RU2195892C2 - Method for surgical treatment of cross-sectional foot spreading and varus defect of the great toe - Google Patents

Abstract

FIELD: medicine, traumatology, orthopedics. SUBSTANCE: one should mobilize the first metatarsal bone by dissecting a capsule of the first tarsometatarsal joint, then one should tighten the first and the second metatarsal bones with an allotransplant coming in front of and behind metatarsal bones that improves the springiness of foot and decreases rubbing action of an allotransplant onto metatarsal bones. EFFECT: higher efficiency of operation. 2 dwg, 1 ex

Description

 The invention relates to medicine and relates to methods for surgical treatment of diseases of the musculoskeletal system, in particular patients with lateral spread of the foot and deviation of the first toe outward.

Known methods of treating lateral flattening of the foot with a deviation of the first toe outward:
1. The method of A. F. Krasnov (AF Krasnov, SG Gerasimov. Tendon-muscle plastics in the treatment of transverse flatfoot: the condition of the tendon-muscle apparatus for injuries and orthopedic diseases. Kuibyshev, 1980 - pp. 108-112 ) The essence of the method is the screed of the foot with the tendon of the long extensor 5 of the toe.

 2. The method of A. A. Korzh, D.A. Yaremenko (On surgical treatment of the transverse spread of the foot and Hallux valgus. Orthopedics, traumatology and prosthetics. 1972 - 4. P. 36). A feature of the method is the screed of the foot with a graft passing through the bone tunnels of the metatarsal bones.

Disadvantages:
1. Method A.F. Krasnova - a rather thin tendon of the long extensor of the fifth finger is used to tighten the foot. It can not withstand static (body weight) and dynamic (walking) loads for a long time, which leads to a relapse of deformation.

 2. Method A.A. Korzha, D.Ya. Yaremenko - the transplant passes through the bone tunnels of the metatarsal bones, which significantly weakens their strength with the possibility of a fracture during exercise (walking, running, jumping).

 The analysis of radiographs of the feet of patients with transverse flatness shows that the deflection is based on the deflection of the first metatarsal bone inside. Due to this, flattening and valgus position of the first finger are formed.

 Therefore, a number of authors use resection of the base of the first metatarsal bone and its displacement outside for the treatment of hallux valgus and lateral flattening (Hohmann, according to Litmann, Operative Surgery, 1985, p. 962; V.F. Anishchenko, Orthopedics, traumatology and prosthetics, 1955, 3. S. 43-48).

 An osteotomy or resection of the first metatarsal bone increases the invasiveness of the operation, and the period of postoperative rehabilitation increases, since the fusion of bone fragments is 1.5 months or more.

 For the prototype taken method A.A. Korzha and D.A. Yaremenko.

 The purpose of the invention is the simultaneous correction of deformation of the foot and first finger, reducing the duration of treatment, reducing the number of complications and relapses.

 The essence of the claimed method is as follows. The first metatarsal bone is mobilized by dissecting the capsule of the first metatarsal tarsal joint, the metatarsal exostosis is removed, the external portion of the metatarsophalangeal capsule is dissected, and the first and second metatarsal bones are tightened together. In this case, flattening of the foot and deformation of the first finger are corrected. The first metatarsal bone is firmly fixed in a predetermined position, which guarantees against recurrence of deformation. In addition, the high mobility of the metatarsal bone reduces the strain of the graft during screed, this reduces the possibility of grinding of the metatarsal bones under load, which is observed in known methods.

 The fundamental difference between the proposed method and the known one is that they mobilize the first metatarsal bone by dissecting the capsule of the first metatarsal and tarsal joint, tighten the first and second metatarsal bones with an allograft, passing in front and behind these bones immediately proximal to their heads.

 Figure 1 is a diagram of the operation - dissection of the capsule of the first tarsal-tarsal articulation and removal of exostosis; figure 2 - the position of the first and second metatarsal bones after their tightening with an allograft.

 The method is as follows. The first skin incision is made along the front surface of the foot in the projection of the first tarsal-tarsal joint. Buyalsky’s spatula is placed under the joint. A fibrous capsule of the joint is dissected with a scalpel from the outer, front and back sides, leaving the section without dissection on the inside (Fig. 1). The wound is sutured in layers.

 A second semi-oval skin incision is made along the anteroposterior side of the foot in the projection of the first metatarsophalangeal joint. An fibrous capsule of the joint is cut through an arcuate incision. The lingual flap of the capsule is distally removed and held crochet. Open the joint. Osteotome cut off exostosis (figure 1). The fibrous capsule is dissected with the achilotome from the outside in the transverse plane. The first finger is set in the correct position.

 The third skin incision is performed in the projection of the second metatarsal bone. The third incision is connected to the second tunnel in the soft tissues. The periosteum is separated by a raspator from the first and second metatarsal bones. An allograft is placed behind the second metatarsal bone from the outside, and both ends through a tunnel in soft tissues lead to the first metatarsal bone. One end of the graft passes along the back, the second - along the front surface of the metatarsal bone. The first metatarsal bone is moved outward, setting in the correct position. The ends of the graft are stitched together (figure 2).

 The tongue-like flap of the metatarsophalangeal joint capsule in the tension position is sutured to the allograft. If necessary (thin capsule), the flap is extended due to one of the ends of the allograft. Wounds are sutured in layers. Apply a plaster cast for 1 month.

 The advantage of the proposed method over the known is as follows. Correction of all components of the deformation of the foot at the same time. The first metatarsal bone is easily, without tension installed and securely held in position by a graft carried out on the front and rear surfaces of the first and second metatarsal bones. An insignificant tension of the transplant provides a peculiar biomechanical complex: the leaf spike improves, the grinding effect of the transplant on the metatarsal bones is reduced.

 The proposed method with a positive effect was performed in two patients with lateral flatness of the foot and the deviation of the first toe outward.

 Example 1. Patient Ch. 18 years old was admitted to the clinic of traumatology and orthopedics of the Samara Medical University with a diagnosis of bilateral transverse flatfoot, deviation of the toes outside February 10, 2000. On February 14, operations were performed according to the described method. The patient is laid on his back. Anesthesia - cerebrospinal anesthesia. The first skin incision along the front surface of the right foot in the projection of the first tarsal-tarsal joint. Soft tissue from the joint is separated with a raspator. Under the joint, Buyalsky’s spatulas are summed up. A fibrous capsule is dissected with a scalpel, leaving a bridge on the inside of the joint. The wound is sutured in layers. The second section is a semi-oval shape along the front inner surface of the foot in the projection of the first metatarsophalangeal joint. A capsule of the joint is dissected with a tongue-shaped incision. The joint is opened. Under the head of the metatarsal bone, Buyalsky’s spatula has been placed. An exostosis is brought down by an osteotome. The capsule is dissected from the outside in the transverse direction by the achillotome. Raspator is detached periosteum from the first metatarsal bone. The third skin incision along the front surface of the foot in the projection of the second metatarsal bone. Raspator detached the periosteum from the bone. A third surgical wound is connected to the second tunnel using a forceps. An allograft is inserted behind the second metatarsal bone from the outside, and the ends are drawn through the tunnel in soft tissues, with one end located on the front and the other on the back surface of the bone. The first metatarsal bone is shifted outward to its normal position. The ends of the graft are stitched together with non-absorbable threads. The tongue-like flap is laid in its place and hemmed in the tension position to the allograft. In this case, the first finger took its usual position. The joint capsule on the inside is strengthened by the free end of the allograft. The graft is tensioned moderately. The wounds are sutured.

 On the control radiograph of the foot it is noted: the first metatarsal bone and the first toe of the foot occupy the correct physiological position. A plaster boot is applied for 1 month. A similar operation was performed on the left foot.

 After removing the plaster cast, a course of rehabilitation treatment was carried out. 6 weeks after surgery, the patient noted restoration of movements in the metatarsophalangeal joints. Feet of the usual form, when standing and walking there is no pain. Designated to wear arch support.

 Clinical testing of the method showed that in all cases (4 feet were operated on in 2 patients), a positive result was obtained.

 The method can be recommended in practical medicine.

Claims (1)

 A method for surgical treatment of lateral flattening of the foot and deflecting the first toe outward, including a foot screed, removal of exostosis and the mucosa of the first metatarsal bone, dissecting the capsule from the outside of the first metatarsophalangeal joint, characterized in that the first metatarsal bone is mobilized by dissecting the capsule of the first metatarsal-tarsal articulations, produce a screed of the first and second metatarsal bones with an allograft passing in front and behind the metatarsal bones.

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