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At least 19 recordsLinked to original sources
PubMedDate not supplied

In vitro effects of osteotomy angle and osteotomy reduction on tibial angulation and rotation during the tibial plateau-leveling osteotomy procedure.

OBJECTIVE: To determine the effect of osteotomy angle, reduction technique, and tibial plateau rotation angle on angular and rotational limb deformities. STUDY DESIGN: Geometric comparison using bone models. METHODS: Rotational osteotomies were made in the proximal metaphysis of artificial tibias at 0 degrees, 10 degrees, 20 degrees, -10 degrees, and -20 degrees from perpendicular with respect to either the proximodistal and craniocaudal tibial axes. Negative-numbered angles represented osteotomies made from distal to proximal or caudal to cranial. Changes in tibial angulation and torsion were measured using a 3-dimensional digitizing instrument at tibial plateau rotation angles from 0 degrees to 30 degrees at 5 degrees increments. Two osteotomy reduction techniques were used: complete osteotomy reduction and alignment of the medial cortex. The mean of 5 measurements of torsional and angular tibial deformity for each of the 9 osteotomy orientations in each reduction technique group was obtained. RESULTS: All had increasing angular and rotational deformity as tibial plateau rotation angle increased. In the medially aligned cortex group, all tibias had valgus deformity, and 8 of 9 tibias were internally rotated. In the reduced osteotomy group, minimal angular deformity was seen in tibias with osteotomy variation along the proximodistal axis; however, tibias with osteotomy variation along the craniocaudal axis had angular deformity ranging from 6.0 degrees of varus deformity to 14.3 degrees of valgus deformity. Rotational deformity was affected similarly by osteotomy variation along either axis. Reduction technique had greater affect on angular and rotational deformity than osteotomy angle variation. CLINICAL RELEVANCE: These results suggest that osteotomy reduction may play a greater role in angular and rotational deformity than osteotomy angle, although extreme osteotomy angles should be avoided. To decrease the severity of deformity, we recommend that the osteotomy be made perpendicular to the craniocaudal and proximodistal axes and be completely reduced with less regard for alignment of the medial cortex.

Animals↗
PubMed2006

Maxillary stability following Le Fort I osteotomy in combination with sagittal split ramus osteotomy and intraoral vertical ramus osteotomy: a comparative study between titanium miniplate and poly-L-lactic acid plate.

PURPOSE: The purpose of this study was to compare changes in maxillary stability after Le Fort I osteotomy with titanium miniplate and poly-L-lactic acid (PLLA) plate (Fixsorb-MX; Takiron Co, Osaka, Japan). PATIENTS AND METHODS: The subjects were composed of 47 Japanese patients with diagnosed jaw deformity: 24 underwent Le Fort I osteotomy and sagittal split ramus osteotomy (SSRO); and 23 underwent Le Fort I osteotomy intraoral vertical ramus osteotomy without internal fixation. Each group was divided into titanium plate and PLLA plate groups. Time course changes between plate groups were compared using lateral and posteroanterior cephalography. RESULTS: Significant differences were identified between titanium plate and PLLA plate groups in A point after Le Fort I osteotomy and SSRO (P < .05). Significant differences existed between titanium plate and PLLA plate groups in vertical component of posterior nasal spine after Le Fort I osteotomy in both combinations with SSRO and intraoral vertical ramus osteotomy (P < .05). However, no significant differences were identified in measurements on posteroanterior cephalography. CONCLUSION: These results suggest a slight tendency for vertical impaction after Le Fort I osteotomy both in combination with SSRO and intraoral vertical ramus osteotomy with PLLA plates, although differences in time course changes were not clinically apparent, and normal occlusion was established in all patients.

Adolescent↗
PubMedDate not supplied

[Valgisation tibial head alignment osteotomy--results of a comparative follow-up of Coventry interligament tibial head osteotomy and Wagner oblique osteotomy].

In the follow-up study presented the results of 33 high tibia-osteotomies (Coventry) are compared with 51 oblique lower tibia-osteotomies (Wagner). Both techniques guarantee a safe improvement of function, pain relief, and biomechanic situation of the arthrotic joint. The results are mainly independent of the grade of joint involvement and the age of the patient. The Coventry-osteotomy tends to accentuate femoropatellar arthrotic destruction, while the Wagner-osteotomy does so in 20% fewer cases. The functional improvements of the Wagner-osteotomy are more than 20% better, up to 5 years postoperatively, when compared with the high tibia-osteotomy. Indication, technical performance of the operation, and the postoperative care are discussed in the light of the results presented.

Adolescent↗
PubMed1977

The metatarsal osteotomy: a 10-year follow-up on the second, third and fourth metatarsal osteotomies and a new approach to the fifth metatarsal osteotomy.

The metatarsal osteotomy, a relatively simple procedure, provides a great amount of correction and relief with a limited amount of bone resection. Postoperative pain and edema are minimal, and disability and loss of time from employment are eliminated as patients are able to walk immediately in a surgical shoe. If biomechanical management is not adequate in relieving discomfort, then a 10-year study of more than 1000 cases indicates that the osteotomy is the procedure of choice.

Follow-Up Studies↗
PubMed2001

Original sagittal split osteotomy revisited for mandibular distraction.

Introduction: A malformed mandible and an abnormally positioned mandibular foramen make it difficult to plan an ideal osteotomy line for mandibular distraction. In addition, there have been reports of such complications as nonunion, damage and stretch injury of the inferior alveolar nerve and tooth germ damage when conventional osteotomy or corticotomy are used for mandibular distraction. The authors utilized the original sagittal split ramus osteotomy for mandibular distraction. Patients and Methods: Five patients (three unilateral hemifacial microsomia, one bilateral hemifacial microsomia, and one mandibular retrusion) were included in this study of distraction osteogenesis using the sagittal split ramus osteotomy. Extraoral distraction devices were applied to the first four patients. An intraoral device with mono-cortical screw fixation was used for the fifth patient. Result: In all five cases, the results of the distraction were satisfactory. Complications (as listed) of conventional osteotomy when used for distraction were avoided. Satisfactory results were achieved and these were also well maintained postoperatively (mean follow up: 36 months). Conclusion: The authors believe that sagittal osteotomy for mandibular distraction osteogenesis makes it possible, to avoid injury to the inferior alveolar nerve during operation and stretching injury during distraction and to prevent tooth germ injury. It is also possible to diversify the osteotomy line for various force vectors to enlarge the bony contact surface area. Therefore, we suggest that sagittal split ramus osteotomy should be used as a preferred modification of osteotomy for mandibular distraction. Copyright 2001 European Association for Cranio-Maxillofacial Surgery.

Journal Article↗
PubMed2000

Osteotomy, compression and reaming techniques for internal fixation of extracapsular hip fractures.

BACKGROUND: Many different surgical techniques, such as osteotomy, have been used in internal fixation of extracapsular hip fractures. OBJECTIVES: To compare different aspects of surgical technique in internal fixation of extracapsular hip fractures that have been subjected to randomised trials in adults. SEARCH STRATEGY: The Cochrane Musculoskeletal Injuries Group trials register, Medline, CENTRAL and reference lists of relevant articles were searched. Date of the most recent search: March 1999. SELECTION CRITERIA: All randomised and quasi-randomised trials investigating operative technique for the treatment of extracapsular hip fractures. DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed trial quality, by use of an eleven item check list, and extracted data. Wherever possible and appropriate, results of outcome measures were pooled. MAIN RESULTS: All eight included trials were of only modest methodological quality. One trial of 65 patients undergoing fixation with a fixed nail-plate compared osteotomy versus anatomical reduction. There was a tendency to a reduced fixation failure rate after osteotomy. Four trials involving 465 patients undergoing fixation with a sliding hip screw (SHS) compared osteotomy versus anatomical reduction. Osteotomy was associated with an increased operative blood loss and length of surgery. There was also a tendency to an increased length of hospital stay and limb shortening for osteotomy. One trial of 200 patients undergoing fixation with a SHS compared results with or without compression across the fracture site. The only significant difference in outcomes was increased varus deformity in those fractures treated with compression. One trial of 19 patients reported reduced temperatures generated by a modified method of reaming the femoral head. Another study used oesophageal ultrasound to demonstrate reduced bone marrow intravascular embolism when a Gamma nail was inserted in 50 patients with, rather than without, a distal pressure venting hole in the femur. REVIEWER'S CONCLUSIONS: There is inadequate evidence to determine if any benefits exist for the routine use of osteotomy in conjunction with a SHS for the internal fixation of an unstable trochanteric femoral fracture. Osteotomy may be relevant if used in conjunction with a fixed nail plate. Based on the evidence of one trial only, there is inadequate evidence to support the application of compression across the fracture site of a trochanteric fracture during SHS fixation. Inadequate information exists for different reaming techniques during SHS or Gamma nail fixation to make definite conclusions.

Fracture Fixation, Internal↗
PubMed1997

Triple innominate osteotomy and rotational acetabular osteotomy in the treatment of congenital hip dysplasia.

Congenital hip dysplasia is a developmental disease which predisposes patients to osteoarthritis of the hip. We compare the results and complications of triple innominate osteotomy and rotational acetabular osteotomy in the treatment of this disease. Between 1984 and 1992, 27 patients with 30 dysplastic hips received reconstructive procedures at National Taiwan University Hospital. Fourteen patients (16 hips) with a median age of 18 years were treated by triple innominate osteotomy. Nine of 16 hips had concomitant femoral osteotomy. Another 13 patients (14 hips) with a median age of 24 years were treated by rotational acetabular osteotomy. We compared the radiologic and functional results, complications and satisfaction of the patients in these two groups. Patients who underwent rotational osteotomy showed more correction in roof obliquity than patients who had triple innominate osteotomy. The functional results when evaluated by Harris scores, were better in patients who had triple innominate osteotomy than rotational osteotomy. Complications included one resubluxation of the hip in each group as well as one perforation of the hip joint and one pin break and nonunion at the osteotomy site in the rotational osteotomy group. Patients who had triple innominate osteotomy were more satisfied with the results. With proper selection of patients and accurate performance of the procedure, both triple innominate osteotomy and rotational osteotomy may be used effectively for the treatment of congenital hip dysplasia. However, in our study, patients who underwent rotational osteotomy had better anatomic correction, while those who underwent triple innominate osteotomy had better functional results.

Acetabulum↗
PubMed2000

High tibial osteotomy with a calibrated osteotomy guide, rigid internal fixation, and early motion. Long-term follow-up.

BACKGROUND: We studied the results of sixty-four valgus-producing high tibial osteotomies performed with the use of a calibrated osteotomy cutting guide and rigid internal fixation, and followed by early motion, in fifty-six patients who had medial unicompartmental osteoarthritis and varus malalignment. Long-term studies have demonstrated that a high tibial osteotomy performed with staple fixation and followed by immobilization in a cast has an expected survival rate of approximately 85 percent at five years and 60 percent at ten years (in studies of ninety-five knees and 213 knees, respectively). To the best of our knowledge, there are no long-term reports on high tibial osteotomies performed with a calibrated osteotomy cutting guide and rigid internal fixation and followed by early motion. METHODS: The indications for high tibial osteotomy were medial unicompartmental osteoarthritis and varus malalignment. A lateral closing-wedge osteotomy was performed. The patients were reexamined to obtain a knee score, to make lateral radiographs of both knees, and to make a full-length anteroposterior radiograph (showing the entire lower extremity, including the hip and ankle) of the involved knee with the patient standing. RESULTS: Twenty-one knees were treated with a subsequent total knee arthroplasty at an average of sixty-five months after the high tibial osteotomy. The remaining forty-three knees had a good or excellent clinical result, with an average knee score of 94 points at an average of 8.5 years after the osteotomy. Survivorship analysis showed an expected rate of survival, with conversion to a total knee arthroplasty as the end point, of 85 percent at five years and 53 percent at ten years. No patient had patella baja postoperatively. There were six complications: four superficial wound infections, one superficial-vein thrombosis, and one delayed union (union occurred at five months). CONCLUSIONS: High tibial osteotomy has been criticized because of a high rate of complications, a loss of effectiveness with time, and the difficulty of conversion to a total knee arthroplasty secondary to patella baja. In our series, in which an osteotomy was performed with a calibrated osteotomy cutting guide and rigid internal fixation and was followed by early motion, the rate of complications was low and approximately two-thirds of the knees had a good or excellent clinical result at an average of 8.5 years. Conversion to a total knee arthroplasty was accomplished without difficulty in the patients who had this procedure. We highly recommend high tibial osteotomy with a calibrated osteotomy cutting guide, rigid internal fixation, and early motion for patients who wish to continue an active lifestyle.

Adult↗
PubMed1998

Indications for intertrochanteric osteotomy after periacetabular osteotomy for adult hip dysplasia.

Residual hip dysplasia in the adult is characterized by deficient anterior and lateral acetabular coverage with subsequent hip joint incongruity and instability. The frequency of periacetabular osteotomy for the treatment of residual hip dysplasia is increasing. In certain morphologic conditions preoperative abduction or intraoperative radiographs reveal that congruency after a periacetabular osteotomy is not optimum; at this point the surgeon may consider the addition of an intertrochanteric osteotomy. In a retrospective study, the radiographs of 25 patients who had a femoral osteotomy with or after periacetabular osteotomy were analyzed and the results were compared with a control group of 34 patients who had periacetabular osteotomy without a femoral osteotomy. The analyzed parameters included: the femoral head extrusion index and the acetabular index, before and after periacetabular osteotomy; the femoral neck shaft angle; the presence of femoral head deformity; the presence of osteoarthrosis; the presence of a secondary acetabulum; the influence of previous ipsilateral hip surgery; the effect of hip adduction or abduction on joint congruency; and the age of the patient. The variables that had a statistically significant association with the performance of an intertrochanteric osteotomy included a femoral head extrusion index and an acetabular index after periacetabular osteotomy outside the normal limits, a neck shaft angle outside the limits of the control group, a deformed femoral head, an osteoarthritic hip, a secondary acetabulum, and a joint space height and congruency dependent on position of the proximal femur. When using statistically significant variables, a discriminant analysis predicted the correct group (periacetabular osteotomy with femoral osteotomy, or periacetabular osteotomy without femoral osteotomy) for 89% of the cases.

Acetabulum↗
PubMed2006

Mandibular mechanics after osteotomy and distraction appliance placement I: Postoperative mobility of the osteotomy site.

PURPOSE: Fixation at the osteotomy site for mandibular distraction osteogenesis (DO) is probably not rigid, especially during mastication. Micromotion may affect the course of DO. This study aimed to measure the mobility of the fresh distractor-fixed osteotomy site in response to mastication and masticatory muscle stimulation. MATERIALS AND METHODS: Twenty-eight domestic pigs, 6 to 8 weeks old, underwent osteotomy of the right mandible and placement of a distractor appliance. Immediately after surgery, displacement at 3 different locations (superior-lateral, inferior-lateral, and inferior-medial) of the osteotomy site was assessed using ultrasound piezoelectric crystals or differential variable reluctance transducers (DVRTs). The amount of lengthening or shortening at each location was measured during mastication and muscle stimulation. Displacement was also measured for bilateral osteotomy during muscle stimulation from a subgroup of 12 pigs. RESULTS: The osteotomy site demonstrated significant mobility during power strokes of mastication with an average magnitude of 0.3 to 0.4 mm. Distinct patterns of displacement were associated with different locations, and the patterns varied between chewing sides. The most common pattern was lengthening at the superior-lateral and shortening at both inferior sites. Similar amounts of displacement were observed during the stimulation of jaw-closers (masseter and medial pterygoid), but the patterns produced by these muscles did not completely explain the masticatory pattern. Opening the osteotomy to 1.5 mm did not alter the displacements observed during muscle stimulation. Bilateral osteotomy tended to decrease displacement. CONCLUSIONS: The study demonstrates that during mastication and masticatory muscle stimulation, an acute mandibular osteotomy site is mobile despite fixation by a distractor appliance.

Analysis of Variance↗
PubMedDate not supplied

The "Z" osteotomy versus the Kalish osteotomy for the correction of hallux abducto valgus deformities: a retrospective analysis.

A retrospective analysis of hallux abducto valgus surgery performed between 1990 and 1995 where the "Z" osteotomy and Kalish osteotomy were utilized was performed. Objective and subjective data were collected to determine the effectiveness of the Z osteotomy versus the Kalish osteotomy. Twenty cases of hallux abducto valgus where the Z osteotomy was utilized were evaluated on the basis of intermetatarsal angle correction and alleviation of preoperative symptoms. The same evaluation was performed on 21 cases where the Kalish osteotomy was utilized. There did not appear to be an appreciable difference in intermetatarsal angle correction between the two osteotomies; however, the Kalish osteotomy did alleviate preoperative symptoms to a greater degree compared with the Z osteotomy.

Adolescent↗
PubMed1996

[A 20-year follow-up study of internal gonarthrosis after tibial valgus osteotomy. Single versus repeated osteotomy].

PURPOSE OF THE STUDY: The study defines the conditions in which valgus osteotomy can produce satisfactory 20-year results in cases of medial unicompartmental gonarthrosis. MATERIAL AND METHODS: Among a series of 93 osteotomies, 35 knees were followed up for 20 years. Changes to the medial and lateral femorotibial compartments were identified on forced varus and valgus radiographs and on foot standing Xray. The condition of the patellofemoral articulation was defined on patellofemoral aspect at 30 degrees flexion. Frontal axial deviation was monitored by preoperative and postoperative standing film (first year, 10 years and 20 years). RESULTS: Only 25 knees still had a satisfactory functional result (no mechanical pain). However, among these 25 knees, 13 good functional results were obtained after a new osteotomy performed between the 7th and 15th year after initial surgery. There were therefore only 12 knees which managed to reach 20 years with their original tibial osteotomy. Radiologically, in absence of adverse hypercorrection (greater than 6 degrees valgus), there was no deterioration or only small deterioration of the lateral femorotibial compartment at 20 years even among the knees which had undergone two tibial osteotomies. DISCUSSION: Osteotomy rarely avoids the problem of recurrent deformity which appears fairly rapidly (before 10 years) when initial correction is poor (below 3 degrees valgus). However, even correction of between 3 and 6 degrees valgus was not immune to recurrent varus deformity at long term (20 years): among knees with goniometry between 3 degrees and 6 degrees at the one-year postoperative review, 20 were still within this group by the 10th year; but only 9 knees were still in this range at 20 years. CONCLUSION: Whilst longevity of a tibial osteotomy seems limited, a second valgus tibial osteotomy can reproduce the same effects as the first (no pain and preservation of the medial femorotibial compartment): 13 repeated tibial osteotomies produced a good result at 20 years follow-up which suggests that medial femorotibial gonarthroses in younger patients can be treated conservatively.

Aged↗
PubMed2006

The prevention of periodontal bone loss at the osteotomy site after anterior segmental and dento-osseous osteotomy.

PURPOSE: Degeneration of the gingival margin and periodontal bone loss between segments can occur in various segmental osteotomies. However, treatment and management of these problems have not yet been resolved; improvement of the conventional method is necessary. The purpose of this retrospective study is to evaluate the usefulness and advantage of orthodontic devices in osteotomies. PATIENTS AND METHODS: Forty Japanese adults presented with jaw deformities diagnosed as mandibular prognathism with maxillary protrusion, bimaxillary protrusion, and anterior crowding. Of these 40 patients, 20 (group 1) underwent anterior segmental osteotomy or dento-osseous osteotomy along with our original orthodontic periodontal management. The remaining 20 (group 2) patients underwent conventional procedures. After surgery, pocket depth and periodontal bone loss at the osteotomy site were evaluated. RESULTS: In all cases of patients who underwent our original technique, degeneration of the gingival marginal and periodontal defects at the osteotomy site were not found. The rate of alveolar bone height in group 1 significantly increased and that in group 2 significantly decreased after maxillary osteotomy (P < .05). CONCLUSION: This technique may prevent periodontal defects from occurring at the interdental osteotomy site.

Adolescent↗
PubMedDate not supplied

A new osteotomy for the correction of mandibular prognathism: techniques and rationale of the intraoral vertico-sagittal ramus osteotomy.

The sagittal split ramus osteotomy (SSRO) and the intraoral vertical ramus osteotomy (IVRO) are long established methods for correcting mandibular prognathism, each having its own advantages. However, both procedures have the same disadvantage: the potential for postoperative condylar displacement. The displacement of the condyle is mainly due to the fact that the osteotomy plane is not parallel to the original sagittal plane in which the mandible is repositioned. The author has developed a new ramus osteotomy since 1985 in which the osteotomy plane is theoretically parallel to the original sagittal plane and thereby attempting to decrease the incidence of condylar displacement. This osteotomy was designed additionally to decrease neurosensory disturbances and has the advantages of both methods, and therefore has been named 'intraoral vertico-sagittal ramus osteotomy (IVSRO)'. Initial experience with the 24 prognathic patients operated on by means of the IVSRO indicated excellent clinical results. It has been noted clinically that the IVSRO is very effective in reducing postoperative iatrogenic TMJ symptoms and in treating preoperative TMJ symptoms. It has the additional effect of reducing neurosensory disturbances. This osteotomy seems to be more applicable in mandibular prognathism with excessive flaring of the ramus, particularly that associated with TMJ dysfunction, because the IVSRO has a 'condylotomy effect' and its splitting plane diverges less from the original sagittal plane than that of the SSRO and the IVRO.

Bone Screws↗
PubMed2001

Stability of skeletal Class II correction with 2 surgical techniques: the sagittal split ramus osteotomy and the total mandibular subapical alveolar osteotomy.

Combined orthodontic and surgical treatment of severe Class II dentoskeletal deformities with the use of the bilateral sagittal split ramus osteotomy is a routine procedure in orthodontic practices. However, an alternative surgical technique, the total mandibular subapical alveolar osteotomy, could be used for the same purpose. The aim of this investigation was to compare the stability of the sagittal split ramus osteotomy with the total mandibular subapical alveolar osteotomy in the correction of dentoskeletal Class II malocclusions. Forty patients that exhibited Class II dentoskeletal relationships were included in the study. Twenty of these patients had mandibular advancement with the sagittal split ramus osteotomy; the remaining 20 patients had advancement of the whole lower alveolar segment with the total mandibular subapical alveolar osteotomy. The cephalograms studied were taken before the surgical procedure (T1 = 4 weeks before operation), immediately after the procedure (T2 = 10 days after surgery), and 1 year later (T3). The statistical analysis used to assess the results between and within the groups over the different time periods was the analysis of variance. The regression analysis was used to test the interdependence of soft tissue response to hard tissue movement. The results of this study show that both procedures are equally stable when correcting Class II malocclusions. This was proved by the stability of the correction of overjet, B point, and incisor-mandibular plane angle. There were no statistically significant differences between or within the groups in the position of these landmarks over time. There was a statistically significant change in the position of pogonion from T1 to T2 (P <.0028) between the groups, although at T3 this difference was not significant (P <.05). There were no significant changes in face height either within or between the groups over time. The hard/soft tissue interactions for the total mandibular subapical alveolar osteotomy were as follows: The lower lip advanced 60% to the incisor movement; soft tissue B' point responded with a 130% advancement in relation to the change in its hard tissue counterpart. Soft tissue pogonion advanced 90% in relation to the hard tissue landmark. The data suggest that the total mandibular alveolar osteotomy is the treatment of choice for the correction of severe dentoalveolar retrusive Class II malocclusion for which alteration of the mentolabial sulcus is desirable.

Adolescent↗
PubMed1993

A new osteotomy for genioplasty--stepped osteotomy: preliminary report.

A new osteotomy for genioplasty, stepped osteotomy, is described. This osteotomy is a combination of horizontal and sagittal osteotomy of the mandibular symphysis. It consists of horizontal osteotomy at a distance of 3 to 4 mm below the apexes of the anterior teeth, connecting at right angles with the conventional horizontal osteotomy below the mental foramen, making a step-fashioned osteotomy of the chin. This procedure is particularly advantageous in simultaneous elongation and advancement genioplasty because the central portion between the apexes of the anterior teeth and the conventional horizontal osteotomy line is available as augmentation and the bony contact of the osteotomized mandible can be retained in elongating the chin. The characteristics of this procedure are described and typical patients are shown.

Adolescent↗
PubMed2005

Clinical results of modified Mitchell's osteotomy for hallux valgus augmented with oblique lesser metatarsal osteotomy.

PURPOSE: To evaluate postoperative results of modified Mitchell's osteotomy and its combination with oblique metatarsal osteotomy for the treatment of hallux valgus. METHODS: A total of 93 feet of 53 patients (2 men and 51 women) with hallux valgus underwent modified Mitchell's osteotomy and were followed up for at least 5 years. Patients' age ranged from 17 to 83 years, and the duration of follow-up ranged from 5 years one month to 18 years 4 months. Modified Mitchell's osteotomy was performed on 53 feet in 31 patients (group A), whereas modified Mitchell's osteotomy augmented with oblique lesser metatarsal osteotomy was performed to the remaining 40 feet in 22 patients (group B). Postoperative results were assessed using a clinical assessment system developed by the Tokyo Medical University based on 5 categories: pain in the first metatarsophalangeal, deformity of the metatarsophalangeal, plantar callosity and/or metatarsalgia of lesser metatarsals, the use of commercially available shoes, and local inflammatory symptoms. RESULTS: Mean total score improved from 3.8 to 7.9 on a 10-point scale. Scores for 2 categories--plantar callosity and/or metatarsalgia and the use commercially available shoes--were significantly higher in group B at postoperative 5 years. Before surgery, at postoperative 3 weeks, and at postoperative 5 years, respectively, the mean hallux valgus angles were 34.2, 12.0, and 17.1 degrees; mean M1-M2 angles were 16.7, 7.4, and 8.7 degrees; mean M1-M5 angles were 34.9, 25.8, and 26.6 degrees; and mean sesamoid bone shifts were 8.7 mm, 4.3 mm, and 5.9 mm. CONCLUSION: Modified Mitchell's osteotomy shortens the length of the first metatarsal bone and thus relieves tension in soft tissues such as the adductor hallucis. Nonetheless, the procedure can induce metatarsophalangeal joint malalignment and metatarsalgia, and plantar callosity may develop or persist after surgery. Combining oblique metatarsal osteotomy of the lesser metatarsal bones is useful in patients with uneven metatarsal bone lengths and metatarsophalangeal joint malalignment.

Adolescent↗