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Results of two different surgical techniques in the treatment of advanced-stage Freiberg's disease.

Abstract：

BACKGROUND:Freiberg's disease is an osteochondrosis most commonly seen in adolescent women and characterized by pain, swelling and motion restriction in the second metatarsal. The early stages of this disease can be managed with semirigid orthoses, metatarsal bars and short leg walking cast. Number of operative methods are suggested which can be used depending on the pathophysiology of the disease, including abnormal biomechanics, joint congruence and degenerative process. We evaluated the outcomes of the patients with Freiberg's disease who were treated with dorsal closing-wedge osteotomy and resection of the metatarsal head. PATIENTS AND METHODS:16 patients (11 female, 5 male) with a mean age of 24.5 (range 13-49 years) years who underwent dorsal closing wedge osteotomy or resection of the metatarsal head were included in this retrospective study. Second metatarsal was affected in 13 and third metatarsal in three patients. According to the Smillie's classification system, ten patients had type IV osteonecrosis and six patients had type V. The results of the patients were evaluated using the lesser metatarsophalangeal-interphalangeal (LMPI) scale. RESULTS:According to the LMPI scale, the postoperative scores for the osteotomy and excision groups were 86 (range 64-100) and 72.6 (range 60-85), respectively. In the osteotomy group, mean passive flexion restriction was 18° (range 0°-35°) and mean passive extension restriction was 12° (range 0°-25°). Mean metatarsal shortening was 2.2 mm (range 2-4 mm) in the osteotomy group as opposed to 9.8 mm (range 7-14 mm) in the excision group. Significant pain relief was obtained in both groups following the surgery. CONCLUSIONS:The decision of performing osteotomy or resection arthroplasty in the patients with advanced-stage Freiberg's disease should be based on the joint injury and the patients should be informed about the cosmetic problems like shortening which may arise from resection.

journal_name

Indian J Orthop

journal_title

Indian journal of orthopaedics

authors

Özkul E,Gem M,Alemdar C,Arslan H,Boğatekin F,Kişin B

doi

10.4103/0019-5413.173514

subject

Has Abstract

pub_date

2016-01-01 00:00:00

pages

70-3

issue

eissn

0019-5413

issn

1998-3727

pii

IJOrtho-50-70

journal_volume

pub_type

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Results of two different surgical techniques in the treatment of advanced-stage Freiberg's disease.