Médecine et chirurgie du pied


Freiberg's Disease: Using of Osteosuture to Fix Intraarticular Dorsal Cuneiform Osteotomy Retrospective Study of 17 Cases Volume 35, issue 3, Septembre 2019


  • Tableau 1

  • Tableau 2

Gauthier's osteotomy is leading in conservative surgical treatment of the Freiberg's disease. A high fixation variability can be used in this dorsal osteotomy. We retrospectively reviewed medical records and radiographs of a consecutive series of 17 patients who underwent intraarticular dorsal cuneiform osteotomy through the affected metatarsal head fixed with osteosuture for symptomatic Freiberg disease, from December 2010 to January 2016, with an average age of 27.3 ± 6.6 (19–45) years. The Smillie stage of necrosis ranged from II to IV. Clinical outcomes were evaluated according to American Orthopaedic Foot and Ankle Society (AOFAS), the patients’ subjective satisfaction and range of motion (ROM) of metatarsophalangeal (MTP) joint. In the radiologic evaluation, we scaled metatarsal shortening and evaluated a sphericity of the head metatarsal and healing of the osteotomy. The mean follow-up was 44.5 ± 16.9 (24–80) months. Points of AOFAS score increased from 47.41 ± 12.3 to 87 ± 10.7 (P < 0.0001). All patients were satisfied with the results of this technique. The ROM of MTP decreased without functional gene. Complications were observed for patients who complained of transfer metatarsalgia. All osteotomy was healed. Congruity of the (MTP) joint was restored in all patients. The mean of metatarsal shortening was 2 ± 0.57 mm (1–3). Intraarticular dorsal cuneiform osteotomy provides patient's efficacy in treatment of the Freiberg disease. The fixation with osteosuture is simple, cheaper and avoids a further procedure for implant removal and hardware-related complications.