관절외 배부 폐쇄 쐐기 절골술을 이용한 Freiberg병의 치료 결과
Outcome of Extraarticular Dorsal Closing Wedge Osteotomy for Freiberg’s Disease
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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 28.0o preoperatively to 46.5o 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.
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 28.0o preoperatively to 46.5o 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.
참고문헌 (17)
- Freiberg AH, "Infraction of the second metatarsal bone : a typical injury", Surg Gynecol Obstet, 19, pp.191~193 (1914)
- Carmont MR, "Current concepts review : Freiberg's disease", Foot Ankle Int, 30, pp.167~176 (2009)
- 양기원, "프라이버그병과 중족지 관절 불안정", 대한족부족관절학회지, 17(1), pp.11~16 (2013), 대한족부족관절학회
- 이화성, "Freiberg병에서 시행한 Weil 절골술", 대한족부족관절학회지, 15(4), pp.217~222 (2011), 대한족부족관절학회
- Jones S, "Scarf osteotomy for hallux valgus. A prospective clinical and pedobarographic study", J Bone Joint Surg Br, 86, pp.830~836 (2004)
- Smillie IS, "Treatment of Freiberg's infraction", Proc R Soc Med, 60, pp.29~31 (1967)
- Al-Ashhab ME, "A simple surgical technique for treatment of Freiberg's disease", Foot(Edinb), 23, pp.29~33 (2013)
- Yoo CI, "Operative treatment of old neglected Freiberg's infraction(comparison of three techniques)", J Korean Foot Ankle Soc, 8, pp.142~148 (2004)
- Gauthier G, "Freiberg's infraction: a subchondral bone fatigue fracture. A new surgical treatment", Clin Orthop Relat Res, 142, pp.93~95 (1979)
- Coughlin MJ, "Lesser toe deformities", Orthopedics, 10, pp.63~75 (1987)
- Yoon JH, "Treatment of Freiberg's disease with joint debridement and reshaping of metatarsal head", J Korean Orthop Assoc, 33, pp.1056~1062 (1998)
- Lee HJ, "Operative treatment of Freiberg disease using extra-articular dorsal closing-wedge osteotomy : technical tip and clinical outcomes in 13 patients", Foot Ankle Int, 34, pp.111~116 (2013)
- Kinnard P, "Freiberg's disease and dorsiflexion osteotomy", J Bone Joint Surg Br, 73, pp.864~865 (1991)
- Chao KH, "Surgery for symptomatic Freiberg's disease : extraarticular dorsal closing-wedge osteotomy in 13 patients followed for 2-4 years", Acta Orthop Scand, 70, pp.483~486 (1999)
- Lee SK, "Treatment of Freiberg disease with intra-articular dorsal wedge osteotomy and absorbable pin fixation", Foot Ankle Int, 28, pp.43~48 (2007)
- Jiyoun Kim, "Modified Weil Osteotomy for the Treatment of Freiberg’s Disease", Clinics in Orthopedic Surgery, 4(4), pp.300~306 (2012), 대한정형외과학회
- Stanley D, "Assessment of etiologic factors in the development of Freiberg's disease", J Foot Surg, 29, pp.444~447 (1990)