Croatian rotatory oblique three-dimensional osteotomy (CROTO) – a modified Wilson’s osteotomy for adult hallux valgus intended to prevent dorsal displacement of the distal fragment and to reduce shortening of the first metatarsal bone

Abstract

<p><strong>Aim <br /></strong>To evaluate biomechanical and clinical outcomes of a newly developed modification of the Wilson's osteotomy for hallux valgus: a three-dimensional subcaptial correction of the metatarsal head position with a simultaneous lateral and plantar shift with derotation intended to reduce displacement of the distal fragment and shortening of the first metatarsal bone. <br /><strong>Methods<br /></strong> Thirty four feet (28 female patients) underwent the new procedure and were evaluated before and 12 to 84 months (medi-an=25.5) after the surgery. <br /><strong>Results<br /></strong> Plantar shift of the distal fragment was achieved in all feet. Shortening of the first metatarsal was moderate: ≤6 mm in 32/34 feet, 7 and 10 mm in the remaining two. Median difference in metatarsal index post-vs. pretreatment was-4.0. The hallux valgus angle, intermetatarsal and distal metatarsal articular angles were reduced in all feet. The American Orthopaedic Foot and Ankle Society score improved in all feet (median increase= 51.5). <br /><strong>Conclusion<br /></strong> The method allows for a lateral and plantar shift with derotation of the distal fragment and a mild/moderate shortening of the first metatarsal bone.</p>