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Treatment of Freiberg's disease by Gauthier's dorsal cuneiform osteotomy: Retrospective study of 30 cases.

Abstract：

INTRODUCTION:Freiberg's disease is osteonecrosis of the dorsal side of a metatarsal head. The gold-standard surgical treatment is the osteotomy procedure first described by Gauthier. HYPOTHESIS:Gauthier osteotomy for Freiberg's disease will restore the joint space and lead to long-term clinical improvement. A retrospective study was carried out to verify this hypothesis. MATERIAL AND METHODS:This study involved 30 consecutive cases treated by a single surgeon in 28 patients having a mean age of 61.2 years. These patients underwent the Gauthier osteotomy procedure with one or two dorsal staples used for fixation. Patients were reviewed 15 days, 45 days and 3 months after the procedure, and then at the last follow-up to look for any complications and determine patient satisfaction, the AOFAS score, metatarsophalangeal range of motion (ROM), sphericity of the metatarsal head, bone union and metatarsal shortening. RESULTS:The average follow-up was 6.5 years ± 2.2. The second metatarsal was affected in 27 cases and the third metatarsal in 3 cases. Discomfort related to the staples was noted in five cases; the staples were removed in three of them. There was one case of severe stiffening (< 20° ROM). At the last follow-up, 17 cases were very satisfied, 11 were satisfied and 2 were moderately satisfied. The average AOFAS score was 83.8 points ± 11.8 at the last follow-up. A mean loss of 15° plantar flexion and 10° dorsiflexion was noted. Bone union and metatarsal head sphericity were achieved in all cases. The average shortening was 2 mm ± 1.4. CONCLUSIONS:The Gauthier osteotomy procedure results in recovery of the metatarsal head's sphericity in every case of this series, with good clinical results and low morbidity.

journal_name

Orthop Traumatol Surg Res

journal_title

Orthopaedics & traumatology, surgery & research : OTSR

authors

Helix-Giordanino M,Randier E,Frey S,Piclet B,French association of foot surgery (AFCP).

doi

10.1016/j.otsr.2015.07.010

subject

Has Abstract

pub_date

2015-10-01 00:00:00

pages

S221-5

issue

6 Suppl

issn

1877-0568

pii

S1877-0568(15)00179-6

journal_volume

101

pub_type

杂志文章

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