, Quint RE, Armstrong DG, Nixon BP. Treatment of Freiberg's infarction with the titanium hemi-implant. J Am Podiatr Med Assoc. 2004;94:590-3.
- 19. Hoskinson J. Freiberg’s Disease: a review of the long-term results. Proc R Soc Med. 1974;67:10-1.
- 20. Gu W, Shi Z, Chai Y, Zeng B. Effect evaluation of Freiberg’s disease with dorsal wedge osteotomy and absorbable pin fixation. Zhongguo Xiu Fu Chong Jian Ke Za Zhi. 2009;23:651-3.
Toplam 19 adet kaynakça vardır.
Ayrıntılar
| Konular | Sağlık Kurumları Yönetimi |
|---|---|
| Bölüm | Araştırma |
| Yazarlar | |
| Yayımlanma Tarihi | 30 Eylül 2017 |
| Kabul Tarihi | 23 Şubat 2017 |
| Yayımlandığı Sayı | Yıl 2017 Cilt: 42 Sayı: 3 |
