[Capsuloperiosteal flap application for the stabilization of chevron osteotomy].

Objectives: We retrospectively analyzed the results of capsuloperiosteal flap application to stabilize modified distal chevron osteotomy in patients with mild to moderate intermetatarsal and hallux valgus angles.

Methods: Modified chevron osteotomy was performed in 27 feet of 25 patients (14 females, 11 males; mean age 30.4 years; range 19 to 43 years) with hallux valgus. The study group was comprised of patients unresponsive to conservative treatment for painful deformity, at ages 18 to 50 years, and having an intermetatarsal angle less than 17 degrees, hallux valgus angle less than 40 degrees, and no osteoarthritic changes in the metatarsophalangeal joint. The patients were evaluated clinically and radiographically preoperatively and in the early postoperative period, in the sixth week, and once in every six weeks. Clinical assessments were made using the subjective and objective evaluation systems of Bonney and Macnab. The mean follow-up was 22 months (range 8 to 67 months).

Results: The mean preoperative hallux valgus angle, which was 31.4 degrees (range 23 degrees to 40 degrees), decreased to 12.8 degrees (4 degrees-22 degrees) postoperatively, with a corresponding decrease in the intermetatarsal angle from 14.2 degrees (11 degrees-17 degrees) to 9.6 degrees (7 degrees-14 degrees). Conformity of the first metatarsophalangeal joint was complete in all the cases. According to the Bonney and Macnab subjective scores, the results were excellent in seven feet (25.9%), good in 17 feet (63%), and moderate in three feet (11.1%). On objective evaluations, the results were excellent in 14 feet (51.9%), good in 11 feet (40.7%), moderate in one foot (3.7%), and poor in one foot.

Conclusion: Our results suggest that modified chevron procedure whose stability is improved by the use of a capsuloperiosteal flap without using any internal fixation material is an effective alternative for the treatment of patients with moderate degrees of hallux valgus without metatarsophalangeal joint degeneration.