Screw Versus Plate Fixation for Chevron Osteotomy: A Retrospective Study

• Published in: The Journal of foot and ankle surgery 2016-01, Vol.55 (1), p.81-84
• Main Authors: Andrews, Boyd J., DPM, Fallat, Lawrence M., DPM, FACFAS, Kish, John P., PhD
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Austin bunionectomy; Bone Plates; Bone Screws; Bone Wires; displacement; Female; hallux valgus; Hallux Valgus - diagnostic imaging; Hallux Valgus - surgery; healing; Humans; Male; metatarsal; Metatarsal Bones - diagnostic imaging; Metatarsal Bones - surgery; Middle Aged; Orthopedics; osteoporotic; Osteotomy - methods; radiographic; Radiography; Retrospective Studies; Young Adult
• ISSN: 1067-2516; 1542-2224
• DOI: 10.1053/j.jfas.2015.06.024

Abstract 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.