A new “tension side” locking plate for Hallux Valgus: A prospective multicentre case series

• Prospective multicentre international series for moderate to severe Hallux Valgus.
• Locking plate applied to the plantar surface of the metatarsal for basal osteotomy.
• Radiological, clinical and functional results comparable with similar series.
• Complications included 3 plate breakages.
• Statistically significant improvement in AOFAS-HMI and VAS measurements.

BackgroundProximal osteotomy of the first metatarsal is often indicated for Hallux Valgus correction. Previously recognised complications however, include transfer metatarsalgia, first metatarsophalangeal joint stiffness, problems with fixation and prominence of metalware.MethodsWe report on one year follow up of an international prospective series between June 2009 and October 2012 involving three centres, including 91 feet (58 patients) that underwent proximal osteotomy, using a new locking plate applied to the plantar surface of the metatarsal.ResultsMean Hallux Valgus angle improved from 27.9 (±13.1)° to 12.4 (±8.2)° while mean Intermetatarsal angle improved from 12.5 (±8.4) to 7.1 (±3.4) and there was a statistically significant improvement in both mean AOFAS-HMI score 54.2 (±13.9) to 94.0 (±9.5) and Visual Analogue Pain Scale 4.7 (±1.5) to 0.6 (±1.3). 70% of patients were back at their preoperative employment at five weeks. Mean surgical time was 56 min and the plate was generally well tolerated. There were five implant related complications.ConclusionsLocked fixation from the tension side of the construct encourages early weight bearing with a low risk of implant prominence. Our radiological, functional and clinical parameters are comparable with similar series and we therefore recommend this technique.