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Towards the Optimization of Surgical Hallux Valgus Corrections

Krakers, S.M. (2023) Towards the Optimization of Surgical Hallux Valgus Corrections.

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Embargo date:20 September 2024
Abstract:Surgical hallux valgus correction is still somewhat tainted by higher than anticipated rates of suboptimal outcomes. As only two-thirds of patients report being completely satisfied with the surgical outcome and the postoperative recurrence rate of hallux valgus is as high as 64% after at least five years of follow-up. Most hallux valgus recurrences are caused by surgical factors such as technical issues including the fixation method, the performance of the orthopedic surgeon, and inadequate procedure selection. Mini-C-arm fluoroscopy is frequently used perioperatively to assist the orthopedic surgeon in hardware placement and the assessment of the deformity correction to prevent technical issues and support the performances of the orthopedic surgeon. During surgical hallux valgus corrections, the objective is to correct the Hallux Valgus Angle (HVA) and Intermetatarsal Angle (IMA) to decrease the chance of hallux valgus recurrence. This process requires repeatable and consistent perioperative images that correlate with the postoperative fluoroscopic images to visualize the achieved correction accurately. To obtain consistent perioperative images, a structured protocol for the use of perioperative fluoroscopy is necessary. The surgical procedure is chosen based on the severity of the deformity and the amount of correction needed, which are assessed using two-dimensional (2D) radiographs. However, due to the multiplanar nature of hallux valgus, it is difficult to describe and quantify hallux valgus accurately and reliably on standard radiological 2D images, necessitating a reproducible three-dimensional (3D) quantification of hallux valgus. This might help to improve the adequate surgical procedure selection of hallux valgus corrections. This study presented a protocol for the efficient and effective use of perioperative fluoroscopy during surgical hallux valgus corrections that fits into the workflow of the procedure and may obtain perioperative images that correlate with the postoperative images. This may help to prevent technical issues during the procedure and improve the performances of the orthopedic surgeon. The transition toward the 3D analysis of hallux valgus requires a relevant global coordinate system in the foot. As a result, this study also presented an automated method for defining a global coordinate system in the foot and explored potential methods for the 3D quantification of hallux valgus. Although the concepts of the 3D quantifications of hallux valgus need further development and finetuning, a variety of future studies can be started to further optimize surgical hallux valgus corrections. This offers perspective to achieve consistent satisfactory, long-term outcomes.
Item Type:Essay (Master)
Orthopedisch Centrum Oost Nederland (OCON), Hengelo, Nederland
Faculty:TNW: Science and Technology
Subject:44 medicine, 50 technical science in general
Programme:Technical Medicine MSc (60033)
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