{"title":"一种治疗严重拇外翻的新技术：叉形截骨与矛钢板固定-回顾性病例系列。","authors":"Kuan-Jung Chen, Chien-Yuan Wang, Chao-Ching Chiang, Chien-Shun Wang, Chien-Hua Chen, Tzu-Cheng Yang","doi":"10.1186/s13018-025-06273-2","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Severe hallux valgus deformity with hallux valgus angle (HVA) greater than 40° presents significant challenges in surgical management. The metatarsal mid-shaft chevron osteotomy (MSCO) with spear plate fixation represents a novel approach for addressing these complex deformities. This study aimed to evaluate its clinical and radiographic outcomes in patients with severe hallux valgus.</p><p><strong>Methods: </strong>This retrospective case series evaluated 54 patients (64 feet) who underwent MSCO with spear plate fixation for severe hallux valgus between January 2023 and March 2024. Inclusion criteria included symptomatic hallux valgus with preoperative HVA greater than 40°, skeletal maturity, and minimum 12-month follow-up. Clinical outcomes were assessed using visual analog scale pain scores (VAS) and American Orthopedic Foot and Ankle Society hallux metatarsophalangeal-interphalangeal (AOFAS-MTP-IP) scale. Radiographic parameters included HVA, intermetatarsal angle (IMA), and tibial sesamoid position. Osteotomy healing was defined as observed bridging of callus from the two segments.</p><p><strong>Results: </strong>The cohort included 46 females and 8 males with mean age of 50.0 years. Mean osteotomy healing time was 3.1 months. HVA improved significantly from 44.1° preoperatively to 7.5° at final follow-up (p < 0.01). IMA decreased from 17.7° to 2.8° (p < 0.01). Tibial sesamoid position showed significant improvement (p = 0.02). VAS pain scores decreased from 5.4 to 0.8 (p < 0.01), and AOFAS-MTP-IP scores improved from 28.0 to 81.6 points (p < 0.01). Five complications (7.8%) occurred: one osteoarthritis, one hallux varus, and three hallux valgus recurrences.</p><p><strong>Conclusions: </strong>MSCO with spear plate fixation demonstrates excellent clinical and radiographic outcomes for severe hallux valgus deformity, with significant improvements in deformity correction, pain relief, and functional scores, accompanied by low complication rates and reliable bone healing.</p><p><strong>Level of evidence: </strong>Level IV, case series.</p>","PeriodicalId":16629,"journal":{"name":"Journal of Orthopaedic Surgery and Research","volume":"20 1","pages":"874"},"PeriodicalIF":2.8000,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"A new technique for severe hallux valgus: mid-shaft chevron osteotomy with spear plate fixation - a retrospective case series.\",\"authors\":\"Kuan-Jung Chen, Chien-Yuan Wang, Chao-Ching Chiang, Chien-Shun Wang, Chien-Hua Chen, Tzu-Cheng Yang\",\"doi\":\"10.1186/s13018-025-06273-2\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Severe hallux valgus deformity with hallux valgus angle (HVA) greater than 40° presents significant challenges in surgical management. The metatarsal mid-shaft chevron osteotomy (MSCO) with spear plate fixation represents a novel approach for addressing these complex deformities. This study aimed to evaluate its clinical and radiographic outcomes in patients with severe hallux valgus.</p><p><strong>Methods: </strong>This retrospective case series evaluated 54 patients (64 feet) who underwent MSCO with spear plate fixation for severe hallux valgus between January 2023 and March 2024. Inclusion criteria included symptomatic hallux valgus with preoperative HVA greater than 40°, skeletal maturity, and minimum 12-month follow-up. Clinical outcomes were assessed using visual analog scale pain scores (VAS) and American Orthopedic Foot and Ankle Society hallux metatarsophalangeal-interphalangeal (AOFAS-MTP-IP) scale. Radiographic parameters included HVA, intermetatarsal angle (IMA), and tibial sesamoid position. Osteotomy healing was defined as observed bridging of callus from the two segments.</p><p><strong>Results: </strong>The cohort included 46 females and 8 males with mean age of 50.0 years. Mean osteotomy healing time was 3.1 months. HVA improved significantly from 44.1° preoperatively to 7.5° at final follow-up (p < 0.01). IMA decreased from 17.7° to 2.8° (p < 0.01). Tibial sesamoid position showed significant improvement (p = 0.02). VAS pain scores decreased from 5.4 to 0.8 (p < 0.01), and AOFAS-MTP-IP scores improved from 28.0 to 81.6 points (p < 0.01). Five complications (7.8%) occurred: one osteoarthritis, one hallux varus, and three hallux valgus recurrences.</p><p><strong>Conclusions: </strong>MSCO with spear plate fixation demonstrates excellent clinical and radiographic outcomes for severe hallux valgus deformity, with significant improvements in deformity correction, pain relief, and functional scores, accompanied by low complication rates and reliable bone healing.</p><p><strong>Level of evidence: </strong>Level IV, case series.</p>\",\"PeriodicalId\":16629,\"journal\":{\"name\":\"Journal of Orthopaedic Surgery and Research\",\"volume\":\"20 1\",\"pages\":\"874\"},\"PeriodicalIF\":2.8000,\"publicationDate\":\"2025-10-08\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Orthopaedic Surgery and Research\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1186/s13018-025-06273-2\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"ORTHOPEDICS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Orthopaedic Surgery and Research","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1186/s13018-025-06273-2","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ORTHOPEDICS","Score":null,"Total":0}
A new technique for severe hallux valgus: mid-shaft chevron osteotomy with spear plate fixation - a retrospective case series.
Background: Severe hallux valgus deformity with hallux valgus angle (HVA) greater than 40° presents significant challenges in surgical management. The metatarsal mid-shaft chevron osteotomy (MSCO) with spear plate fixation represents a novel approach for addressing these complex deformities. This study aimed to evaluate its clinical and radiographic outcomes in patients with severe hallux valgus.
Methods: This retrospective case series evaluated 54 patients (64 feet) who underwent MSCO with spear plate fixation for severe hallux valgus between January 2023 and March 2024. Inclusion criteria included symptomatic hallux valgus with preoperative HVA greater than 40°, skeletal maturity, and minimum 12-month follow-up. Clinical outcomes were assessed using visual analog scale pain scores (VAS) and American Orthopedic Foot and Ankle Society hallux metatarsophalangeal-interphalangeal (AOFAS-MTP-IP) scale. Radiographic parameters included HVA, intermetatarsal angle (IMA), and tibial sesamoid position. Osteotomy healing was defined as observed bridging of callus from the two segments.
Results: The cohort included 46 females and 8 males with mean age of 50.0 years. Mean osteotomy healing time was 3.1 months. HVA improved significantly from 44.1° preoperatively to 7.5° at final follow-up (p < 0.01). IMA decreased from 17.7° to 2.8° (p < 0.01). Tibial sesamoid position showed significant improvement (p = 0.02). VAS pain scores decreased from 5.4 to 0.8 (p < 0.01), and AOFAS-MTP-IP scores improved from 28.0 to 81.6 points (p < 0.01). Five complications (7.8%) occurred: one osteoarthritis, one hallux varus, and three hallux valgus recurrences.
Conclusions: MSCO with spear plate fixation demonstrates excellent clinical and radiographic outcomes for severe hallux valgus deformity, with significant improvements in deformity correction, pain relief, and functional scores, accompanied by low complication rates and reliable bone healing.
期刊介绍：
Journal of Orthopaedic Surgery and Research is an open access journal that encompasses all aspects of clinical and basic research studies related to musculoskeletal issues.
Orthopaedic research is conducted at clinical and basic science levels. With the advancement of new technologies and the increasing expectation and demand from doctors and patients, we are witnessing an enormous growth in clinical orthopaedic research, particularly in the fields of traumatology, spinal surgery, joint replacement, sports medicine, musculoskeletal tumour management, hand microsurgery, foot and ankle surgery, paediatric orthopaedic, and orthopaedic rehabilitation. The involvement of basic science ranges from molecular, cellular, structural and functional perspectives to tissue engineering, gait analysis, automation and robotic surgery. Implant and biomaterial designs are new disciplines that complement clinical applications.
JOSR encourages the publication of multidisciplinary research with collaboration amongst clinicians and scientists from different disciplines, which will be the trend in the coming decades.
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