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The impact of associated tenotomies on the outcome of incomplete phalangeal osteotomies for lesser toe deformities
BACKGROUND: Partial or incomplete osteotomy (IO) of the phalanx is recently described in the literature. However, the clinical outcome and the rate of complications when applied to lesser toe deformities (LTD) have been never addressed. This study aims to find out if the association of tenotomies to...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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BioMed Central
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6739948/ https://www.ncbi.nlm.nih.gov/pubmed/31511051 http://dx.doi.org/10.1186/s13018-019-1353-0 |
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author | Nieto-García, Eduardo Ferrer-Torregrosa, Javier Ramírez-Andrés, Leonor Nieto-González, Elena Martinez-Nova, Alfonso Barrios, Carlos |
author_facet | Nieto-García, Eduardo Ferrer-Torregrosa, Javier Ramírez-Andrés, Leonor Nieto-González, Elena Martinez-Nova, Alfonso Barrios, Carlos |
author_sort | Nieto-García, Eduardo |
collection | PubMed |
description | BACKGROUND: Partial or incomplete osteotomy (IO) of the phalanx is recently described in the literature. However, the clinical outcome and the rate of complications when applied to lesser toe deformities (LTD) have been never addressed. This study aims to find out if the association of tenotomies to incomplete or partial phalanx osteotomies has a significant impact on the clinical outcomes, the occurrence of complications, and the recovery time after surgery. METHODS: A retrospective review of two cohorts of cases operated in our institution for hallux abductus valgus (HAV) and associated LTD from 2008 to 2014 was carried out. The surgical correction of both HAV and the associated LTD was always performed by minimally invasive techniques. The study included a total of 223 patients (723 IO in 556 toes). In 129 cases, the IO for LTD correction was performed without tenotomies, and in 94, the procedure was combined with flexor and/or extensor tenotomies. Patients were assessed with the American Orthopaedic Foot and Ankle Society (AOFAS) questionnaire before surgery and at 6- and 12-month follow-up. RESULTS: The mean preoperative AOFAS score before surgery was similar in both cohorts. At 12-month follow-up, the cohort without tenotomies showed better recovery (95.7 ± 2.8 versus 92.5 ± 6.8; p < 0.01). AOFAS scores decreased as the number of associated LTD increased (r = − 0.814; p < 0.001). Cases operated on by PO + tenotomy showed a high rate of complications such as delayed union of the osteotomy (p < 0.01), hypertrophic callus (p < 0.01), phalangeal fracture at the osteotomy site (p < 0.01), and lack of correction (p < 0.05). The overall occurrence of adverse events was 38.6% in cases operated by PO + tenotomy and 13.9% in cases receiving PO alone (p < 0.0001). Cases operated on without tenotomy showed a shorter time to complete recovery for daily life activities (37.4 ± 2.3 versus 43.0 ± 1.7 days; p < 0.01). CONCLUSION: The performance of associated tenotomies to incomplete phalanx osteotomies provides worse clinical outcomes, higher complication rates, and longer recovery time as compared to similar forefoot surgeries without tenotomies. TRIAL REGISTRATION: The study was based on retrospectively registered data starting on May 24, 2008. |
format | Online Article Text |
id | pubmed-6739948 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-67399482019-09-16 The impact of associated tenotomies on the outcome of incomplete phalangeal osteotomies for lesser toe deformities Nieto-García, Eduardo Ferrer-Torregrosa, Javier Ramírez-Andrés, Leonor Nieto-González, Elena Martinez-Nova, Alfonso Barrios, Carlos J Orthop Surg Res Research Article BACKGROUND: Partial or incomplete osteotomy (IO) of the phalanx is recently described in the literature. However, the clinical outcome and the rate of complications when applied to lesser toe deformities (LTD) have been never addressed. This study aims to find out if the association of tenotomies to incomplete or partial phalanx osteotomies has a significant impact on the clinical outcomes, the occurrence of complications, and the recovery time after surgery. METHODS: A retrospective review of two cohorts of cases operated in our institution for hallux abductus valgus (HAV) and associated LTD from 2008 to 2014 was carried out. The surgical correction of both HAV and the associated LTD was always performed by minimally invasive techniques. The study included a total of 223 patients (723 IO in 556 toes). In 129 cases, the IO for LTD correction was performed without tenotomies, and in 94, the procedure was combined with flexor and/or extensor tenotomies. Patients were assessed with the American Orthopaedic Foot and Ankle Society (AOFAS) questionnaire before surgery and at 6- and 12-month follow-up. RESULTS: The mean preoperative AOFAS score before surgery was similar in both cohorts. At 12-month follow-up, the cohort without tenotomies showed better recovery (95.7 ± 2.8 versus 92.5 ± 6.8; p < 0.01). AOFAS scores decreased as the number of associated LTD increased (r = − 0.814; p < 0.001). Cases operated on by PO + tenotomy showed a high rate of complications such as delayed union of the osteotomy (p < 0.01), hypertrophic callus (p < 0.01), phalangeal fracture at the osteotomy site (p < 0.01), and lack of correction (p < 0.05). The overall occurrence of adverse events was 38.6% in cases operated by PO + tenotomy and 13.9% in cases receiving PO alone (p < 0.0001). Cases operated on without tenotomy showed a shorter time to complete recovery for daily life activities (37.4 ± 2.3 versus 43.0 ± 1.7 days; p < 0.01). CONCLUSION: The performance of associated tenotomies to incomplete phalanx osteotomies provides worse clinical outcomes, higher complication rates, and longer recovery time as compared to similar forefoot surgeries without tenotomies. TRIAL REGISTRATION: The study was based on retrospectively registered data starting on May 24, 2008. BioMed Central 2019-09-11 /pmc/articles/PMC6739948/ /pubmed/31511051 http://dx.doi.org/10.1186/s13018-019-1353-0 Text en © The Author(s). 2019 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Research Article Nieto-García, Eduardo Ferrer-Torregrosa, Javier Ramírez-Andrés, Leonor Nieto-González, Elena Martinez-Nova, Alfonso Barrios, Carlos The impact of associated tenotomies on the outcome of incomplete phalangeal osteotomies for lesser toe deformities |
title | The impact of associated tenotomies on the outcome of incomplete phalangeal osteotomies for lesser toe deformities |
title_full | The impact of associated tenotomies on the outcome of incomplete phalangeal osteotomies for lesser toe deformities |
title_fullStr | The impact of associated tenotomies on the outcome of incomplete phalangeal osteotomies for lesser toe deformities |
title_full_unstemmed | The impact of associated tenotomies on the outcome of incomplete phalangeal osteotomies for lesser toe deformities |
title_short | The impact of associated tenotomies on the outcome of incomplete phalangeal osteotomies for lesser toe deformities |
title_sort | impact of associated tenotomies on the outcome of incomplete phalangeal osteotomies for lesser toe deformities |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6739948/ https://www.ncbi.nlm.nih.gov/pubmed/31511051 http://dx.doi.org/10.1186/s13018-019-1353-0 |
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