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Minimal invasive Metatarsaleosteotomien beim Metatarsalgiesyndrom

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Minimal invasive Metatarsaleosteotomien beim Metatarsalgiesyndrom

  1. 1. Minimal invasive Metatarsaleosteotomien beim Metatarsalgiesyndrom C. Kinast , M. Olos
  2. 2. Diagnostik: Plantare Druckdolenz Hyperkeratose 2, ( 3 ) ( 4 ) Röntgen: Sono: Erguss, MTPG-Lachman, MRT: einige Fälle mit Prädislokations-syndrom, Varus / Valgus Zehen Präop/ postop Röntgen Präop / postop Pedographie Klinische Untersuchung
  3. 3. Anatomie aus De Prado 2010
  4. 4. OP-Technik : percutane Metatarsaleosteotomien PCMO von distal dorsal nach pantar proximal möglichst im spitzen Winkel offene Hallux valgus Rekonstruktion gleichzeitig L Austin, Akin 52 Lapidus Akin 8 Andere Vor- OP am 1. Strahl 7
  5. 5. Studie: prospektiv Material : 63 Patienten 67 Füsse minimum follow up 1 Jahr M 2 3 OT n=12 Füsse M2 3 4 OT n=50 Füsse M3,4 n=1 Füsse M2 n=4 Füsse Hammerzehen- Korrektur minimal-invasiv Technik dePrado n = 42 Hammerzehen PIP Arthrodese offen, KD Transfixation n = 15
  6. 6. 2009-F.B. M1 Z 1 Osteotomie Lactosorb pc WEIL Osteotomien 2 3; M 5 Osteotomie
  7. 7. prä prä post post
  8. 9. prä post prä post
  9. 10. post prä
  10. 11. Röntgen: Heilung ohne wesentlichen Callus 24 Heilung mit starkem Callus 41 inkomplette Heilung nach 1 Jahr 2
  11. 12. Pedographie: n = M2 P max kPA prä-post-Differenz M2 post weniger als prä n=60 Füsse -403 kPa M2 alle n=67 Füsse -313 kPa M2 post mehr als präop n=7 Füsse +262 kPa M 3 P max > M 2 P max n = 8x transfer-overload noch keine klinisch Transfer-Metatarsalgie !!! P max M2 kPA x präop 969 post op 652
  12. 13. Klinische Untersuchung: Metatarsalgie keine Sensibilitätsstörung nach 6 Monaten + , 5 persistierend Z 2 Bodenkontakt spontan nach 6 Monaten 61 Z 2 Bodenkontakt bei aktiver Plantarflex. 6
  13. 14. Zusammenfassung: percutane Osteotomien 2 3 4 subcapitale pcOT heilen schneller Metatarsalgie wurde behoben Bodenkontakt der 2. Zehe überwiegend + Sensibilitätsstörungen
  14. 15. Minimal invasive Fusschirurgie Fallbeispiele C. Kinast , M. Olos
  15. 16. Scarf Akin GKD tightrope, pc MOT R Scarf Akin tightrope Weil 2-5 L
  16. 17. 6 WO postop R keine plantare Plattenrekonstruktion L percutane M OT 2, 3,4 R
  17. 18. VARUS ZEHEN KORREKTUR
  18. 19. Unterkorrektur u. Recidiv Hammerzehe Kasperkowitz

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