Matched retrospective analysis of three different fixation devices for chevron osteotomy

Fixation with bioabsorbable pins in distal chevron bunionectomy reduces the inconvenience and the risk of infection associated with fixation with stainless-steel Kirschner wires, which leaves a portion of the wires protruding from the skin. However, use of bioabsorbable implants has been reported to be associated with osteolysis and formation of a sinus with a sterile discharge. We studied the outcome and complications seen with use of poly-p-dioxanone pins and those seen with use of stainless-steel Kirschner wires after chevron bunionectomy in 114 patients (144 feet). We found no difference between the treatment groups with regard to the prevalence of complications or the stability of fixation. Notably, the prevalence of osteolysis was quite similar between the treatment groups; none of the feet that had had fixation with bioabsorbable pins had formation of a sinus with a sterile discharge. We believe that bioabsorbable pins can be used reliably to fix the site of the osteotomy for a distal chevron bunionectomy without undue risk of osteolysis or other complications.

The authors propose a new bioabsorbable fixation device to be applied to V-shaped transverse osteotomies of the head of the first metatarsal (Austin-chevron osteotomies) for hallux valgus surgery. Namely, a 3.3-mm. diameter cortical screw made of poly-L-lactic acid. This screw was applied in 30 patients with an average age of 44 years (range: 20 to 61). A total of 35 osteotomies was performed. The study refers to the period between 1992 and 1994 with a mean follow-up of 18 months (range: 12 to 36 months). The results of the study demonstrate good stability of the synthesis, with normal union (mean: 4 weeks), no adverse tissue reactions or osteolytic phenomena were noted. One patient developed avascular necrosis of the metatarsal head, which in the opinion of the authors, was not due to the device implanted. Over 90% of the patients were satisfied with both the aesthetic and functional results. The authors conclude that the poly-L-lactic acid cortical screw is a promising bioabsorbable fixation device for this corrective osteotomy in selected patients less than 50 years old, with good first metatarsal bone stock.

The chevron osteotomy is a popular procedure used for the correction of moderate hallux abducto valgus deformity. Fixation is typically accomplished with Kirschner wires or bone screws; however, in cystic or osteoporotic bone, these could be inadequate, resulting in displacement of the capital fragment. We propose using a locking plate and interfragmental screw for fixation of the chevron osteotomy that could reduce the healing time and decrease the incidence of displacement. We performed a retrospective cohort study for chevron osteotomies on 75 feet (73 patients). The control groups underwent fixation with 1 screw in 30 feet (40%) and 2 screws in 30 feet (40%). A total of 15 feet (20%) were included in the locking plate and interfragmental screw group. The patients were followed up until bone healing was achieved at a median of 7 (range 6 to 14) weeks. Our hypothesis was that those treated with the locking plate and interfragmental screw would have a faster healing time and fewer incidents of capital fragment displacement compared with the 1- or 2-screw groups. The corresponding mean intervals to healing for the 1-screw group was 7.71 ± 1.28 (range 6 to 10) weeks, for the 2-screw group was 7.27 ± 1.57 (range 6 to 14) weeks, and for the locking plate and interfragmental screw group was 7.01 ± 1.00 (range 6 to 9) weeks. One case of capital fragment displacement occurred in the single screw group and one in the 2-screw group. No displacement occurred in the locking plate and interfragmental screw group. Neither finding was statistically significant. However, we believe the locking plate and interfragmental screw could be a viable option in patients with osteoporotic and cystic bone changes for correction of hallux abducto valgus.