J Korean Foot Ankle Soc.  2016 Sep;20(3):126-130. 10.14193/jkfas.2016.20.3.126.

Outcome of Extraarticular Dorsal Closing Wedge Osteotomy for Freiberg's Disease

• Lee JY
• Kim WH
• Jung S
• Yang SH

• KMID: 2351418
• DOI: http://doi.org/10.14193/jkfas.2016.20.3.126

Abstract

PURPOSE
The aim of this study was to evaluate the result of extraarticular dorsal closing wedge osteotomy in Freiberg's disease.
MATERIALS AND METHODS
Between February 2012 and July 2014, total 10 patients who underwent dorsal closing wedge osteotomy and followed up more than 1 year were selected for inclusion. Average age was 16.3 years, and average follow-up period was 15.5 months. The diagnosis was made using magnetic resonance imaging of those with a limitation in walking or usual activity due to pain in the metatarsal head. During operation, we removed loose body, and synovectomy was done. Osteotomy at the metatarsal neck and fixation with Kirschner wire were performed. X-ray was taken to check shortening of 2nd metatarsal and bone union. Moreover, we checked the active range of motion of 2nd metatarsophalangeal joint before and after surgery. At the last follow-up, the shortening of metatarsal, American Orthopaedic Foot and Ankle Society (AOFAS) score, visual analogue scale (VAS), and patient's subjective satisfaction were evaluated.
RESULTS
According to the Smillie's stage, there were 3 cases of stage II, 4 cases of stage III, and 3 cases of stage IV. Average bone union time on the osteotomy site was 8 weeks. Average shortening of metatarsal was 2.53 mm. Average AOFAS score improved significantly from 56.9 to 82.8 points at final follow-up (p<0.05), and average VAS score also improved significantly from 6.4 to 1.4 points at final follow-up (p<0.05). Average active range of motion at metatarsophalangeal joint improved from 28.0° preoperatively to 46.5° at the final follow-up. Other complications, such as metatarsalgia and arthritis, were not found; however, there was 1 case of delayed union with no symptom.
CONCLUSION
In Freiberg's disease, dorsal closing wedge osteotomy is recommended for the improvement of clinical symptoms and range of motion.

Keyword

Freiberg disease; Osteotomy; Dorsal closing wedge; Outcomes

MeSH Terms

Ankle
Arthritis
Diagnosis
Follow-Up Studies
Foot
Head
Humans
Magnetic Resonance Imaging
Metatarsal Bones
Metatarsalgia
Metatarsophalangeal Joint
Neck
Osteotomy*
Range of Motion, Articular
Walking

Figure

• 

  Figure 1. Triangle was drawn at metatarsal neck to measure the amount of osteotomy using the tangent trigonometric ratio. Arrow, rotation of center.

• 

  Figure 2. Plain radiographs and photographs of a 14-year-old female patient. (A, B) Preoperative anteroposterior (AP) and lateral show osteophytes and collapse of second metatarsal head and joint destruction. (C) Preoperative magnetic resonance imaging T2 proton density view show joint effusion and combination of low and high signal intensity with osteonecrosis. Postoperative AP radiograph (D) and last follow-up AP and lateral radiographs (E, F) show well maintained osteotomy site without joint destruction.

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  Figure 3. Jone’s method that mesure the length of the second metatarsal. Line α and β are drawn along the longitudinal axis of the metatarsals. Metatarsal shortening=[{β preoperative × (α postoperative/α preoperative)}– β postoperative]

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