RU2320287C1 - Method for surgical therapy of transverse platypodia - Google Patents

Abstract

FIELD: medicine, orthopedics.

SUBSTANCE: the present innovation deals with carrying out osteotomy of proximal department of the 1^st metatarsal bone and fixing the first radius of the foot. Moreover, one should resect the capita of the 2^nd and the 3d metatarsal bones from plantar side, out of the capsule of the 1^st metatarso-phalangeal joint one should cut a fragment, its bottom being on proximal phalanx of a great toe. Then it is necessary to dissect the excess of the fragment, carry out marginal resection of the caput of the 1^st metatarsal bone, wedge osteotomy of proximal department of the 1^st metatarsal bone. After that distal fragment of metatarsal bone should be shifted towards inside of the foot, rotated towards outside to be bent. Through the bones that comprise the first radius of the foot one should apply the needles to fix them upon a threaded rod. A fragment cut out of articular capsule should be sutured towards proximal department of articular capsule. Then one should fulfill the compression in area of osteotomy followed by distraction of the 1^st metatarso-phalangeal joint. The innovation enables to exclude the disorders in circulation of the caput of the 1^st metatarsal bone and subsequent development of arthrosis, avoid all the components of deformation (such as: varus deviation and internal rotation of the 1^st metatarsal bone, valgus deviation of the great toe, decreased transverse arch of the foot), decrease the possibility for the development of deformation relapse and provide stable osteosynthesis.

EFFECT: higher efficiency of therapy.

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Description

The present invention relates to medicine, in particular to orthopedics.

A known method of surgical treatment of transverse flatfoot by osteotomy of the proximal metatarsal bone with preservation of the lateral cortical layer, implantation of a sphenoid bone autograft and fixation of the first and second metatarsal bones with a nylon screed (see Bezhenutsa V.I. Reconstruction of the forefoot with hallux valgus // Orthopedics, traumatology and prosthetics. - 1979. - No. 7. - P.56-57).

As a prototype, the method of surgical treatment of transverse flatfoot was chosen, consisting in segmental subepiphysial resection of the first metatarsal bone, displacement of the distal fragment to the proximal, osteotomy of the first metatarsal bone in the proximal section with the introduction of a sphenoid bone autograft into the osteotomy zone and fixation of the spoke through the first metatarsal see Popov A.V. Treatment of lateral flattening of the foot and hallux valgus deviation of the first toe: Abstract of thesis ... of Candidate of Medical Sciences. - M., 2000 .-- P.7).

However, the implementation of subepiphyseal resection of the first metatarsal bone leads to disruption of blood supply to the head of the first metatarsal bone with the subsequent development of arthrosis of the first metatarsophalangeal joint, and fixation with a spoke through the joint causes the development of contracture and damage to the articular cartilage. In addition, the method does not provide a sufficiently stable fixation of bone fragments.

The objective of the invention is to eliminate the violation of blood supply to the head of the first metatarsal bone, prevent the development of postoperative complications and ensure stable osteosynthesis.

The problem is solved due to the fact that in the method, including osteotomy of the proximal first metatarsal bone and fixation of the first ray of the foot, the plantar crests of the heads of the second and third metatarsal bones are resected, capsule plastic of the first metatarsophalangeal joint is performed, osteotomy with resection of the wedge, distal metatarsal bone fragment displaced inside the foot, rotate it outward and bend, and through the bones that make up the first beam of the foot, draw the spokes and fix them on a threaded rod with subsequent compression in not osteotomy and distraction of the first metatarsophalangeal joint.

The method of surgical treatment of transverse flatfoot is illustrated in the drawing, which shows a diagram of the operation.

The method is as follows. A plantar incision provides access to the second and third metatarsophalangeal joints and excision of the changed soft tissues and resection of the plantar crests of the second and third metatarsal bones are performed. Then, a semi-oval incision along the dorsum-inner surface of the foot provides access to the first metatarsal bone and the first metatarsophalangeal joint. To eliminate the deviation of the first finger, a flap 1 is cut from the joint capsule, the base of which is located on the proximal phalanx of the first finger. Excess flap is excised. Then the tendon 2 of the muscle leading to the first finger is crossed, and a marginal modeling resection of the head of the first metatarsal bone is performed. After that, through the first sphenoid bone from the dorsal-medial surface of the foot in the direction from the outside to the inside of the lateral section, a spoke 3 is inserted percutaneously with a diameter of 1.5 mm. The knitting needle 4 is carried out at an acute angle to the knitting needle 3, positioning the skin injection site proximal. Through the diaphysis, the spoke 5 is carried perpendicular to the axis of the metatarsal bone, the spoke 6 is drawn into the diaphysis of the bone at an acute angle to the spoke 5, and the spoke 7 is passed through the main phalanx of the first finger, perforating both cortical layers. Then, an osteotomy is performed between the knitting needles 4 and 5 with a resection of the wedge with a lateral base and the distal fragment of the first metatarsal bone is displaced inside the foot, eliminating flatness and normalizing the tarsal angle. The distal fragment is rotated outwardly within 10 ° and bent by 5-10 ° in the plantar direction. The first finger is also brought to the correction position. The spokes are fixed on a threaded rod 8 provided with washer special fixators 9. The cut capsule flap 1 is sutured to the proximal section 10 of the joint capsule. Using nuts 11, distraction of the first metatarsophalangeal joint is performed until a normal joint gap is reached and compression in the osteotomy zone. The surgical wound is sutured.

Clinical example

Patient N., 22 years old, (and / b No. 210987) was admitted to the adult orthopedics department of the NNIIITO with complaints of pain in both feet while walking, inconvenience in choosing shoes, calluses on the II and III fingers, inferiority complex: shyness when doing exercises in pool. Diagnosis at admission: transverse flatfoot 3 tbsp., Right-sided hallux valgus III degree. After appropriate examination and preoperative preparation, an osteoplastic reconstruction of the forefoot of the right foot was performed. Accessed to the first metatarsal bone. At the same time, the mucous bag of the first metatarsophalangeal joint was partially excised, a flap was cut from the joint capsule in the form of a wide internal ligament 25 mm long and 15 mm wide. Using a bit, an edge resection of the medial surface of the head of the first metatarsal bone was performed. The needles are made according to the above method. In the proximal metatarsal bone, corrective sphenoid osteotomy was performed. The distal bone fragment is deerotated, shifted to normal values of the first intertarsal angle, plantar flexion is performed. The first finger is in the correct position. Layered seam wounds. Compression in the osteotomy zone of the first metatarsal bone and mild distraction in the first metatarsophalangeal joint are given. Aseptic dressing. X-ray control. The patient was examined after 45 days. The condition is satisfactory, on the control radiograph the position of the bones of the first ray of the foot is correct, the metal structures are removed. The patient is satisfied with the cosmetic result.

The proposed method allows to avoid trauma to the articular cartilage of the first metatarsophalangeal joint by metal structures, prevents blood supply to the head of the first metatarsal bone and subsequent development of arthrosis, eliminates all components of the deformation (varus deviation and internal rotation of the first metatarsal bone, valgus deviation of the first finger, deformation of the head of the first metatarsal bone, deformation heads of the second and third metatarsal bones, a decrease in the transverse arch of the foot), reduces the likelihood of developing recurrence deformation strain, provides stable osteosynthesis.

Claims (1)

A method of surgical treatment of transverse flatfoot, consisting in an osteotomy of the proximal first metatarsal bone and fixation of the first ray of the foot, characterized in that the heads of the second and third metatarsal bones are resected from the plantar side, a flap is cut from the capsule of the first metatarsophalangeal joint with the base on the proximal phalanx of the first finger, dissect the excess flap, produce a marginal resection of the head of the first metatarsal bone, sphenoid osteotomy of the proximal first metatarsal bone, distal The metatarsal bone fragment is displaced inside the foot, rotated outwardly and bent, through the bones that make up the first ray of the foot, spokes are held and fixed on a threaded rod, a flap cut from the joint capsule is sutured to the proximal joint capsule, compression is performed in the osteotomy zone and distraction the first metatarsophalangeal joint.