RU2269959C1 - Method for operative treatment of valgus deformation of the great toe - Google Patents

Abstract

FIELD: medicine, orthopedics.

SUBSTANCE: the method deals with resecting osteophyte of the 1^st metatarsal bone caput, withdrawing the great toe out of defective position, shortening capsular flap for the value pre-calculated by the following formula X = l - l x cos α, where X - excess of capsular flap developed after withdrawing the toe out of defective position, l - the length of the great toe, α - the angle of deviation of the great toe against the axis of the 1^st metatarsal bone and suturing up capsular flap to proximal capsular department and due to applying transossal p-shaped suture to the 1^st metatarsal bone that enables to optimally develop capsular flap for improving parameters of components of metatarso-phalangeal articulation.

EFFECT: higher efficiency of therapy.

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Description

The present invention relates to medicine, in particular to orthopedics, and can be used in surgical treatment of hallux valgus deformity of the first toe.

A known method, which consists in a Y-shaped dissection of the capsule and suturing with tension after correction of the axis of the finger (Helal D. The Foot. New York, 1993, P.124).

As a prototype, a method was selected consisting in making an incision on the rear of the first metatarsophalangeal joint, cutting out the capsule flap with the base on the proximal phalanx of the first toe, removing it from the vicious position, removing the osteophyte of the head of the first metatarsal bone, sawing off the head along the edge of the articular cartilage, removing the heads of the spongy substance with the formation of a bone-cartilaginous cap, dressing it on the sawdust of the first metatarsal bone with correction of the axis of the first finger and suturing of the wound [see Barteneva I.S. Osteoplastic reconstruction of the head of the first metatarsal bone according to the method of A.K. Tychinkina with hallux valgus deformity of the big toe. - Abstract. diss ... cand. honey. sciences. Gorky, 1969, pp. 8-10].

However, as a result of the method, there is an excess of capsule tissue and a thickening of the rough subcutaneous scar, which leads to pain in the region of the head of the first metatarsal bone and relapse of deformation.

The task of the invention is to improve the anatomical and functional results of the operation.

The problem is solved due to the fact that after access to the first metatarsophalangeal joint, separation of the capsule flap with the base on the proximal phalanx of the first finger, resection of the osteophyte of the head of the first metatarsal bone, removal of the first finger from the vicious position, shorten the capsule flap by the amount previously calculated by the formula: X = ll × cosα, where

X - excess capsular flap formed after removing the finger from a vicious position;

l is the length of the first finger;

α is the angle of deviation of the first finger from the axis of the first metatarsal bone,

and hem it to the proximal portion of the capsule and to the first metatarsal bone with a transossal U-shaped suture with tension.

The essence of the method of surgical treatment of hallux valgus of the first toe is illustrated by the drawings, in which Fig. 1 shows the position of the capsule of the first metatarsophalangeal joint before correcting the axis of the first toe, and Fig. 2 shows the position of the capsule after putting the toe in the correct position.

The method is as follows: make an arcuate incision along the dorsum-medial surface of the foot, cut out the capsule flap 1 with the base on the proximal phalanx of the first finger, osteophyte 2 of the head of the first metatarsal bone is resected (Fig. 1). The first finger and the first metatarsal bone are removed from the vicious position and the capsule flap is shortened, after calculating the excess capsule according to the formula: X = ll × cosα, where X is the excess capsule flap formed after removing the finger from the vicious position, l is the length of the first finger, α - the angle of deviation of the first finger from the axis of the first metatarsal bone. Then the capsule flap 1 is sutured to the proximal 3 of the capsule "edge to edge" with tension (figure 2) and additionally impose a transossal U-shaped seam. Layered stitches on the wound.

Clinical example.

Patient Ch., And / b No. 204788, was admitted with a diagnosis of bilateral valgus deformity of the first toe of the second degree. Previously, the patient was not treated. The disease is five years old. The patient walked with a limp without additional support. The pain occurred when walking for more than three hours. Movements in the first metatarsophalangeal joint in the sagittal and horizontal planes were moderately limited. The following were determined: deformation of the first metatarsophalangeal joints, violation of the axis of the first and second fingers. The deflection angle of the first finger was 20 °, the length of the first finger was 6 cm. The shortening of the capsule flap was calculated by the formula X = l-l × cosα, where

X - excess capsular flap formed after removing the finger from a vicious position;

l is the length of the first finger;

α is the angle of deviation of the first finger from the axis of the first metatarsal bone.

In this patient: X = 60-60 × cos20 ° = 60-60 × 0.9397 = 60-56.4 = 3.6 mm.

The patient underwent surgery: reconstruction of the forefoot of the right foot (removal of osteophyte, capsular plastic of the first metatarsophalangeal joint, corrective osteotomy of the first metatarsal bone with the introduction of a bone wedge made of resected osteophyte into the osteotomy zone, fixation with a spoke). The postoperative period was uneventful. Anatomical, functional and cosmetic results are excellent. When viewed after six months, no complaints. The outcome of surgical treatment is rated as excellent.

The proposed method allows to increase the anatomical and functional results of surgical treatment of hallux valgus of the first toe due to a thorough preoperative examination and improve the anatomical parameters of the components of the first metatarsophalangeal joint.

Claims (1)

A method of surgical treatment of hallux valgus of the first toe by accessing the first metatarsophalangeal joint, cutting out the capsule flap with the base on the proximal phalanx of the first finger, resection of the osteophyte of the head of the first metatarsal bone, removing the first finger from the vicious position, characterized in that the capsular flap is shortened by an amount previously calculated by the formula: X = ll · cosα, where X is the excess of the capsule flap formed after removing the finger from the vicious position, l is the length of the first pal d, α - the angle of deviation of the first finger from the axis of the first metatarsal bone, and hem it to the proximal portion of the capsule and first metatarsal bone with a transossal U-shaped suture with tension.

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