Original article

Croatian rotatory oblique three-dimensional osteotomy (CROTO) – a modified Wilson’s osteotomy for adult hallux valgus intended to prevent dorsal displacement of the distal fragment and to reduce shortening of the first metatarsal bone

Authors

• • Robert Kolundžić Robert Kolundžić ORCID profile. (opens in new tab)
  • University Hospital Centre “Sestre Milosrdnice”, Zagreb, Department of Trauma surgery, Croatia
• • Mladen Mađarević
  • University Hospital Centre, Zagreb, Department of Orthopaedic Surgery, Croatia
• • Vladimir Trkulja
  • School of Medicine, Zagreb University, Zagreb, Croatia
• • Tomislav Crnković
  • County General Hospital, Požega, Department of Orthopaedic and Trauma Surgery, Croatia
• • Igor Šmigovec
  • University Hospital Centre, Zagreb, Department of Orthopaedic Surgery, Croatia
• • Daniel Matek
  • University Hospital Centre, Zagreb, Department of Orthopaedic Surgery, Croatia

Abstract

Aim: To evaluate biomechanical and clinical outcomes of a newly developed modification of the Wilson's osteotomy for hallux valgus: a three-dimensional subcaptial correction of the metatarsal head position with a simultaneous lateral and plantar shift with derotation intended to reduce displacement of the distal fragment and shortening of the first metatarsal bone.

Methods: Thirty four feet (28 female patients) underwent the new procedure and were evaluated before and 12 to 84 months (medi-an=25.5) after the surgery.

Results: Plantar shift of the distal fragment was achieved in all feet. Shortening of the first metatarsal was moderate: ?6 mm in 32/34 feet, 7 and 10 mm in the remaining two. Median difference in metatarsal index post-vs. pretreatment was-4.0. The hallux valgus angle, intermetatarsal and distal metatarsal articular angles were reduced in all feet. The American Orthopaedic Foot and Ankle Society score improved in all feet (median increase= 51.5).

Conclusion: The method allows for a lateral and plantar shift with derotation of the distal fragment and a mild/moderate shortening of the first metatarsal bone.

Keywords: hallux valgus, surgery, metatarsal

How to Cite: Kolundžić, R. , Mađarević, M. , Trkulja, V. , Crnković, T. , Šmigovec, I. & Matek, D. (2017) “Croatian rotatory oblique three-dimensional osteotomy (CROTO) – a modified Wilson’s osteotomy for adult hallux valgus intended to prevent dorsal displacement of the distal fragment and to reduce shortening of the first metatarsal bone”, Medicinski glasnik. 14(2). doi: https://doi.org/10.17392/903-17