Numerical analysis of the stress-strain state of osteotomies of the first metatarsal bone

A. Polienko ; D. V. Ivanov ; S. I. Kireev ; L. V. Bessonov ; A. M. Muldasheva ; E. S. Olenko

Izvestiya of Saratov University. Mathematics. Mechanics. Informatics, Tome 23 (2023) no. 4, pp. 496-511

Résumé

Deviation of the first toe to the outside, interconnected with the deviation of the first metatarsal bone to the inside, occurs in 46% of patients of the older age group and is called valgus deformity of the first toe. The negative impact of this pathology on the quality of life of patients is the reason for seeking medical help, the gold standard of which is surgical correction, and the basic surgical technique is osteotomy (sawing the bone and fixing its fragments with implants) of the first metatarsal. At the same time, an ideal osteotomy should provide initial stability in the early postoperative period. However, a large number of ways to perform osteotomy, as well as the advantages and disadvantages of each of the surgical techniques, do not allow to consider one of them as the most successful. In this regard, the aim of the work was to develop and validate a biomechanical model of osteotomy of the first metatarsal bone to analyze its stability and reliability depending on the type of osteotomy, the degree of displacement of bone fragments, as well as the number of fastening screws. In this study, biomechanical modeling of the most commonly used variants of osteotomy of the first metatarsal bone of the foot in the surgical treatment of its valgus deformity was carried out. For this purpose, 10 models of osteotomies of a separate first metatarsal bone were created, which were then subjected to static loading to analyze their stress-strain state and assess their success. Successful (stable and reliable) treatment options were identified, as well as unsuccessful ones. Two of the ten options considered were unsuccessful – scarf type osteotomies with displacement of bone fragments by 2/3 of its diameter and fixed with a single screw. It was revealed that osteotomies of the chevron type showed higher stability in comparison with scarf osteotomies. As a result, we note that in this study, numerical experiments were conducted for the first time to compare the stability and strength of the most commonly used variants of osteotomies based on a single bone model. A biomechanical model of scarf osteotomy of the first metatarsal bone has been developed and validated on the basis of mechanical experiments.