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Headless Compression and Twist-Off Screws
Surgical Technique
Figure 1
Figure 2
The following surgical technique describes a Twist-Off
Screw being used in a Weil osteotomy.
Surgical Approach
A Weil osteotomy is performed using a dorsal approach.
Incision is initiated within the intermetatarsal space
and extends to the web space ( Figure 1). Osteotomy
skin retraction provides exposure of both extensor
muscles.
Place the lesser metatarsal in plantar flexion to expose
the metatarsal head and dislocate the joint. Placing
one Hohmann retractor on each side of the metatarsal
should make this maneuver much easier. The use
of a spreader helps to ensure a safe osteotomy by
providing adequate protection.
Osteotomy
The osteotomy is made horizontal and parallel to the
sole. It starts in the cartilage of the head, near the
dorsal margin, and should be at least 2.5 cm long
(Figure 2).
Caution:
The direction of the cut should be adjusted
according to the condition of the forefoot. In case of
pes cavus, the cut may be too short and the resection
level should therefore be raised. In case of pes planus
(or for the fourth or fifth metatarsals), the cut may be
too long and the resection level should be lowered.
Twist-Off Screw Technique
