Objective: To investigate the operative technique of treating Freiberg's disease with dorsal wedge osteotomy and absorbable pin fixation, and to evaluate the clinical outcome.
Methods: From June 2005 to June 2007, 8 patients with Freiberg's disease were treated, including 2 males and 6 females aged 16-66 years old (average 36 years old). X-ray films revealed osteosclerosis, collapse of the metatarsal head and ischemic necrosis of the second metatarsal head. According to Smillie classification system, there were 4 cases of stage II, 3 of stage III and 1 of stage IV. The duration of symptoms was 6-36 months (average 19 months). After dorsal wedge osteotomy, the metatarsal heads were rotated to reconstrust the joint surface, then 3-4 pieces of absorbable pin 1.5 mm in length were implanted for fixation.
Results: All wounds healed by first intention, and no early postoperative complications occurred. Five patients were followed for 11-35 months (average 14 months) and had significant pain relief. At 3 months after operation, the dorsal-flexion of metatarsophalangeal joint was improved by 0-50 degrees (average 21 degrees), and the plantar-flexion was increased by 0-10 degrees (average 5 degrees). X-ray films showed that solid union of the osteotomy was achieved in all patients at 8-13 weeks after operation (average 10 weeks). Average shortening of metatarsal was 1.7 mm (range 1.3-2.0 mm). All patients returned to sports and recreational activities at 4 months after operation, except one case of stage IV who had constant swelling and stiffness in the joint and was improved at 12 months after operation.
Conclusion: Dorsal wedge osteotomy in complex with absorbable pin fixation is an effective procedure for stage II and III Freiberg's disease, because it is capable of reconstructing the metatarsophalangeal joint effectively, allowing early joint motion and avoiding a second operation.