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Online ISSN 1827-1707
Zorzi R. 1, Pessina R. 2, Confalonieri N. 2, Biffi A. 3, Albisetti W. 3
1 C.O.O. Istituto Ortopedico Gaetano Pini, Milano
2 Divisione di Ortopedia e Traumatologia Ospedale di Vimercate
3 Istituto di Scienze Ortopediche Traumatologiche Università di Medicina, Milano
Aim. Demand, from patients with forefoot diseases, to be treated with short hospitalisation surgery, early post-surgery autonomy and quicker functional recovery, led us to employ the mini-invasive technique introduced by Bosch to treat patients suffering from hallux valgus.
Methods. Between September 1999 and Decem-ber 2002 at the Orthopaedic Institute Gaetano Pini in Milan and at the Orthopaedic Division of Vimercate’s Hospital (Milan), 40 patients were operated with Percutaneous Distal Osteo-tomy (PDO) technique : indication for surgery included hallux valgus angle greater than 15° and inter-metatarsal angle (IMA) greater than 12°. The aim of this surgerical technique is “to line up the diaphysis stump of M1 with hallux axle”, through percutaneous distal metaphyseal extra-capsular osteotomy, and to obtain an articular re-orientation through “lateral displacement, tilt, rotation and possible plantar-flexion of the metatarsal head”. A Kirschner wire is positioned, as a stabilizer, by para-ungual medial subcutaneous route. Loading is allowed 2 days after surgery, with Talus shoe. Kirschner wire removal occurs after 4-5 weeks, after X-ray control. Taping, with hallux in hypercorrection, remains for further 15 days, and the patient is invited to start the active and passive mobilization of the metatarsal-phalangeal articulation.
Results. Very satisfying results were obtained as to X-ray parameters and clinical efficacy, with the best patients’ compliance (87,5% would undergo again PDO surgery).
Conclusion. The surgical complications observed are not ascribable to the surgical technique but to surgeon’s errors or to a wrong nursing in the postoperative period.