First metatarsal Pronation is increasingly recognised as an important component of Hallux valgus (HV) and can contribute towards intraoperative malreduction, postoperative recurrence and patient reported outcome measures (1,2,3). There are numerous radiological ways to measure metatarsal rotation on plain radiographs and weight bearing CT (WBCT), however there are no clinical tests to evaluate metatarsal pronation pre- or intra-operatively. This study therefore aimed to examine the relationship between clinical pronation of the toe and metatarsal pronation. Single-centre, retrospective analysis over 5 years. Measurements were performed on WBCT images with digital reconstructions to add soft tissues. First metatarsal rotation was measured using the Metatarsal Pronation Angle as previously described (4). Toe rotation was measured by the Phalangeal Condylar Angle (PCA), the angle between the condyles of the proximal phalanx and the floor, and the Nail Plate Angle (NPA), the angle of the base of the nail plate to the floor in the coronal Plane. These were obtained from 50 feet in Hallux valgus patients, and 50 control patients with CTs done for osteochondral lesions without hallux valgus or hindfoot malalignment.Aims
Methods
Angular deformities of the distal femur can be corrected by opening, closing and neutral wedge techniques. Opening wedge (OW) and closing wedge (CW) are popular and well described in the literature. CW and OW techniques lead to leg length difference whereas the advantage of neutral wedge (NW) technique has several unique advantages. NW technique maintains limb length, wedge taken from the closing side is utilised on the opening side and since the angular correction is only half of the measured wedge on either side, translation of distal fragment is minimum. Leg lengths are not altered with this technique hence a useful technique in large deformities. We found no reports of clinical outcomes using NW technique. We present a technique of performing external fixator assisted NW correction of large valgus and varus deformities of distal femur and dual plating and discuss the results. We have treated 20 (22 limbs – 2 patients requiring staged bilateral corrections) patients for distal femoral varus and valgus deformities with CWDFO between 2019 and 2022. Out of these 4 patients (5 limbs) requiring large corrections of distal femoral angular deformities were treated with Neutral Wedge (NW) technique. 3 patients (four limbs) had distal femoral valgus deformity and one distal femoral varus deformity. Indication for NW technique is an angular deformity (varus or valgus of distal femur) requiring > 12 mm opening/closing wedge correction. We approached the closing side first and marked out the half of the calculated wedge with K – wires in a uniplanar fashion. Then an external fixator with two Schanz screws is applied on the opposite side, inserting the distal screw parallel to the articular surface and the proximal screw 6–7 cm proximal to the first pin and at right angles to the femoral shaft mechanical axis. Then the measured wedge is removed and carefully saved. External fixator is now used to close the wedge and over correct, creating an appropriate opening wedge on the opposite side. A Tomofix (Depuoy Synthes) plate is applied on the closing side with two screws proximal to osteotomy and two distally (to be completed later). Next the osteotomy on the opposite side is exposed, the graft is inserted. mLDFA is measured under image intensifier to confirm satisfactory correction. Closing wedge side fixation is then completed followed by fixation of opposite side with a Tomofix or a locking plate.Introduction
Materials & Methods
