Modified Lindgren-Turan Osteotomy for Hallux Valgus Deformity - a Review of 60 Cases.

PURPOSE OF THE STUDY To evaluate the clinical and radiological results of a new modification of relatively less-known Lindgren-Turan osteotomy technique in HV deformity that is performed by combining bunionectomy and capsuloplasty. MATERIAL AND METHODS 60 feet of 52 patients with moderate and heavy deformity who were operated between 2009 and 2014 were included in the study. The patients had clinically severe pain, did not respond to at least 6-month conservative treatment and had moderate and severe deformity before Hallux valgus angle (HVA), intermetatarsal angle (IMA), distal metatarsal joint angle (DMAA), proximal phalangeal joint angles (PPAA) and shortening amount in the first metatarsus were measured through preoperative and follow-up radiography. Clinical evaluations were conducted on all patients using American Orthopedic Foot and Ankle Society's (AOFAS) and visual analog scale (VAS). Data of the radiological and clinical evaluations in preoperative and follow-up periods were compared statistically. Statistical significance was accepted at p < 0.05. RESULTS 42 (76.1%) and 10 (23.9%) of 52 patients were female and male, respectively. Mean age of the patients was 50.9±15.52 years. Mean follow-up period of the patients was 43.3±2.1. Preoperative and last measurements: HVA: 36.34°±6.36° - 15.6°±2.83°, IMA: 12.62°±2.24° - 5.83°±1.32°, DMAA: 16.3°±3.45° - 10.3°±2.24°, PFAA: 7.24°±1.32° - 6.12°±0.84° (p < 0.001). Shortness of first metatarsus was measured to be 5.94±1.84 mm. Mean VAS values of the patients which was 8.6±0.4 before the operation was detected as 0.8±0.04 after follow-up (p < 0.001). AOFAS score of the patients which was 42.4±5.3 before the operation was found to be 88.9±7.6 (p < 0.001). All patients started to work again within 5.22±1.7 weeks. Union was completely seen along osteotomy line in all cases. Three patients had screw extraction. Two patients had superficial wound infection. DISCUSSION Capsule plication which we apply with osteotomy as part of our surgical procedure is a significant point in correcting deformity and raising stability. First metatarsophalangeal rigidity risk can be avoided with a controlled plication in operation and by giving the final decision after testing. Such flexibility shows that soft tissue contracture is not the main factor of deformity, so lateral release is not indicated. Thus, our opinion is that digital nerve damage and extra scar are avoided during lateral release. The osteotomy we applied which is extraarticular and subcapital, and protection of racket-shaped capsule cannot be attributed to finding no AVN case. CONCLUSIONS Modified Lindgren-Turan surgical procedure which is applied with capsuloplasty and bunionectomy is an effective and reliable method in treatment of moderate and severe HV deformities. It is recommended as a satisfactory option in HV treatment due to its ease in surgery, use of single incision and perfect clinical and radiological long-term results. Key words:hallux valgus, osteotomy, Lindgren-Turan, capsuloplasty, capsulorrhaphy, bunionectomy, plication.