METHOD FOR SURGICAL MANAGEMENT OF HALLUX VALGUS IN TRANSVERSE PLATYPODIA Russian patent published in 2024 - IPC A61B17/56 

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to traumatology and orthopaedics, and can be used for surgical treatment of hallux valgus in transverse platypodia. Access to the first metatarsal bone for its osteotomy is 5 cm and it is performed along the medial surface of the metatarsal bone. Lateral release is performed through the main approach by cutting the capsule with a scalpel longitudinally above and below the collateral ligament with preserving adductors. At the next stage, a Z-reverse osteotomy is performed with a distal saw line at distance of 1 to 1.5 cm from the edge of the cartilaginous part of the head of the metatarsal bone, and a proximal saw line at distance of 2 to 2.5 cm from the metatarsal joint. Both made saw lines are connected to each other by means of saw line in horizontal plane, while direction of distal saw line is performed at angle of 90° to the axis of the metatarsal bone, the proximal saw line is performed at angle of 45 to 50° to the axis of the metatarsal bone towards the head of the metatarsal bone, and the angle of inclination of the horizontal saw line is from 0 to 65°. In the proximal part of the plantar fragment of the metatarsal bone, a sharp outer edge is resected; in the remaining part, 1 to 1.5 cm deep cut is formed. At the next stage, the position of the plantar fragment of the metatarsal bone is corrected by its outward displacement, correcting the varus deviation of the first metatarsal bone. After the plantar fragment of the metatarsal bone is displaced, X-ray control is performed, and the required shortening and lateralization of the plantar fragment is calculated. In the area of external edge of the distal saw line, a ledge is formed taking into account the shortening and lateralization of the plantar fragment of the metatarsal bone. Plantar fragment is wedged by means of formed projections, and K-wire is inserted into head of metatarsal bone, and rotation of plantar fragment is eliminated by its rotation along axis. X-ray control is performed, and the second K-wire is used for temporary osteosynthesis. Final fixation stage is performed by osteosynthesis with a full-threaded cannulated screw with diameter of 4.5 mm. First, the guide pin is delivered from the base of the metatarsal bone, then through the outer wall of the metatarsal bone at the level of the diaphysis into the head of the metatarsal bone. Canal for the screw is reamed, and the osteotomy fragments are fixed. At the final stage of the operation, an oscillatory saw is used to simulate the shape of the metatarsal bone, the formed bone fragments are inserted into the medullary canal, wedging the plantar fragment, increasing its stability, and the anatomical shape of the metatarsal bone is formed. Residual deviation of the first finger is levelled by performing an osteotomy of the proximal phalanx of the first finger at different levels, and after correction, the osteosynthesis is performed with a screw. Capsule is closed with two continuous sutures with restoration of capsular-ligamentous balance and reduction of sesamoid hammock. Cosmetic sutures are applied on the skin, and the finger is placed in a neutral position with the help of a tape bandage. In case of formation of excessive ledge in area of distal saw line, excessive shortening or insufficient lateralization, bone autoplasty is performed from previously sawn edge of plantar fragment of metatarsal bone. Residual deviation of the first finger is levelled with performing medialisation.

EFFECT: method provides control over elimination of all components of deformation, enables to achieve stability of fragments, reduces frequency of load fractures of metatarsal bone and development of metatarsalgia due to osteotomy by means of changed directions and shape of osteotomy cuts and fixation with one screw 4-4,5 mm with three support points, as well as control of plantarisation of plantar fragment and degree of shortening of first metatarsal bone.

3 cl, 5 dwg, 5 ex