Use of a percutaneous osteotomy with plate fixation in hallux valgus correction

Background

With hundreds of operative methods described for correction of hallux valgus we can state that the ideal surgical treatment is still controversial. The Bösch technique has been used as a percutaneous way of correcting hallux valgus deformities with the use of a pin fixation. The aim of this study is to evaluate a new method of fixation by using a percutaneous locking plate.

Methods

Between June 2013 and January 2015, 24 consecutive percutaneous subcapital osteotomies of the first metatarsal bone were performed for the treatment of painful hallux valgus deformities in 24 patients. Additional surgical procedures included DMMO’s (Distal Metatarsal Minimally-Invasive Osteotomies) in 12 of the operated feet (44.44%); minor digits were corrected in 7 cases (25.9%). An Akin procedure was performed in 81% of cases and all cases underwent an adductor hallucis tenotomy. All patients were clinically assessed using the AOFAS score. Radiographic measures included the preoperative and postoperative values of the Hallux Valgus Angle (HVA), Intermetatarsal Angle (IMA), and the Distal Metatarsal Articular Angle (DMAA).

Results

The mean correction achieved improved for AHV from 36.57 ± 7.1 to 12.22 ± 8.69°, for IMA from 13.8 ± 1.59 to 7.08 ± 2.72 and for DMAA from 13.98 ± 7.38 to 6.07 ± 4.99. Clinically, scores on the AOFAS scale improved from a 45.8 ± 9.6 to 91.29 ± 9.8.Although healing of the osteotomies was observed radiographically within 6 to 12 weeks, two cases (8.3%) exhibited delayed healing. There were no cases of nonunion. There were no superficial or deep infections or wound healing problems. Plate had to be removed in 3 cases (12.5%).

Conclusion

This technique modification is an acceptable procedure to correct hallux valgus in patients with a moderate level of deformity.

Level of evidence

Level IV. Case series.