Wagner Pablo, Wagner Emilio
Orthopedic Department, Clínica Alemana, Universidad del Desarrollo, Santiago, Chile.
Hospital Militar de Santiago, Universidad de los Andes, Santiago, Chile.
Foot Ankle Orthop. 2023 Aug 14;8(3):24730114231195049. doi: 10.1177/24730114231195049. eCollection 2023 Jul.
Hallux valgus deformity consists of a lateral deviation of the great toe, metatarsus varus, and pronation of the first metatarsal. Most osteotomies only correct varus, but not the pronation of the metatarsal. Persistent postoperative pronation has been shown to increase deformity recurrence and have worse functional outcomes. The proximal rotational metatarsal osteotomy (PROMO) technique reliably corrects pronation and varus through a stable osteotomy, avoiding fusing any healthy joints. The objective of this research is to show a prospective series of the PROMO technique.
Twenty-five patients (30 feet) were operated with the PROMO technique. The sample included 22 women and 3 men, average age 46 years (range 22-59), for a mean prospective follow-up of 1 year (range 9-14 months). Inclusion criteria included symptomatic hallux valgus deformities, absence of severe joint arthritis, or inflammatory arthropathies, with a metatarsal malrotation of 10 degrees or more, with no tarsometatarsal subluxation or arthritis on the anteroposterior or lateral foot radiograph views. The mean preoperative and postoperative Lower Extremity Functional Scale (LEFS) score, metatarsophalangeal angle, intermetatarsal angle, metatarsal malrotation, complications, satisfaction, and recurrence were recorded.
The mean preoperative and postoperative LEFS scores were 56 and 73. The median pre-/postoperative metatarsophalangeal angle was 32.5/4 degrees and the intermetatarsal angle 15.5/5 degrees. The metatarsal rotation was satisfactorily corrected in 24 of 25 patients. An Akin osteotomy was needed in 27 of 30 feet. All patients were satisfied with the surgery, and no recurrence or complications were found.
PROMO is a reliable technique, with good short-term results in terms of angular correction, satisfaction, and recurrence. Long-term studies are needed to determine if a lower hallux recurrence rate occurs with the correction of metatarsal rotation in comparison with conventional osteotomies.
IV, prospective case series.
拇外翻畸形包括拇趾向外偏斜、跖骨内翻以及第一跖骨前旋。大多数截骨术仅能矫正内翻，而无法纠正跖骨前旋。术后持续性前旋已被证明会增加畸形复发率，并导致更差的功能结果。近端旋转跖骨截骨术（PROMO）技术通过稳定的截骨术可靠地矫正前旋和内翻，避免融合任何健康关节。本研究的目的是展示一系列关于PROMO技术的前瞻性病例。
25例患者（30足）接受了PROMO技术手术。样本包括22名女性和3名男性，平均年龄46岁（范围22 - 59岁），平均前瞻性随访1年（范围9 - 14个月）。纳入标准包括有症状的拇外翻畸形、无严重关节关节炎或炎性关节病、跖骨旋转不良10度或以上，在足部前后位或侧位X线片上无跗跖关节半脱位或关节炎。记录术前和术后的平均下肢功能量表（LEFS）评分、跖趾关节角、跖间角、跖骨旋转不良、并发症、满意度和复发情况。
术前和术后LEFS评分的平均值分别为56分和73分。术前/术后跖趾关节角的中位数分别为32.5度/4度，跖间角为15.5度/5度。25例患者中有24例的跖骨旋转得到了满意矫正。30足中有27足需要进行Akin截骨术。所有患者对手术均满意，未发现复发或并发症。
PROMO是一种可靠的技术，在角度矫正、满意度和复发方面具有良好的短期效果。需要进行长期研究以确定与传统截骨术相比，矫正跖骨旋转是否能降低拇趾复发率。
IV级，前瞻性病例系列。
