Cotton Osteotomy Case Study

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When compared to medial column arthrodesis, the Cotton osteotomy has shown to be superior in multiple facets. In all 5 papers reviewed, all studies reported no nonunions using the Cotton. Only Boffeli et al. reported a single case of delayed union that was treated with a bone stimulator, which resolved at 6 months. Nonunion rates in midfoot arthrodesis procedures has been reported to be as high as 20%, strongly supporting the use of the Cotton.2 All papers reviewed supported the effectiveness of the Cotton as an adjunctive procedure in flatfoot surgery. Three papers reported statistically significant improvement of Mearys angle, among others, that they used to conclude medial column correction.2,5,6 The problem with this parameter for the Cotton is its inability to isolate the correction from the Cotton from the correction of the rear foot procedure in the reconstruction. Two papers newly described their own radiographical parameter that isolates medical column correction from the rearfoot correction.1,7 Each the MASA and the medial cuneiform proximal and distal articular surface angle saw significant improvement utilizing the Cotton that showed…show more content…
All papers reviewed supported the use of the Cotton osteotomy when intraoperative assessment presented fixed forefoot varus after hindfoot procedures for flatfoot correction that meet certain criteria: absence of arthritis, absence of medial column instability, or had a symptomatic HAV deformity. The deformity also had to be correctable within limits of a 5-8mm plantarflexory bone block.10 When utilized, all papers assessed and confirmed correction of medial column sag and forefoot varus by one or more of the following parameters; Meary’s angle, MASA, and angle between the proximal and distal articular surfaces of the medial

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