An investigation of the damage to flexor tendons incurred by different minimally invasive proximal phalangeal closing wedge osteotomy surgical techniques in cadaveric feet
N. Abdul, R. Kakwani, D. Townshend
Background: Minimally invasive surgery (MIS) for hammer toe correction has become increasingly popular in the United Kingdom. The proximal phalangeal closing wedge osteotomy component of hammer toe correction can be performed by passing the burr via a plantar incision through the flexor tendons (transtendinous) or passing the burr adjacent to the flexor tendons (paratendinous).
Aim: To investigate damage to the flexor tendons by transtendinous and paratendinous techniques in cadaveric feet.
Method: Institutional approval was granted. Alternating between right and left feet of 8 donors, MIS proximal phalangeal osteotomies were performed transtendinous (n=24) and paratendinous (n=24) using the 2nd, 3rd and 4th toes. Osteotomies were performed by 2 experienced surgeons using a 2mm x 8mm wedge burr. Toes were then dissected by an independent observer to assess damage to the flexor tendons.
Results: Using the paratendinous technique, significantly more damage to the flexor tendons was noted compared to the transtendinous technique (47% vs 4%, p< 0.05). The position of the osteotomy at or distal to the metaphyseal/diaphyseal junction was assessed. There was a significant difference in flexor tendon damage in the paratendinous group when the osteotomy was sited at the junction compared to more distally (67% vs 27%, p< 0.05). There was no significant difference accordingly to site using the transtendinous technique (7% vs 1%, p>0.05).
Conclusion: The least damage to the flexor tendon in MIS proximal phalangeal osteotomy is achieved with a transtendinous technique regardless of osteotomy site. The most damage to the flexor tendon occurs with a paratendinous technique at the metaphyseal/diaphyseal junction.
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