Background: This is a case series of 76 knees of 62 patients who underwent upper tibial VALGUS OSTEOTOMY for treatment of medial compartment osteoarthritis during a 20-year period and who were followed for a mean of 7.6 years. Methods: The patients were evaluated by validated outcome assessment systems of general health status short form (SF- 36), the Western Ontario McMaster osteoarthritis index (WOMAC), McMaster Toronto arthritis patient preference questionnaire (MACTAR) and also knee society clinical rating system (KSS). Two control groups - one consisting of 60 patients with similar age with osteoarthritis who had not receivedany surgical treatment and another 60 patients who had received knee replacement for osteoarthritis-were also studied. The results were compared among these three groups. Results/Conclusion: Tibial OSTEOTOMY caused improvement in SF-36 and WOMAC scores compared to the non-operated control group, but it did not do so when it was compared with knee arthroplasty. The mean±SD KSS was 103.37±12.19 with a failure rate (defined as candidacy for knee arthroplasty) of 28.94%. Improvement in patients’ pain level, social activity, housework activities and self-esteem was observed. Stair navigation, surface walking, getting on and off a car were not significantly better than the non-operated group.

Background: Double OSTEOTOMY of first metatarsal has been advocated as a procedure of choice for severe hallux VALGUS in adolescent age group. We would like to report our experience with such an OSTEOTOMY in Meshhad.Methods: Over a five year period (1999-2004), 26 feet in 17 adolescents- mean age of 15.5 years- with moderate to severe hallux VALGUS underwent double first metatarsal osteotomies. With a mean follow- up of 26 months, the cases were evaluated by American Ortopaedics Foot & Ankle Society Hallux Metatarso- phalangeal- interphalangeal scale (AOFAS/ HMI). In this study per and post hallux VALGUS (HVA), intermetatarsal (IMA), and distal metatarsal articular (DMAA) angles, and the relation between the angles and patient satisfaction were evaluated.Results: The mean angular corrections for hallux VALGUS (HVA), intermetatarsal (IMA) and distal metatarsal articualr (DMAA) angles were 26.56, 6.20 and 5.55 degrees respectively. Four cases could not be reached and from the remaining 13 patients, 2 cases had required second surgery for non- union and 3 cases had stiffness in MTP (metatarsophalangeal) joints. Sixteen cases reported good to excellent results.Conclusions: Double first metatarsal OSTEOTOMY for severe hallux VALGUS is reasonable procedure in adolescents which maintains the correction. Non- union and first MTP joint contractures are the two main side effects.

Eighteen patients underwent surgery for correction of intermetatarsal angle between first and second metatarsal bones. There were 12 females and 6 males, with an average VALGUS angle of 30° and intermetatarsal angle of 15°. Radiographic findings were either negligible or else absent. An oblique OSTEOTOMY in sagital plane, called "Ludloff OSTEOTOMY" was performed on the shaft of first metatarsal bone. After rotating the distal fragment laterally to achieve a corrected angle, two fragments were fixed, using 2.7 or 3.5 mm AO screws. The mean time of following up of these patients was 3.2 years.By OSTEOTOMY, the average correction angles of varus and VALGUS were nearly 6 and 15 respectively.

Background: The aim of this study was to compare the results of percutaneous sub capital metatarsal OSTEOTOMY with open distal chevron OSTEOTOMY of first metatarsal in hallux VALGUS surgery.Methods: In a clinical trial study, 29 patients with bilateral hallux VALGUS (58 foot) were selected randomly. All patients were female and the average age was 31 years old (17-55 yrs). The average time of follow-up was 13 months (6-20 months). Hallux VALGUS angle (HVA) up to 40o and intermetatarsal angle (IMA) up to 17o were included. For each patient, a percutaneous sub capital OSTEOTOMY on one foot and an open distal chevron OSTEOTOMY on the other foot were performed at the same time and by the same surgeon. Left or right side deformities were randomly selected for MIS or open procedure.Results: The average HVA correction was similar in both groups but the IMA correction was better in the open distal chevron OSTEOTOMY. In the chevron OSTEOTOMY, both patient's and surgeon's satisfaction level were in the similar range. In the MIS technique, the level of satisfaction varied between the surgeon and the patient. 86% of the patients were completely satisfied but the surgeon was fully satisfied in only 38% of the cases.Conclusions: Distal chevron OSTEOTOMY is recommended as a reliable corrective technique in mild to moderate hallux VALGUS but the percutaneous sub capital OSTEOTOMY can still be considered in selected patients with relatively low IMA.

Between 1980 and 1998, we performed 27 VALGUS osteotomies for nonunion of femoral neck fractures. Patients were aged 17 to 79, with an average of 45 years. Twenty-four patients had undergone previous surgery. Prior to OSTEOTOMY, the average neck-shaft angle was 105° (80 – 130°), with an average shortening of 2.5 cm (1.5 – 4.5 cm). After VALGUS OSTEOTOMY, 24 of the 27 fractures healed after 3 – 10 months (average, 5 months). One patient died 2 months after surgery (79 years old) and two had implant failures. Five patients had mild avascular necrosis at the time of study, which was not symptomatic. Pain and limitation of motion improved remarkably, so that the majority of the patients did not have to use crutches. Shortening was reduced to an average of 1 cm. We recommend VALGUS OSTEOTOMY of the proximal femur in the nonunion of femoral neck fractures.

Background: Mitchell OSTEOTOMY is one of first metatarsal distal corrective osteotomies for hallux VALGUS deformity. The purpose of this study was to evaluate the outcome of MitchellOSTEOTOMY. Methods: Eighteen patients underwent Mitchell corrective OSTEOTOMY using screw fixation for hallux VALGUS deformities from 2011 to 2015 were included. Clinical outcome was assessed using American Orthopedic Foot and Ankle Score, Hallux metatarsophalangeal-interphalangeal scale, (AOFAS Hallux), visual analogue score, and changes in hallux VALGUS and intermetatarsal angles based on standard weight-bearing radiographs, at least one year after surgery. Results: About 95 % of patients were completely satisfied. Mean of AOFAS score was 86. 7 at final follow-up. The mean of changes in intermetatarsal and hallux VALGUS angles were 5. 6 ± 3. 1 and 17. 0 ± 5. 2 respectively. Pain of the cases based on visual analogue score decreased from 5. 8 ± 0. 8 preoperatively to 1. 3 ± 1. 2 postoperatively. There were no deep infections, non: : union: : or osteonecrosis of first metatarsal head. Conclusion: Mitchell corrective OSTEOTOMY with screw fixation could bea simple and effective procedure to correct hallux VALGUS deformity with high levels of patient satisfaction.

Introduction: In the moderate and severe cases of hallux VALGUS with metatarsus VALGUS, one of the most important parts of surgical technique is proximal metatarsal OSTEOTOMY.Objective: In this study, the results of a distal soft tissue procedure and a medial open wedge proximal metatarsal OSTEOTOMY were reviewed.Materials and Methods: In this study we operated 22 feet (16 patients) with moderate or severe hallux VALGUS . In all the patients distal soft tissue procedure were done then with the bunion part of the metatarsal head medial open wedge proximal metatarsal OSTEOTOMY were done and fixed. Average follow up period was 13 months.Results: 13 patients were female. At follow up 16 feet were free from pain at the first metatarsophalyngeal joint. In 6 feet the pain was improved but persisted. The mean hallux VALGUS and intermetatarsal angles were 38 and 18 before and 13 and 6 after surgery respectively. The postoperative hallux VALGUS and intermetatarsal angles in patients who had pain at the first metatarsophalyngeal joint after surgery were greater than those in patients without pain after surgery.Conclusion: This procedure corrects moderate and severe hallux VALGUS deformity and relieves the symptoms effectively, but careful attention should be paid to the surgical technique to obtain consistent and satisfactory results.

Objectives: To compare the therapeutic outcomes of proximal crescentic OSTEOTOMY (PCO) versus proximal opening wedge OSTEOTOMY (POWO). Methods: In this retrospective analytical study, 88 patients with moderate to severe unilateral hallux VALGUS (HV) were enrolled. HV severity and angle, intermetatarsal angle, MTPJ status, and AOFAS score were collected. Results: The AOFAS score, HV and intermetatarsal angles, and MTPJ status improved in all patients with no significant differences between the two groups. The POWO group showed significantly higher satisfaction score at the 3rd month post-operation. Conclusions: Both osteotomies demonstrated acceptable outcomes; however, short term patient satisfaction was greater in the POWO technique.

Background: Femoral neck fracture nonunion is a frequent and challenging complication, with several surgical options. Objectives: The present study reported the outcome of VALGUS OSTEOTOMY for treating femoral neck nonunion in patients aged <65 years. Methods: This case series research included young patients who underwent VALGUS OSTEOTOMY for treating femoral neck nonunion or device failure of the index surgery. The fixation of the OSTEOTOMY site was performed using either a dynamic hip screw or a fixed angle blade. The union of the neck and OSTEOTOMY site (subtrochanteric region) was evaluated by monitoring callus formation in the postoperative radiographs. Limb length discrepancy, Pauwels’,angle, and the neck-shaft angle were evaluated before the surgery and at the last follow-up. Postoperative complications were extracted from the explored patients’,profiles. Results: Twenty patients with a Mean±, SD age of 27. 2±, 10. 8 years were examined in this study. The Mean±, SD follow-up time of the patients was 6. 1±, 3. 9 years. The femoral neck was united in 18 patients in a Mean±, SD period of 5. 1±, 2. 3 months. The Mean±, SD limb length discrepancy was measured as 1. 3±, 0. 8 cm before and 0. 5±, 0. 7 cm after the OSTEOTOMY. The Mean±, SD Pauwels’,angle was calculated as 65. 5±, 16. 9º,before and 32. 4±, 16. 2º,after the OSTEOTOMY. The Mean±, SD neck-shaft angle was computed to be 121. 9±, 22. 8º,before and 144. 5±, 17. 7º,after the OSTEOTOMY. Revision surgery was performed for 6 (30%) patients. This measure included device removal in 4 and total hip arthroplasty in 2 patient. Conclusion: VALGUS OSTEOTOMY is a safe and efficient technique for managing femoral neck nonunion. Therefore, this approach is suggested as a good alternative for total hip arthroplasty, particularly in young and active patients.