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Biomechanical Evaluation of Different Fixation Methods for Percutaneous Extracapsular Transverse Cervical Metatarsal Osteotomy in a Hallux Valgus Sawbone Model
(SAGE Publications, 2024-10)
WAGNER HITSCHFELD, PABLO
;
WAGNER HITSCHFFELD, EMILIO
;
Miguel Pinochet
;
David Salinas
;
Peter Lam
<jats:sec><jats:title>Background:</jats:title><jats:p> There is limited literature available that provide information about fixation methods for minimally invasive hallux valgus osteotomies. Our objective was to evaluate the strength of different fixation methods for a percutaneous extracapsular transverse cervical metatarsal (PTCM) osteotomy in a sawbone model. </jats:p></jats:sec><jats:sec><jats:title>Methods:</jats:title><jats:p> Thirty solid foam sawbone foot models were used. Percutaneous extracapsular transverse cervical metatarsal osteotomies were performed and fixed in a standardized fashion in 6 different groups: (1) one 4.0-mm screw; (2) 2 (one 4.0-mm and one 3.0-mm) parallel screws; (3) 2 (one 4.0-mm and one 3.0-mm) divergent screws; (4) same as group 3, but with lateral metatarsal head cortex purchase with the 4.0-mm screw; (5) same as group 4, but with two 4.0-mm screws; (6) same as group 5, but with two 3.5-mm screws. Cyclic and load to failure testing were performed applying a plantar load to the metatarsal head. The measured variables were stiffness and force needed to create deformity using a Zwick Roell Universal Testing Machine. </jats:p></jats:sec><jats:sec><jats:title>Results:</jats:title><jats:p> Group 1 failed as a result of rotational instability in cyclic testing. In load to failure testing, group 3 did not achieve difference compared with group 2 ( P = .09) (181 vs 131 N). Group 4 was stronger ( P = .02) (250 N) than groups 1-3. Group 5 did not show differences relative to group 4 ( P = .1) (223 N). Group 6 was stronger only than groups 1 and 2 ( P = .01) (193 N). </jats:p></jats:sec><jats:sec><jats:title>Conclusion:</jats:title><jats:p> In this sawbones-based study, we found that the use of two 4.0-mm screws or use of a 3.0-mm screw and a 4.0-mm screw with lateral first metatarsal head cortical purchase was superior to other screw configurations. </jats:p></jats:sec>
2Scopus© Citations 1
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Proximal Oblique Sliding Closing Wedge Osteotomy for Hallux Valgus
(2013)
WAGNER HITSCHFFELD, EMILIO
;
Cristián Ortiz
;
John S. Gould
;
Sameer Naranje
;
Pablo Wagner
<jats:sec><jats:title>Background:</jats:title><jats:p> The proximal oblique sliding closing wedge osteotomy (POSCOW) technique was developed to address moderate to severe hallux valgus deformity. We present a retrospective multicenter study to analyze the midterm radiological and clinical outcomes of patients treated with this type of proximal osteotomy fixed with plates. </jats:p></jats:sec><jats:sec><jats:title>Materials and Methods:</jats:title><jats:p> One hundred and forty-four patients (187 feet) were operated on between May 2005 and June 2010 in 2 separate centers. Inclusion criteria were symptomatic moderate to severe incongruent hallux valgus deformity, no significant restriction in the first metatarsophalangeal joint movement, none to minimal degenerative changes in the first metatarsophalangeal or the tarsometatarsal joints, and no hypermobility. The median age was 60 years. The preoperative hallux valgus angle (HV) was 35.6 degrees, intermetatarsal angle (IM) was 15.3 degrees, AOFAS score was 53 points. The median follow-up was 35 months (range, 12-73). A POSCOW osteotomy was performed in all patients and fixed with plates. We recorded the satisfaction rate, postoperative clinical and radiological results, and complications. </jats:p></jats:sec><jats:sec><jats:title>Results:</jats:title><jats:p> The patient satisfaction rate was 87%. The mean postoperative HV angle was 12.3 degrees, IM angle 4.8 degrees, AOFAS score 89 points. The mean decrease in the first metatarsal length was 2.2 mm (range, 0-8). Twelve feet (6.4%) with recurrence of the deformity required revision surgeries. Removal of complete or partial hardware was needed in 23 feet (12.3%) for symptomatic hardware. Five feet (2.6%) developed hallux varus but only 2 required surgery. Transfer metatarsalgia was noted in 9 feet (4.8%). </jats:p></jats:sec><jats:sec><jats:title>Conclusions:</jats:title><jats:p> The POSCOW osteotomy was an effective and reliable method for relieving pain and improving function. A learning curve was present, as most of the complications happened in the initial cases. To our knowledge, this is the largest reported series of proximal closing wedge osteotomy for hallux valgus deformities. </jats:p></jats:sec><jats:sec><jats:title>Level of Evidence:</jats:title><jats:p> Level IV, case series. </jats:p></jats:sec>
36Scopus© Citations 24
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Republication of “Proximal Rotational Metatarsal Osteotomy for Hallux Valgus (PROMO): Short-term Prospective Case Series With a Novel Technique and Topic Review”
(2023)
WAGNER HITSCHFELD, PABLO
;
WAGNER HITSCHFFELD, EMILIO
<jats:sec><jats:title>Background:</jats:title><jats:p> Hallux valgus deformity consists of a lateral deviation of the great toe, metatarsus varus, and pronation of the first metatarsal. Most osteotomies only correct varus, but not the pronation of the metatarsal. Persistent postoperative pronation has been shown to increase deformity recurrence and have worse functional outcomes. The proximal rotational metatarsal osteotomy (PROMO) technique reliably corrects pronation and varus through a stable osteotomy, avoiding fusing any healthy joints. The objective of this research is to show a prospective series of the PROMO technique. </jats:p></jats:sec><jats:sec><jats:title>Methods:</jats:title><jats:p> Twenty-five patients (30 feet) were operated with the PROMO technique. The sample included 22 women and 3 men, average age 46 years (range 22-59), for a mean prospective follow-up of 1 year (range 9-14 months). Inclusion criteria included symptomatic hallux valgus deformities, absence of severe joint arthritis, or inflammatory arthropathies, with a metatarsal malrotation of 10 degrees or more, with no tarsometatarsal subluxation or arthritis on the anteroposterior or lateral foot radiograph views. The mean preoperative and postoperative Lower Extremity Functional Scale (LEFS) score, metatarsophalangeal angle, intermetatarsal angle, metatarsal malrotation, complications, satisfaction, and recurrence were recorded. </jats:p></jats:sec><jats:sec><jats:title>Results:</jats:title><jats:p> The mean preoperative and postoperative LEFS scores were 56 and 73. The median pre-/postoperative metatarsophalangeal angle was 32.5/4 degrees and the intermetatarsal angle 15.5/5 degrees. The metatarsal rotation was satisfactorily corrected in 24 of 25 patients. An Akin osteotomy was needed in 27 of 30 feet. All patients were satisfied with the surgery, and no recurrence or complications were found. </jats:p></jats:sec><jats:sec><jats:title>Conclusions:</jats:title><jats:p> PROMO is a reliable technique, with good short-term results in terms of angular correction, satisfaction, and recurrence. Long-term studies are needed to determine if a lower hallux recurrence rate occurs with the correction of metatarsal rotation in comparison with conventional osteotomies. </jats:p></jats:sec><jats:sec><jats:title>Level of evidence:</jats:title><jats:p> IV, prospective case series. </jats:p></jats:sec>
9Scopus© Citations 5
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Validity and Reliability of a New Radiological Method to Estimate Medial Column Internal Rotation in Hallux Valgus Using Foot Weight-Bearing X-Ray
(2021)
WAGNER HITSCHFELD, PABLO
;
Nicole Lescure
;
Noman Siddiqui
;
Jessica Fink
;
WAGNER, EMILIO
<jats:sec><jats:title>Background</jats:title><jats:p> Medial column internal rotation in hallux valgus (HV) can be measured using weight-bearing computed tomography (WBCT). Anteroposterior weight-bearing foot radiographs’ (WBXR) ability to estimate medial column internal rotation in HV was evaluated comparing these measurements with those obtained from WBCT. </jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p> Three observers evaluated WBCT and WBXR of 33 HV feet twice. Medial column internal rotation was measured with WBCT and classified into 3 levels according to WBXR findings. Intra- and interobserver reliability were obtained for WBXR and WBCT, in addition to WBXR-WBCT correlation. </jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p> WBXR and WBCT intraobserver agreement was substantial and near perfect, respectively (κ 0.79 and 0.84). Their interobserver agreement was excellent (intraclass correlation 0.85 and 0.9, respectively). The WBXR-WBCT correlation was substantial (κ 0.68). WBXR diagnostic accuracy to predict the WBCT results was 85%. </jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p> The proposed method for medial column internal rotation measurement using WBXR is reliable and has a substantial agreement with WBCT measurements. </jats:p></jats:sec><jats:sec><jats:title>Levels of Evidence</jats:title><jats:p> Level III </jats:p></jats:sec>
Scopus© Citations 10 1
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Foot and Ankle Disorders
(2022)
Emilio Wagner Hitschfeld
;
WAGNER HITSCHFELD, PABLO
Scopus© Citations 1 9
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Hallux Valgus
(2022)
WAGNER HITSCHFELD, PABLO
;
Emilio Wagner Hitschfeld
4
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Biomechanical Cadaveric Evaluation of the Role of Medial Column Instability in Hallux Valgus Deformity
(2022)
WAGNER, EMILIO
;
WAGNER HITSCHFELD, PABLO
;
Florencia Pacheco
;
Mario López
;
Felipe Palma
<jats:sec><jats:title>Background:</jats:title><jats:p> Medial column instability is a frequent finding in patients with flatfeet and hallux valgus, within others. The etiology of hallux valgus is multifactorial, and medial ray axial rotation has been mentioned as having an individual role. Our objective was to design a novel cadaveric foot model where we could re-create through progressive medial column ligament damage some components of a hallux valgus deformity. </jats:p></jats:sec><jats:sec><jats:title>Methods:</jats:title><jats:p> Ten fresh-frozen lower leg specimens were used, and fluorescent markers were attached in a multisegment foot model. Constant axial load and cyclic tibial rotation (to simulate foot pronation) were applied, including pull on the flexor hallucis longus tendon (FHL). We first damaged the intercuneiform (C1-C2) ligaments, second the naviculocuneiform (NC) ligaments, and third the first tarsometatarsal ligaments, leaving the plantar ligaments unharmed. Bony axial and coronal alignment was measured after each ligament damage. Statistical analysis was performed. </jats:p></jats:sec><jats:sec><jats:title>Results:</jats:title><jats:p> A significant increase in pronation of multiple segments was observed after sectioning the NC ligaments. Damaging the tarsometatarsal ligament generated small supination and varus changes mainly in the medial ray. No significant change was observed in axial or frontal plane alignment after damaging the C1-C2 ligaments. The FHL pull exerted a small valgus change in segments of the first ray. </jats:p></jats:sec><jats:sec><jats:title>Discussion:</jats:title><jats:p> In this biomechanical cadaveric model, the naviculocuneiform joint was the most important one responsible for pronation of the medial column. Bone pronation occurs along the whole medial column, not isolated to a certain joint. Flexor hallucis longus pull appears to play some role in frontal plane alignment, but not in bone rotation. This model will be of great help to further study medial column instability as one of the factors influencing medial column pronation and its relevance in pathologies like hallux valgus. </jats:p></jats:sec><jats:sec><jats:title>Clinical Relevance:</jats:title><jats:p> This cadaveric model suggests a possible influence of medial column instability in first metatarsal pronation. With a thorough understanding of a condition’s origin, better treatment strategies can be developed. </jats:p></jats:sec>
20Scopus© Citations 7
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Metatarsal Pronation in Hallux Valgus Deformity: A Review
(2020)
EMILIO WAGNER HITSCHFFELD
;
Pablo Wagner
2Scopus© Citations 66
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The Use of a Triplanar Metatarsal Rotational Osteotomy to Correct Hallux Valgus Deformities
(2019)
Pablo Wagner
;
EMILIO WAGNER HITSCHFFELD
10Scopus© Citations 14
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Angle to Be Corrected in Preoperative Evaluation for Hallux Valgus Surgery: Analysis of a New Angular Measurement
(2016)
Cristian Ortiz
;
WAGNER HITSCHFELD, PABLO
;
Omar Vela
;
Daniel Fischman
;
Gabriel Cavada
<jats:sec><jats:title>Background:</jats:title><jats:p> The most common methods for assessing severity of hallux valgus deformity and the effects of an operative procedure are the angular measurements in weightbearing radiographs, specifically the hallux valgus angle and intermetatarsal angle (IMA). Our objective was to analyze the interobserver variability in hallux valgus patients of a new angle called the “angle to be corrected” (ATC), and to compare its capacity to differentiate between different deformities against IMA. </jats:p></jats:sec><jats:sec><jats:title>Methods:</jats:title><jats:p> We included 28 symptomatic hallux valgus patients with 48 weightbearing foot x-rays. Three trained observers measured the 1 to 2 IMA and the ATC. We then identified retrospectively 45 hallux valgus patients, which were divided into 3 operative technique groups having used the ATC as reference, and analyzed the capacity of the IMA to differentiate between them. </jats:p></jats:sec><jats:sec><jats:title>Results:</jats:title><jats:p> The IMA average value was 13.6 degrees, and there was a significant difference between observer 3 and observer 1 ( P = .001). The average value for the ATC was 8.9 degrees, and there was no difference between observers. Both angles showed a high intraclass correlation. Regarding the capacity to differentiate between operative technique groups, the ATC was different between the 3 operative technique groups analyzed, but the IMA showed differences only between 2. </jats:p></jats:sec><jats:sec><jats:title>Conclusions:</jats:title><jats:p> The ATC was at least as reliable as the intermetatarsal angle for hallux valgus angular measurements, showing a high intraclass correlation with no interobserver difference. It can be suggested that the ATC was better than the IMA to stratify hallux valgus patients when deciding between different operative treatments. </jats:p></jats:sec><jats:sec><jats:title>Level of Evidence:</jats:title><jats:p> Level III, comparative study. </jats:p></jats:sec>
9 1Scopus© Citations 8

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