Long-term Follow-up of Dorsal Wedge Osteotomy for Pediatric Freiberg Disease. (January 2016)

• Record Type: Journal Article
• Authors: Pereira, Bruno S.; Frada, Tiago; Freitas, Daniel; Varanda, Pedro; Vieira-Silva, Manuel; Oliva, Xavier Martin; Duarte, Rui M.
• Is Part Of: Foot & ankle international. Volume 37:Number 1(2016:Jan.)
• Page Start: 90
• Page End: 95
• Publication Date: 2016-01
• Subjects: forefoot disorders -- Freiberg disease -- Gauthier and Elbaz -- metatarsal heads -- dorsal wedge osteotomy; Foot -- Abnormalities -- Periodicals; Ankle -- Abnormalities -- Periodicals; Orthopedics -- Periodicals; 617.585
• DOI: 10.1177/1071100715598602
• Languages: English
• ISSNs: 1071-1007

Abstract

Background: Treatment for Freiberg disease has been largely conservative despite availability of various operative options for severe or refractory cases. The aim of this study was to evaluate the long-term results of pediatric patients with symptomatic Freiberg disease treated with intra-articular dorsal wedge osteotomy. Methods: Pediatric patients treated for Freiberg disease with surgery between January 1982 and 1999 were identified and selected for long-term clinical evaluation. Patients were evaluated regarding operative satisfaction and clinical outcome, performed according to the American Orthopaedic Foot & Ankle Society (AOFAS) lesser toe metatarsophalangeal-interphalangeal scale and range of motion (ROM) of metatarsophalangeal (MTP) joint. Patients had radiographic assessment of degenerative joint status with anteroposterior and oblique foot x-ray. Twenty patients (18 female, 2 male; mean age 15.2 years; range 12-17 years) were identified. The mean follow-up period was 23.4 (range 15-32) years. Results: The clinical outcomes of our patients were classified as excellent in 16 (80%) and good in 4 (20%). The AOFAS mean score was 96.8 (range 91-100) points at the last clinical appointment. A negative correlation between AOFAS score and time of follow-up (r's = −0.61, P < .001) was found. Also, a strong negative correlation was found between Smillie classification and AOFAS final score (r's = −0.88, P < .001). Conclusion: The patients were very satisfied with pain and quality of life at a mean follow-up time of 23.4 years. To our knowledge, this is the first long-term follow-up report supporting the procedure described by Gauthier and Elbaz as a good option for operative treatment of Freiberg disease. Level of Evidence: Level IV, retrospective case series.