Abstract:Objective To explore the surgical method of the modified Coughlin osteotomy for surgical treatment of Ⅲ type tailors bunion and report the clinical outcomes.Methods The data of 22 patients (31 feet) with Ⅲ type tailors bunion deformity who were hospitalized for treatment in Xuzhou Central Hospital from March 2013 to April 2015 were retrospectively analyzed. There were 3 males (3 feet) and 19 females (28 feet), aged 26-78(mean 45.3) years old. The modified coughlin osteotomy was used for surgical treatment. Main postoperatively outcome measures included fracture healing, 4-5 intermetatarsal angle, the fifth metatarsophalangeal angle, lateral deviation of the fifth metatarsal angle, pain and appearance. Patients were scored using the American Orthopaedic Foot and Ankle Society (AOFAS) lesser toe metatarsophalangeal-interphalangeal scale.Results All operations were performed with no complications. Primarily healing of the wound was achieved in all cases. All the patients were followed up for a mean time of 17.8 months (range from 6 to 30 months). The mean fracture healing time was 11.6 weeks (range, 6 to 14 weeks). All the patients had satisfactory appearance and sensory function without callosum and metastatic metatarsalgia at the final follow-up. At the final follow-up, the average 4-5 intermetatarsal angle, fifth metatarsophalangeal angle and lateral deviation of the fifth metatarsal angle were 5.9°±1.6°, 6.1°±2.3° and 2.2°±1.2°, respectively, and were less than those of preoperatively angles of 16.3°±5.1°, 10.7°±3.5°, 5.8°±2.6°, respectively, with statistically significant difference(t=10.833, 6.115, 7.000, all P values<0.01); the mean AOFAS score was 89.0±8.4,which was more than that of preoperatively value of 60.2±9.3 with statistically significant difference (t=12.795, P<0.01).Conclusions The modified coughlin osteotomy is a safe and easy treatment option for the Ⅲ type tailors bunion deformity and provides patient satisfaction results.
Deveci A, Yilmaz S, Firat A, et al. An overlooked deformity in patients with hallux valgus tailors bunion[J]. J Am Podiatr Med Assoc, 2015, 105(3): 233-237. DOI:10.7547/0003-0538-105.3.233
[2]
DiDomenico L, Baze E, Gatalyak N. Revisiting the tailors bunion and adductovarus deformity of the fifth digit[J]. Clin Podiatr Med Surg, 2013, 30(3): 397-422. DOI:10.1016/j.cpm.2013.04.004.
[3]
Weil L Jr, Consul D. Fifth metatarsal osteotomies[J]. Clin Podiatr Med Surg, 2015, 32(3): 333-353. DOI:10.1016/j.cpm.2015.03.001.
[4]
Cohen BE, Nicholson CW. Bunionette deformity[J]. J Am Acad Orthop Surg, 2007, 15(5): 300-307. DOI:10.5435/00124635-200705000-00008.
[5]
Michels F, Van Der Bauwhede J, Guillo S, et al. Percutaneous bunionette correction[J]. Foot Ankle Surg, 2013, 19(1): 9-14. DOI:10.1016/j.fas.2012.06.003.
[6]
Vienne P, Oesselmann M, Espinosa N, et al. Modified coughlin procedure for surgical treatment of symptomatic tailors bunion: a prospective followup study of 33 consecutive operations[J]. Foot Ankle Int, 2006, 27(8): 573-580. DOI:10.1177/107110070602700802.
[7]
Kitaoka HB, Alexander IJ, Adelaar RS, et al. Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes[J]. Foot Ankle Int, 1994, 15(7): 349-353. DOI:10.1177/107110079401500701.
[8]
Laffenêtre O, Millet-Barbé B, Darcel V, et al. Percutaneous bunionette correction: results of a 49-case retrospective study at a mean 34 months follow-up[J]. Orthop Traumatol Surg Res, 2015, 101(2): 179-184. DOI:10.1016/j.otsr.2014.11.017.
[9]
Cooper MT, Coughlin MJ. Subcapital oblique osteotomy for correction of bunionette deformity: medium-term results[J]. Foot Ankle Int, 2013, 34(10): 1376-1380. DOI:10.1177/1071100713489121.
[10]
Shimobayashi M, Tanaka Y, Taniguchi A, et al. Radiographic morphologic characteristics of bunionette deformity[J]. Foot Ankle Int, 2016, 37(3): 320-326. DOI:10.1177/1071100715614923.
[11]
Lui TH. Percutaneous osteotomy of the fifth metatarsal for symptomatic bunionette[J]. J Foot Ankle Surg, 2014, 53(6): 747-752. DOI:10.1053/j.jfas.2014.07.016.
[12]
Weil L Jr, Weil LS Sr. Osteotomies for bunionette deformity[J]. Foot Ankle Clin, 2011, 16(4): 689-712. DOI:10.1016/j.fcl.2011.08.012.
Roukis TS, Schade VL. Minimum-incision metatarsal osteotomies[J]. Clin Podiatr Med Surg, 2008, 25(4): 587-607, viii. DOI:10.1016/j.cpm.2008.05.007.
[15]
Hrubina M, Skotak M, Letocha J, et al. The modified scarf osteotomy in the treatment of tailors bunion: midterm follow-up[J]. Acta Orthop Belg, 2015, 81(1): 57-64.
[16]
Waizy H, Olender G, Mansouri F, et al. Minimally invasive osteotomy for symptomatic bunionette deformity is not advisable for severe deformities: a critical retrospective analysis of the results[J]. Foot Ankle Spec, 2012, 5(2): 91-96. DOI:10.1177/1938640011433828.