Local Anatomy as Applied to the BRT Osteotomy

The proximal part of the metatarsals:

Bone Aspects

- The plantar edge is plantarly curved, provi ding favorable conditions for an oblique proximal and plantar cut.

-The articular and intermetatarsal surfaces are located partly the dorsal part, and therefore preserved from the osteotomy cut.

- The fifth metatarsal has a flattened proximal part where the osteotomy is more delicate to perform.

- The first metatarsal has a particularly voluminous proximal plantar part.

Vascular Aspect

- The dorsal and plantar vascular arches are not a problem for performing this osteotomy. The only problem arises from the perforating arteries: Each one must be protected when performing the cut, particularly the first perforating artery.

Fig. 18a2. BRT osteotomy. Anatomy.

1, 2. This osteotomy is extra-articular, its cut is located plantarly from the intermetatarsal joints.

3. Care has to be taken not to jeopardize the perforating arteries, notably the first perforating one.

4. The dorsal wedge has to be very thin: a 2 mm large wedge elevates the metatarsal head of 4 mm.

Fig. 18a2. BRT osteotomy. Anatomy.

1, 2. This osteotomy is extra-articular, its cut is located plantarly from the intermetatarsal joints.

3. Care has to be taken not to jeopardize the perforating arteries, notably the first perforating one.

4. The dorsal wedge has to be very thin: a 2 mm large wedge elevates the metatarsal head of 4 mm.

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