Efectividad de la cirugía invasiva mediante osteotomía falángica incompleta en "curly toe" sintomático del adulto con falange trapezoidal

Resumo

Background and aims Digital deformity in flexion, varismus (external rotation), and adduction with the toe in both supraduction and infraduction are called clinocampodactyly or curly toe. All adult patients with symptoms and a diagnosis of semirigid/rigid curly toes underwent radiological examination to verify the presence of a trapezoidal phalanx. The purpose of this study was to quantitatively determine the degrees of improvement of a dysmetric phalanx after incomplete phalangeal osteotomy (IPO) using minimally invasive surgery (MIS). The points of improvement were determined using the American Orthopedic Foot and Ankle Society (AOFAS) scale score before surge and at 6 and 12-month follow-up. Methods Between May 2021 and June 2022, 30 patients, 7 men and 23 women, age average 56.5 ± 15.4 years, diagnosed with curly toes semirigid (13) or rigid (23) with trapezoidal phalanx, underwent unicortical osteotomy of the affected phalanx. The convergence angle was measured and the AOFAS scale scores were compared. Of the 30 participants in this study, 26 (86.7%) underwent surgery on a single toe, 2 (6.7%) underwent bilateral intervention on one toe of each foot, and 2 (6.7%) underwent intervention on three toes of the same foot (left foot for both patients). After the push-up test examination, all symptoms were diagnosed as semirigid and rigid curly toe deformities. Results Of the 30 patients, two presented with bilateral deformity and two presented with deformity in three toes of the same foot. Of the 36 osteotomies performed, 19 involved the fourth toe (7 right and 12 left toes), 11 involved the third toe (5 right and 6 left toes), and six involved the second toe (2 right and 4 left toes). The average reduction of the convergence angle was 9° (presurgical angle 12.3 ± 5.8 degrees and postsurgical angle 3.2 ± 3.5 degrees). The average improvement in the AOFAS scale score was 53 points and reached almost 90 points (89.9 ± 6.1 points) at 6 months. At 12-mont follow-up the AOFAS questionnaire was 92.5 points (92.5 ± 5.4) Conclusions IPO performed with Minimally Invasive Surgery is the technique of choice in symptomatic semi-rigid or rigid curly toe in adults with trapezoidal phalanx because it achieves digital alignment measured objectively by 9º radiological angulation. An average improvement of 53 points was obtained on the AOFAS scale at 6 months without presenting alterations in digital grasp and 57.4 points at 12 months. It achieves a good realignment of the toe preserving the joint and it improves functionality with little postoperative pain and few complications.