bunion surgery

The Hong Kong Chronicle

BUNION SURGERYTHE NON BONE BREAKING ALTERNATIVE

Non-Bone Breaking Alternative for Hallux Valgus Surgery

A Biological Bridge to Restoration of Form & Function

A Challenge to the “Gold Standard”

THE SYNDESMOSIS PROCEDURE:

Picture 1: In the OR with

Dr. Wu (left), Dr. Fellner (center)

Picture 1: In the OR with

Dr. Wu (left), Dr. Fellner (center)

In 2014, I travelled to Hong Kong to meet with Dr. Wu, Orthopedic Surgeon, to learn the unique syndesmosis technique to correct bunion deformity.

To understand, better, what makes the syndesmosis unique, let me recap the standard surgical approach to bunion surgery

When a patient has a painful bunion that requires surgery a common approach is the osteotomy.Bone is cut, shifted and fixated, with screws, plates or wires, or a joint is fused e.g. the Lapidus procedure.

TRADITIONAL BUNION SURGERY

Figure 1: example of a typical osteotomy

The problem with conventional, ‘bone breaking’ bunion surgery:• Bone is not truly deformed• The surgery creates a

deformity in the bone, in an attempt to correct a displacement of bones

• The displacement is the result of ligamentous loosening causing the metatarsal to lean.

Would it not be much better if the normal anatomy of the foot is restored?

Dr. Wu believes so. He uses a syndesmosis technique. This is also sometimes referred to, in the literature as, as an osteodesis.

How it works:

• The first metatarsal is re-positioned using sutures. This is a cerclage technique that provides temporary correction.

• Permanent correction is from the induction of a biological bridge, composed of fibrous tissue.

• After this material has formed the anatomically correct first metatarsal position is permanently maintained

Pre-Operative Post-Operative

Courtesy of Dr. Wu

The Syndesmosis Procedure: Does it work?

Dr. Wu has performed over 1400 procedures. I was fortunate to follow his patients in his office, and to learn the technique in the operating room. The outcome is impressive.

In addition to correcting the bunion I observed the benefit of 1st metatarsal stabilization:• 1st metatarsal-phalangeal joint motion consistently 80-90 degrees• Joint motion has a very natural, flexible feel on examination• Lesser metatarsalgia is consistently eliminated • Plantar forefoot callus vanishes, or is significantly ameliorated • Flexible lesser toe deformity is reduced

Without additional surgery

This is a very brief overview Please see the reference list for additional information

Contact: dieter.fellner@gmail.com

FOR FURTHER INFORMATION

Cape, L. R. I. J., 1999. Intermetatarsal osteodesis: a fresh approach to hallux valgus. The Foot, Volume 9, pp. 93-98.

Botteri G, Castellana A., 1961. L'osteodesi distale dei due primi metatarsi nella cura dell' alluce valgo. La Clinica Ortopedica, XIII(Fasc 1), pp. 39-46.

Daniel Yiang Wu, 2007. Syndesmosis Procedure: A Non-Osteotomy Approach to Metatarsus Primus Varus Correction. FOOT &ANKLE INTERNATIONAL, 9.pp. Vol. 28, No. 9, pp 1000-6.

Wu D, 2006. A Non Osteotomy Technique for Hallux Valgus Correction. Hong Kong J Ortho Surg, 10(1), pp. 34-38.

Pagella P, Pierleoni. G., 1971. Hallux Valgus and Its Correction. A Technique That Deserves To Be Better Known Instituto Ortopedico Toscano, 1(55).

Wong DW, W. D. M. H. L. A., 2014. The use of a syndesmosis procedure for the treatment of hallux valgus: good clinical and radiological results two years post-operatively. Bone Joint J. , Volume 96-B(4), pp. 502-7.

Wu DY, L. K., 2014. Osteodesis for Hallux Valgus Correction: Is it Effective?. Clin Orthop Relat Research, p. October 28.

Wu D, Lobo L, 2010 Does Wearing High Heeled Shoes Cause Hallux Valgus? A Survey of 1,056 Chinese Females, Foot & Ankle Online Journal 3: (5) : 3

References

The 20th century economist John Maynard Keynes once described

the "gold standard" as "a barbarous relic" and noted "the

difficulty lies not so much in developing new ideas as in escaping from old ones”

http://en.wikiquote.org/wiki/John_Maynard, n.d.