Outcomes of Mini-Screw Fixation Following Dorsal Closing Wedge Osteotomy for Treatment of Freiberg's Disease.

Background

Freiberg's disease is an osteochondrosis of the lesser metatarsal heads, most commonly the 2nd, that predominantly affects adolescent females and causes pain and limited motion; early cases are treated conservatively, while advanced or refractory ones may need dorsal closing wedge osteotomy. This study aimed to evaluate the clinical and radiological outcomes of dorsal closing wedge osteotomy fixed with a single mini-screw in patients aged 13 to 30 years.

Methods

This prospective observational case series included 48 consecutive patients with Freiberg's disease, Smillie stage II, III, or IV, who underwent dorsal closing wedge osteotomy with mini-screw fixation after failed conservative treatment. Pain was assessed with a 0-10 visual analogue scale (VAS) preoperatively and at the final 6-month follow-up, radiographs were reviewed for osteotomy union, and complications were recorded.

Results

There was a substantial reduction in pain, with the mean VAS score improving from 8.67 ± 0.88 to 1.33 ± 2.01 (P<0.001). Radiographic union was achieved in all patients at a mean of 7.31 ± 1.22 weeks. Intraoperative fragmentation of the metatarsal head occurred in 3 patients (6.25%) and superficial wound infection in 3 (6.25%), and all patients had some loss of metatarsophalangeal joint plantarflexion (mean 11°).

Conclusions

In this case series, dorsal closing wedge osteotomy with mini-screw fixation for Freiberg's disease was associated with a substantial reduction in pain and a low complication rate, although some loss of metatarsophalangeal joint motion occurred in all patients. LEVEL OF EVIDENCE Level IV, prospective observational case series study.