I have now completed a number of these procedures which have been challenging to say the least.
The one step procedure involves breaking the metatarsal and inserting a bone graft. All of the patients experience some stiffness post op which is difficult to avoid.
One particular challenge is tendon balance
The tendons require a tenotomy to allow for lengthening. The EDL is easy, but the FDL is more difficult.
I have attempted to cut at the osteotomy interface, but locating it here is quite difficult. Cutting more distally means that the toe may be unstable.
I have been able to reduce the incision size with experience and have made the incision more proximal-this should improve the cosmetic appearance.
Generally, the patients do well, however should be cautioned over risks, especially stiffness and plantarflexion of metatarsal.
The external fixator technique is simple to apply, but requires patient involvement.
This is more protracted and can be frustrating for patients. It seems most patients want the one step procedure. Is this due to their lack of understanding, thinking that it’s much easier!!
I have done one case involving a double osteotomy of 3 and 4. The patient did well, but needed a lot of support post op. The fixator bar came loose and had to be replaced under local anaesthetic.
Reflection
Patients must be cautioned regarding the risks of surgery
Expectations need to be managed carefully
Time will tell how good the procedure is- there are some issues with gaining length with the one step
I intend to visit Dr Lamm, in Florida, at some point to learn his technique