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Shortening Z-osteotomy for the proximal phalanx of the hallux using axial guides.

The shortening Z-osteotomy of the proximal phalanx of the hallux has been presented as an alternative to the Regnauld enclavement procedure for patients with the appropriate indications. In addition to sharing the same positive characteristics as the Regnauld procedure, the Z-osteotomy has technical and physiologic advantages. The advantages of the Z-osteotomy over the Regnauld include maintenance of the intrinsic attachments at the base of the proximal phalanx, less risk of avascular necrosis, less technical difficulty, and absence of complications associated with an autogenous bone graft. Also, it does not affect the sesamoid apparatus. Research and extended follow-up studies will continue at Lakewood Regional Medical Center. In the last year, one author has completed approximately 13 of these procedures. The postoperative results have been encouraging and successful with one exception. In one case, the increase of the hallux interphalangeal angle was probably caused by excessive tightening of the distal screw compared with the proximal screw.