DMMO for met adductus

[Boba Foot]

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Is anyone here doing DMMOs for met adductus and can offer any pearls? I've done a few Adductoplasties in the past but they're long and tedious with significant dissection and post-op pain. Recently read about doing laterally angulated cuts on a DMMO to reduce the deformity, but have only found a paper or two about it. Going to experiment in a lab this week for technique.

 

[Adam Smasher]

According to the published literature and the seminars I've watched, they work great as long as your name isn't Adam Smasher.

 

[deleted1235332]

I run from met adductus like the plague but I’m also not the best admittedly. @air bud is a big adductoplasty guy.

 

[air bud]

I run from met adductus like the plague but I’m also not the best admittedly. @air bud is a big adductoplasty guy.

To be fair I'm finding less of a need for it

Is anyone here doing DMMOs for met adductus and can offer any pearls? I've done a few Adductoplasties in the past but they're long and tedious with significant dissection and post-op pain. Recently read about doing laterally angulated cuts on a DMMO to reduce the deformity, but have only found a paper or two about it. Going to experiment in a lab this week for technique.

@wakaflocka88 does a lot of DMMO on sense8 patients. I've done a fair number over the last year. Certainly finding that it's not a super accurate cut. You definitely need to take multiple passes with the bur. I think somebody has a 3 mm bird but with a 2 mm you need a larger pass to remove more bone otherwise things just don't move very well. Also finding that you need to kind of wrap it around plantarly to remove that shelf to let it actually properly displace. Obviously in this case you're trying to get more transverse plane motion than vertical plane motion but it's not like you can really control which way it moves other than your angled cut. I'm finding them to be less predictable then I expected. They are amazing for diabetic patients. With sensate patients if you do one you got to do them all and go all the way across to the 5th. You can do isolated 5th DMMO but nothing centrally without doing them all. I'm just going to stick to a doctoplasty although I'm finding myself doing it less often now and guess what a first MPJ fusion kind of fixes everything. Reps hate this one trick

Actually now that I think about it I'm trying to remember somebody told me about a technique and literally it was a Treace rep where you use a large clamp to essentially pull two through five together giving you room to move the first Ray negating the need for adductoplasty

 

[air bud]

To more specifically address this, yeah you look at the X-ray and you're like oh yeah I'm just going to angle my cut from distal medial to proximal lateral and they're just going to slide and shorten.... It doesn't necessarily work out that way

 

[Boba Foot]

To more specifically address this, yeah you look at the X-ray and you're like oh yeah I'm just going to angle my cut from distal medial to proximal lateral and they're just going to slide and shorten.... It doesn't necessarily work out that way

Yeah that's what it looks like was done in this study. If you were going to do MIS hammertoes, leave a k-wire in and advance it up to the metatarsal cuts, would that make your outcome more predictable? Granted it limits how far you can translate the capital fragment.

 

[Feli]

According to the published literature and the seminars I've watched, they work great as long as your name isn't Adam Smasher.

Correct... the patients are doing "great."
Every podiatry seminar... every lecturer... every procedure. They are all invariabley going to be doing "great."
None ever get neuritis, nonunion, crps, wound issues, revisions, any of that stuff. 🙂

This is where ortho is much better. They discuss their complications, if they've since stopped doing procedure/method, etc.
It is more about learning the most and less about bragging. One of the best I saw was on OBWO bunions... flat out said at the end of the lecture that they'd abandoned it due to unacceptable results. Good stuff.

 

[Stormblest]

Correct... the patients are doing "great."
Every podiatry seminar... every lecturer... every procedure. They are all invariabley going to be doing "great."
None ever get neuritis, nonunion, crps, wound issues, revisions, any of that stuff. 🙂

This is where ortho is much better. They discuss their complications, if they've since stopped doing procedure/method, etc.
It is more about learning the most and less about bragging. One of the best I saw was on OBWO bunions... flat out said at the end of the lecture that they'd abandoned it due to unacceptable results. Good stuff.

Yes most pod lecturers I’ve seen are unwilling to show their failures or complications. Everyone just does great with no complications somehow.

I did have one somewhat recently presenting on limb salvage who talked about a couple of complex cases and ended both saying one of the patients ended up dying from a heart attack shortly after a slew of surgeries and the other one they decided to end their own life a few months after…

 

[wakaflocka88]

Is anyone here doing DMMOs for met adductus and can offer any pearls? I've done a few Adductoplasties in the past but they're long and tedious with significant dissection and post-op pain. Recently read about doing laterally angulated cuts on a DMMO to reduce the deformity, but have only found a paper or two about it. Going to experiment in a lab this week for technique.

Angle your DMMO MIS cuts to the direction you want met head to shift. You can always shoot a K wire down the met shaft to help keep met head translated medial or lateral (kind of like the old school SERI bunions)

But be careful. Try to make your MIS cuts in one pass. Multiple passes will likely mess up the angle of translation you want. Start a little more proximal to the met neck to give some margin of error in case you do need to make another pass

I do a lot on healthy sensate patients, mainly for chronic FF overloading pain, but have done a few for metadductus foot with MPJ fusion and most have done well. The one metadductus lady that did not do well was because my DMMOs did not shift enough and was in esrly
Phase of experimenting. If I threw k wires down her met shafts then likely would have held the DMMO translation.

 

[Stormblest]

What are your thoughts on correcting met adductus by taking out a lateral base wedge at the TMTJ and fusing?

I’ve thought about doing this but have a feeling it will be much harder than I anticipate. I have done second and third TMTJ fusions for arthritis before.

 

[Boba Foot]

What are your thoughts on correcting met adductus by taking out a lateral base wedge at the TMTJ and fusing?

I’ve thought about doing this but have a feeling it will be much harder than I anticipate. I have done second and third TMTJ fusions for arthritis before.

That’s an Adductoplasty my man.

 

[Feli]

That’s an Adductoplasty my man.

He's talking about cubo-met joints closing wedge.
That only works in kids (flexible enough) for adductus and skew foot... take out a cuboid wedge, add a cunieforms wedge, staples fix... stay out of TMT joints.

I want to know why distal and not prox met osteotomies for adductus ... guessing to avoid fixation, but so much more power prox metaph osteotomies.

And how did you get privileges without ABFAS anyways? 😀

 

[Boba Foot]

He's talking about cubo-met joints closing wedge.
That only works in kids (flexible enough) for adductus and skew foot... take out a cuboid wedge, add a cunieforms wedge, staples fix... stay out of TMT joints.

I want to know why distal and not prox met osteotomies for adductus ... guessing to avoid fixation, but so much more power prox metaph osteotomies.

And how did you get privileges without ABFAS anyways? 😀

You can be a dick if you want, but word for word Gemini describes an Adductoplasty with what he said.

 

[Adam Smasher]

Nope, not an adductoplasty, a completely original non-trademarked operation, like Rickey Rouse or Monald Muck