Complications and Early Radiographic Outcomes of Flatfoot Deformity Correction With Metallic Midfoot Opening Wedge Implants
Background: Forefoot varus is a common component of flatfoot deformity that is often surgically addressed. Multiple options exist to plantarflex the medial column, with midfoot fusion and the Cotton osteotomy being the most common. This study analyzes radiographic outcomes and complications when a t...
| Main Authors: | , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
SAGE Publishing
2019-09-01
|
| Series: | Foot & Ankle Orthopaedics |
| Online Access: | https://doi.org/10.1177/2473011419868971 |
| _version_ | 1811333285915131904 |
|---|---|
| author | Tyler W. Fraser MD Anish R. Kadakia MD Jesse F. Doty MD |
| author_facet | Tyler W. Fraser MD Anish R. Kadakia MD Jesse F. Doty MD |
| author_sort | Tyler W. Fraser MD |
| collection | DOAJ |
| description | Background: Forefoot varus is a common component of flatfoot deformity that is often surgically addressed. Multiple options exist to plantarflex the medial column, with midfoot fusion and the Cotton osteotomy being the most common. This study analyzes radiographic outcomes and complications when a titanium wedge is used for structural support in a dorsal opening wedge Cotton osteotomy of the medial cuneiform. Methods: Between December 2016 and May 2018, 32 feet in 31 patients were treated with medial column titanium wedges for residual forefoot varus in association with flatfoot corrections. All participants had preoperative and weight-bearing postoperative radiographs examined for analysis of radiographic correction. The average age of the patients was 41.1 (range: 12-70). The average follow-up time for patients was 12.2 months (8-24). Results: All radiographic parameters were statistically significantly improved from preoperative to postoperative ( P < .05). There were no instances of nonunion of the medial cuneiform osteotomy. There was 1 implant that loosened and was revised to a larger implant that healed uneventfully. No wedges were removed for continued pain at the osteotomy site. Conclusion: This study suggests that metal wedges are both safe and effective for use in medial column correction based on early follow-up data. Future studies comparing titanium wedges versus traditional bone grafting for Cotton osteotomies may provide further analysis of radiographic correction, operative time, procedure cost, and outcomes. There were no instances of pain over the titanium wedge site. Radiographic outcomes are similar to those reported for opening wedge Cotton osteotomies including bone grafting and wedge plates with screws. Future studies will help determine the long-term maintenance of correction and hardware survivorship. Level of Evidence: Level IV, case series. |
| first_indexed | 2024-04-13T16:50:14Z |
| format | Article |
| id | doaj.art-9c96311feb0e48c9b9cac5aaf1b763ef |
| institution | Directory Open Access Journal |
| issn | 2473-0114 |
| language | English |
| last_indexed | 2024-04-13T16:50:14Z |
| publishDate | 2019-09-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Foot & Ankle Orthopaedics |
| spelling | doaj.art-9c96311feb0e48c9b9cac5aaf1b763ef2022-12-22T02:38:58ZengSAGE PublishingFoot & Ankle Orthopaedics2473-01142019-09-01410.1177/2473011419868971Complications and Early Radiographic Outcomes of Flatfoot Deformity Correction With Metallic Midfoot Opening Wedge ImplantsTyler W. Fraser MD0Anish R. Kadakia MD1Jesse F. Doty MD2 University of Tennessee College of Medicine Chattanooga, Chattanooga, TN, USA Northwestern University, Chicago, IL, USA Erlanger Health System, Chattanooga, TN, USABackground: Forefoot varus is a common component of flatfoot deformity that is often surgically addressed. Multiple options exist to plantarflex the medial column, with midfoot fusion and the Cotton osteotomy being the most common. This study analyzes radiographic outcomes and complications when a titanium wedge is used for structural support in a dorsal opening wedge Cotton osteotomy of the medial cuneiform. Methods: Between December 2016 and May 2018, 32 feet in 31 patients were treated with medial column titanium wedges for residual forefoot varus in association with flatfoot corrections. All participants had preoperative and weight-bearing postoperative radiographs examined for analysis of radiographic correction. The average age of the patients was 41.1 (range: 12-70). The average follow-up time for patients was 12.2 months (8-24). Results: All radiographic parameters were statistically significantly improved from preoperative to postoperative ( P < .05). There were no instances of nonunion of the medial cuneiform osteotomy. There was 1 implant that loosened and was revised to a larger implant that healed uneventfully. No wedges were removed for continued pain at the osteotomy site. Conclusion: This study suggests that metal wedges are both safe and effective for use in medial column correction based on early follow-up data. Future studies comparing titanium wedges versus traditional bone grafting for Cotton osteotomies may provide further analysis of radiographic correction, operative time, procedure cost, and outcomes. There were no instances of pain over the titanium wedge site. Radiographic outcomes are similar to those reported for opening wedge Cotton osteotomies including bone grafting and wedge plates with screws. Future studies will help determine the long-term maintenance of correction and hardware survivorship. Level of Evidence: Level IV, case series.https://doi.org/10.1177/2473011419868971 |
| spellingShingle | Tyler W. Fraser MD Anish R. Kadakia MD Jesse F. Doty MD Complications and Early Radiographic Outcomes of Flatfoot Deformity Correction With Metallic Midfoot Opening Wedge Implants Foot & Ankle Orthopaedics |
| title | Complications and Early Radiographic Outcomes of Flatfoot Deformity Correction With Metallic Midfoot Opening Wedge Implants |
| title_full | Complications and Early Radiographic Outcomes of Flatfoot Deformity Correction With Metallic Midfoot Opening Wedge Implants |
| title_fullStr | Complications and Early Radiographic Outcomes of Flatfoot Deformity Correction With Metallic Midfoot Opening Wedge Implants |
| title_full_unstemmed | Complications and Early Radiographic Outcomes of Flatfoot Deformity Correction With Metallic Midfoot Opening Wedge Implants |
| title_short | Complications and Early Radiographic Outcomes of Flatfoot Deformity Correction With Metallic Midfoot Opening Wedge Implants |
| title_sort | complications and early radiographic outcomes of flatfoot deformity correction with metallic midfoot opening wedge implants |
| url | https://doi.org/10.1177/2473011419868971 |
| work_keys_str_mv | AT tylerwfrasermd complicationsandearlyradiographicoutcomesofflatfootdeformitycorrectionwithmetallicmidfootopeningwedgeimplants AT anishrkadakiamd complicationsandearlyradiographicoutcomesofflatfootdeformitycorrectionwithmetallicmidfootopeningwedgeimplants AT jessefdotymd complicationsandearlyradiographicoutcomesofflatfootdeformitycorrectionwithmetallicmidfootopeningwedgeimplants |