Treatment of Freiberg's disease by Gauthier's dorsal cuneiform osteotomy: Retrospective study of 30 cases.

Abstract

INTRODUCTION:

Freiberg's disease is osteonecrosis of the dorsal side of a metatarsal head. The gold-standard surgical treatment is the osteotomy procedure first described by Gauthier.

HYPOTHESIS:

Gauthier osteotomy for Freiberg's disease will restore the joint space and lead to long-term clinical improvement. A retrospective study was carried out to verify this hypothesis.

MATERIAL AND METHODS:

This study involved 30 consecutive cases treated by a single surgeon in 28 patients having a mean age of 61.2 years. These patients underwent the Gauthier osteotomy procedure with one or two dorsal staples used for fixation. Patients were reviewed 15 days, 45 days and 3 months after the procedure, and then at the last follow-up to look for any complications and determine patient satisfaction, the AOFAS score, metatarsophalangeal range of motion (ROM), sphericity of the metatarsal head, bone union and metatarsal shortening.

RESULTS:

The average follow-up was 6.5 years ± 2.2. The second metatarsal was affected in 27 cases and the third metatarsal in 3 cases. Discomfort related to the staples was noted in five cases; the staples were removed in three of them. There was one case of severe stiffening (< 20° ROM). At the last follow-up, 17 cases were very satisfied, 11 were satisfied and 2 were moderately satisfied. The average AOFAS score was 83.8 points ± 11.8 at the last follow-up. A mean loss of 15° plantar flexion and 10° dorsiflexion was noted. Bone union and metatarsal head sphericity were achieved in all cases. The average shortening was 2 mm ± 1.4.

CONCLUSIONS:

The Gauthier osteotomy procedure results in recovery of the metatarsal head's sphericity in every case of this series, with good clinical results and low morbidity.

• Authors: M Helix-Giordanino, E Randier, S Frey, B Piclet, French association of foot surgery (AFCP)
• Journal: Orthopaedics & traumatology, surgery & research : OTSR (Orthop Traumatol Surg Res) Vol. 101 Issue 6 Suppl Pg. S221-5 (Oct 2015) ISSN: 1877-0568 [Electronic] France
• PMID: 26362040 (Publication Type: Journal Article)
• Copyright: Copyright © 2015 Elsevier Masson SAS. All rights reserved.

Topics

• Adult
• Aged
• Aged, 80 and over
• Female
• Follow-Up Studies
• Humans
• Male
• Metatarsal Bones (surgery)
• Metatarsus (abnormalities, physiopathology, surgery)
• Middle Aged
• Osteochondritis (congenital, physiopathology, surgery)
• Osteotomy (methods)
• Patient Satisfaction
• Range of Motion, Articular
• Retrospective Studies
• Time Factors