Case Presentation
Failed Crescentic Osteotomy

Greetings. I would like to get us back onto the occasional habit of including some interesting clinical cases for discussion in this column. Please give this a review and write in with your thoughts / comments / questions.

One great advantage of having email and a good group of colleagues is that you can pass around photos and case histories of some challenging cases that may come your way. This is a great way to confirm that you are doing the right thing for your patient, and is also a great way to learn from the experience of others. Sometimes you just need another pair of eyes to look at an x-ray or clinical photo in order to pick up on the entire scenario.

The photo set below is one that I received recently by email from a former resident who is now in private practice. The patient history includes complaint of painful 1st ray with recurrent bunion approximately 1 year out from surgery by another physician. In the first photo you can see the loss of fixation at the crescentic base osteotomy site and obvious motion / displacement in the early post op period. The second photo is at the 1 year post op time with hardware removal and significant 1st ray deformity evident.

The patient is anxious to get this corrected with a revision surgery. What procedure would you recommend and what would you use for fixation?

Loss of fixation at crescentic osteotomy site

1 year post-op

If this was your patient, what would you recommend ?

If you have an interesting case of your own, please send it in so we can share it with the entire residency community…

Have a great rest of the week!

John Steinberg, DPM
Editor - PRESENT