First metatarsal bone

Abstract: Free, vascularized thin corticoperiosteal grafts and small periosteal bone grafts harvested from the supracondylar region of the femur are described. These grafts are nourished from the articular branch of the descending genicular artery and vein. Thin corticoperiosteal grafts consist of periosteum with a thin layer of outer cortical bone and include the cambium layer, which has a better osteogenic capacity. This graft is elastic and readily conforms to the recipient bed configuration. Thin corticoperiosteal grafts were used to treat 11 patients with fracture non-union of an upper extremity that had no massive bone defects. Early, rapid union occurred in all patients except three: one in which the anastomosed vessel became obstructed and two in which the internal fixation of the fracture was unsecured. The small bone grafts consist of periosteum, full thickness cortex, and the underlying cancellous bone. This graft can be successfully harvested without disturbing the vascularity, unlike the currently used vascularized bone grafts. This graft was used to treat three patients with avascular necrosis of the body of the talus and could prevent the necrotic talus body from progressive collapse in patients in early stages of the disease. One patient with an infectious bone defect of the first metatarsal bone was successfully treated by vascularized bone graft with an accompanying skin flap.

Abstract: This paper presents a new name—metatarsus primus varus—for a well known foot deformity; the name indicates the situation of the primary focus of that deformity at the proximal end of the first metatarsal bone; it notes the constant varus position of that bone and the lateral bone wedging at its proximal joint, and considers this an anatomic variation and not the result of inflammation or of the use of faulty shoes; it further considers that the hallux valgus deformity is acquired, and that it may be the result of the varus of the first metatarsal, although faulty shoes and chronic arthritis may also be causative factors. The writer presents the thesis that any operative procedure that does not include the correction of the deformity at its proximal focus is unscientific and inadequate; and that simple cuneiform osteotomy at the metatarso-cuneiform joint, with the redressement of certain secondary changes, is adequate and permanent. Other accompanying foot deformities are briefly discussed.

Abstract: Seventy-eight chevron osteotomies augmented by internal fixation with self-reinforced polyglycolide pins, 2 mm in diameter, were performed in 60 patients suffering from a painful hallux valgus. The mean metatarsophalangeal angle was 31 degrees, and there was a metatarsus primus varus varying from 10 degrees to 20 degrees. The average follow-up time was 14 (range, 12 to 31) months. No postoperative redisplacement or disturbance of healing of the osteotomy was observed, but recurrence of hallux valgus occurred in 8 feet (10%), each initially with a moderate to severe hallux valgus. Some pain at the first metatarsophalangeal joint during physical activity remained in 12 feet (15%). There was a mean shortening of 2.5 mm of the first metatarsal bone, and the most significant shortening was associated with pain in the forefoot. The metatarsophalangeal joint motion was not decreased. The subjective overall result was excellent or good in 75% of the patients. Because of the biodegradability of the implants used, no secondary procedures to remove the implants were necessary.

Abstract: Ninety feet in fifty-one patients have been subjected to distal osteotomy of the first metatarsal bone for metatarsus primus varus and hallux valgus.The technique described by Mitchell, Fleming, Allen, Glenney, and Sanford has been used. The results have been satisfactory in all but six feet. Unsati