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The Application of an Allogenic Bone Screw for Stabilization of a Modified Chevron Osteotomy: A Prospective Analysis.

ABSTRACT: Background: Distal first metatarsal osteotomies are commonly performed operative procedures for hallux valgus deformity, and usually involve fixation with a metal screw. However, various bioabsorbable osteosynthesis materials have been in use for a number of years. One recent innovation is the Shark Screw®, a human cortical bone allograft. This study aimed to evaluate the efficacy and safety of this allogeneic screw in the stabilization of Reversed L-Shaped osteotomy, a modified Chevron osteotomy. Methods: In a prospective study, 15 patients underwent a Reversed L-Shaped osteotomy stabilized with the allogenic bone screw Radiological data on osteointegration of the screw and correction of the intermetatarsal angle were recorded. Furthermore, each follow-up examination included the collection of clinical data, the American Orthopedic Foot and Ankle Society (AOFAS) score, evaluation of pain level, and patient’s overall satisfaction. Results: Full osseous fusion of the osteotomy was seen in all patients. The bone screws were radiographically integrated after approximately 6.5 (±2.6) months. Neither nonunion nor failure occurred in any of our cases. Furthermore, we did not find any potential graft reaction. The AOFAS score improved significantly from 51.6 (±15.2) points to 90.9 (±10.3) (p < 0.001). The preoperative hallux valgus angle and intermetatarsal angle decreased significantly from 24.8 (±4.9) degrees to 7.2 (±4.4) degrees (p < 0.001) and 12.6 (±3.2) degrees to 4.8 (±1.3) degrees (p < 0.001), respectively. Conclusions: With this study, we demonstrated the efficiency of the allogenic bone screw (Shark Screw®) in regard to clinical and radiological short-term outcomes.

SUBMITTER: Huber T

PROVIDER: S-EPMC8911083 | biostudies-literature | 2022 Mar

REPOSITORIES: biostudies-literature

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The Application of an Allogenic Bone Screw for Stabilization of a Modified Chevron Osteotomy: A Prospective Analysis.

Huber Thorsten T Hofstätter Stefan G SG Fiala Rainer R Hartenbach Florian F Breuer Robert R Rath Björn B

Journal of clinical medicine 20220303 5

Background: Distal first metatarsal osteotomies are commonly performed operative procedures for hallux valgus deformity, and usually involve fixation with a metal screw. However, various bioabsorbable osteosynthesis materials have been in use for a number of years. One recent innovation is the Shark Screw®, a human cortical bone allograft. This study aimed to evaluate the efficacy and safety of this allogeneic screw in the stabilization of Reversed L-Shaped osteotomy, a modified Chevron osteotom ...[more]

PMID: 35268475

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Project description:Hallux valgus (HV) deformity, which is characterized by lateral deviation and pronation of the metatarsophalangeal joint, demonstrates complex 3-dimensional challenges, thus prompting the development of various surgical approaches, including traditional Chevron osteotomy (CO) and novel triplanar Chevron osteotomy (TCO). The objective of this study is to determine TCO at various tilt angles by employing 3D printing for ex vivo osteotomy angle simulations and computer modeling to correct deformities across 3 planes, thus aiming to enhance surgical outcomes by preserving or even increasing the length of the first metatarsal and thereby overcoming the limitations of CO. In this study, we collected and analyzed non-weight-bearing CT data from 55 patients (61 feet) with mild-to-moderate hallux valgus, plantar callosities and metatarsalgia from June 2019 to June 2020. The study utilized Mimics software for 3D digital reconstructions and simulation osteotomy of both TCO and CO. For both procedures, the apex was centered at the first metatarsal head, with CO specifically oriented towards the fourth metatarsal head at a 60° angle. The plantar-oblique Chevron osteotomy (POCO) was defined by a 15° plantar tilt, whereas TCO involved a further 9° tilt towards the metatarsal head. The key metrics that were measured included the hallux valgus angle (HVA), 1-2 intermetatarsal angle (IMA), distal metatarsal articular angle (DMAA) and first metatarsal length (FML). Our study aged between 30 and 71 years, with an average age of 47.37 years. Postoperative assessments using Mimics software showed significant improvements in reducing the HVA, IMA, and DMAA after CO and TCO. However, when comparing both techniques, their corrective capacities were roughly equivalent, with no significant differences observed in these metrics. Notably, compared with CO, TCO significantly increased the FML (P < .001), thus suggesting that TCO has greater potential to effectively prevent transfer metatarsalgia. This study underscores the ability of TCO to significantly extend the first metatarsal, with precise adjustments to its distal tilt to tailor deformity corrections. In computational simulation experiments, TCO offers a superior alternative to CO for treating hallux valgus by addressing 3-dimensional deformities and preserving or even increasing FML, thereby preventing transfer metatarsalgia.

Dataset Information

The Application of an Allogenic Bone Screw for Stabilization of a Modified Chevron Osteotomy: A Prospective Analysis.

Publications

The Application of an Allogenic Bone Screw for Stabilization of a Modified Chevron Osteotomy: A Prospective Analysis.

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