Radiographic Outcomes of a Percutaneous, Reproducible Distal Metatarsal Osteotomy for Mild and Moderate Bunions: A Multicenter Study.

Hallux valgus is a prevalent condition. Many open surgical methods of correction have been described. We performed a percutaneous, extra-articular distal metatarsal osteotomy for mild to moderate bunion deformity. The minimally invasive technique was used in 217 feet (180 patients; age 49 ± 4.7 years, mean ± standard deviation) at 4 centers in North America (Center 1: November 2012 to March 2017; Center 2: January 2010 to May 2016; Center 3: October 2013 to June 2016; Center 4: January 2015 to June 2017). The procedure was used in simultaneous bilateral cases in 28 patients (15.6%) and in nonsimultaneous bilateral cases in 9 patients (5.0%). Immediate postoperative weightbearing was used in all cases. The mean preoperative intermetatarsal angle, hallux abductus angle, and tibial sesamoid position were 14.6° ± 3.5°, 30.7° ± 7.8°, and 5.4 ± 1.4, respectively. At final follow-up of 9.3 ± 6.1 months, the mean intermetatarsal angle, hallux abductus angle, and tibial sesamoid position were 4.7° ± 2.8°, 8.4° ± 6.1°, and 2.0 ± 1.0, respectively (p < .0001 for all comparisons). No major complications were noted. All 217 osteotomies achieved union; 3 feet (1.4%) in 3 patients (1.7%) experienced asymptomatic malunion. Superficial pin-site infection was seen in 42 (19.4%) of the 217 feet (39 patients, 21.7%). The radiographic results of this percutaneous technique appear to be reproducible across multiple centers, and the technique is useful when correcting intermetatarsal and hallux abductus angles. This percutaneous osteotomy for realignment of the first ray allows immediate postoperative weightbearing and, in this initial review, appears to be safe and effective, even in simultaneous bilateral cases.

Hinged external fixation distraction for treatment of first metatarsophalangeal joint arthritis.

Treatment for hallux rigidus varies from joint preservation to joint destructive procedures. The objective of the present study was to report an alternative method of treatment of hallux rigidus using hinged external fixation distraction of the first metatarsophalangeal joint and to present our surgical technique. Ten distractions were performed in 9 patients (9 female feet [90%] and 1 male foot [10%]). The mean age at surgery was 41.0 (range 20 to 64) years. All patients had stage II or III hallux rigidus on the Regnauld classification system for hallux rigidus. The patients were evaluated clinically and radiographically before and after the distraction treatment. The mean period of fixation was 16.40 (range 7 to 21) weeks. Six of the patients (60%) with distraction experienced pin tract infections that were treated with oral antibiotics. The reported mean preoperative categorical pain score in 7 patients (7 feet) was 8.2 (range 5 to 10), and the postoperative score was 0.83 (range 0 to 2; p = .001). Of the 6 patients (6 feet) who responded to the remaining portion of the survey, 4 (66.67%) were very satisfied with their results, and 2 (33.33%) were satisfied with their surgical result. None of the patients required additional surgical treatment during the mean 2.2 (range 1.2 to 3.3) years of follow-up. Hinged first metatarsophalangeal joint distraction with external fixation has been shown to be a viable treatment option for joint preservation for stage II and III hallux rigidus in the short term.