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Abstract：
BACKGROUND: Forefoot varus is a common component of flatfoot deformity that is often surgically addressed. Multiple options exist to plantarflex the medial column, with midfoot fusion and the Cotton osteotomy being the most common. This study analyzes radiographic outcomes and complications when a titanium wedge is used for structural support in a dorsal opening wedge Cotton osteotomy of the medial cuneiform.
METHODS: Between December 2016 and May 2018, 32 feet in 31 patients were treated with medial column titanium wedges for residual forefoot varus in association with flatfoot corrections. All participants had preoperative and weight-bearing postoperative radiographs examined for analysis of radiographic correction. The average age of the patients was 41.1 (range: 12-70). The average follow-up time for patients was 12.2 months (8-24).
RESULTS: All radiographic parameters were statistically significantly improved from preoperative to postoperative (P < .05). There were no instances of nonunion of the medial cuneiform osteotomy. There was 1 implant that loosened and was revised to a larger implant that healed uneventfully. No wedges were removed for continued pain at the osteotomy site.
CONCLUSIONS: This study suggests that metal wedges are both safe and effective for use in medial column correction based on early follow-up data. Future studies comparing titanium wedges versus traditional bone grafting for Cotton osteotomies may provide further analysis of radiographic correction, operative time, procedure cost, and outcomes. There were no instances of pain over the titanium wedge site. Radiographic outcomes are similar to those reported for opening wedge Cotton osteotomies including bone grafting and wedge plates with screws. Future studies will help determine the long-term maintenance of correction and hardware survivorship.
METHODS: Level IV, case series.
METHODS: Between December 2016 and May 2018, 32 feet in 31 patients were treated with medial column titanium wedges for residual forefoot varus in association with flatfoot corrections. All participants had preoperative and weight-bearing postoperative radiographs examined for analysis of radiographic correction. The average age of the patients was 41.1 (range: 12-70). The average follow-up time for patients was 12.2 months (8-24).
RESULTS: All radiographic parameters were statistically significantly improved from preoperative to postoperative (P < .05). There were no instances of nonunion of the medial cuneiform osteotomy. There was 1 implant that loosened and was revised to a larger implant that healed uneventfully. No wedges were removed for continued pain at the osteotomy site.
CONCLUSIONS: This study suggests that metal wedges are both safe and effective for use in medial column correction based on early follow-up data. Future studies comparing titanium wedges versus traditional bone grafting for Cotton osteotomies may provide further analysis of radiographic correction, operative time, procedure cost, and outcomes. There were no instances of pain over the titanium wedge site. Radiographic outcomes are similar to those reported for opening wedge Cotton osteotomies including bone grafting and wedge plates with screws. Future studies will help determine the long-term maintenance of correction and hardware survivorship.
METHODS: Level IV, case series.
摘要：
背景：前脚内翻是平足畸形的常见组成部分，通常通过手术解决。存在多个选项来plantarflex内侧柱，最常见的是中足融合术和Cotton截骨术。这项研究分析了钛楔形用于背侧开口楔形棉骨切开术中的结构支撑时的影像学结果和并发症。
方法：在2016年12月至2018年5月之间，31例患者中的32英尺接受内侧柱钛楔治疗，用于治疗与平足矫正相关的残余前足内翻。所有参与者都进行了术前和负重术后X线检查，以分析X线校正。患者的平均年龄为41.1（范围：12-70）。患者平均随访时间为12.2个月(8～24个月)。
结果：所有影像学参数从术前到术后均有显著改善（P<0.05）。没有内侧楔形骨截骨术不愈合的实例。有1个植入物松动，并被修改为一个较大的植入物，愈合顺利。在截骨部位没有因持续疼痛而移除楔形物。
结论：这项研究表明，根据早期随访数据，金属楔子用于内侧柱矫正既安全又有效。未来的研究比较钛楔与传统植骨的棉花截骨术可能提供进一步的分析，影像学矫正，手术时间,程序成本，和结果。钛楔部位没有疼痛的情况。放射学结果与所报道的开放楔形棉花截骨术相似，包括植骨和带螺钉的楔形板。未来的研究将有助于确定矫正和硬件生存的长期维持。
方法：四级，案例系列。
方法：在2016年12月至2018年5月之间，31例患者中的32英尺接受内侧柱钛楔治疗，用于治疗与平足矫正相关的残余前足内翻。所有参与者都进行了术前和负重术后X线检查，以分析X线校正。患者的平均年龄为41.1（范围：12-70）。患者平均随访时间为12.2个月(8～24个月)。
结果：所有影像学参数从术前到术后均有显著改善（P<0.05）。没有内侧楔形骨截骨术不愈合的实例。有1个植入物松动，并被修改为一个较大的植入物，愈合顺利。在截骨部位没有因持续疼痛而移除楔形物。
结论：这项研究表明，根据早期随访数据，金属楔子用于内侧柱矫正既安全又有效。未来的研究比较钛楔与传统植骨的棉花截骨术可能提供进一步的分析，影像学矫正，手术时间,程序成本，和结果。钛楔部位没有疼痛的情况。放射学结果与所报道的开放楔形棉花截骨术相似，包括植骨和带螺钉的楔形板。未来的研究将有助于确定矫正和硬件生存的长期维持。
方法：四级，案例系列。
