Consensus in percutaneous bunionette correction

Michels, Frederick; Demeulenaere, B.; Cordier, Guillaume

doi:10.1016/j.otsr.2020.03.029

Cited by 13 publications

(13 citation statements)

References 19 publications

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“…1 Factors that cause increased pressure and friction on the lateral edge of the foot, such as constrictive footwear, induce hypertrophy of the surrounding soft tissues, resulting in BD. 16,22 Patients complained of erythematous swelling and pain, difficulty ambulating, and falling. 15 The initial management of BD is conservative treatment, such as wearing appropriate footwear, semirigid shoe inserts, metatarsal pads, metatarsal bars, and medication such as nonsteroidal oral analgesics and steroid injections.…”

Section: Introductionmentioning

confidence: 99%

Percutaneous Fifth Metatarsal Osteotomy for Bunionette Deformity Without Fixation or Strapping: A Retrospective Study

Al Ramlawi,

Patel,

Ashinsky

et al. 2023

Foot Ankle Int.

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Background: Bunionette deformity (BD) is a painful condition of the fifth metatarsal characterized by an osseous prominence and fifth toe varus deformity. The purpose of this study is to assess the clinical, functional, and radiographic outcomes of percutaneous distal metatarsal metaphyseal osteotomy (DMMO) without fixation or postoperative strapping of the foot. Methods: A retrospective case series was performed on 111 patients (132 feet) with symptomatic BD who underwent percutaneous DMMO of the fifth metatarsal from September 2020 to January 2022 by an experienced minimally invasive surgeon. According to the Shimobayashi classification, we treated 1 type I deformity, 37 type II deformities, 52 type III deformities, 42 feet with type IV deformity, and no patient with a type V deformity. Ninety patients (81%) underwent unilateral osteotomy, and 21 (19%) had bilateral osteotomies. Most cases included other procedures including treatment of 114 associated deformities of the same feet: 68 bunions, 12 lesser metatarsal osteotomies (2-3-4 metatarsals), and 34 hammertoes (20 second hammertoes, 10 third hammertoes, 1 fourth hammertoes, 2 fifth hammertoes). Patient-reported clinical outcome measures, including the Foot Function Index (FFI) questionnaire, the visual analog score (VAS), and overall satisfaction were collected. Fourth-to-fifth intermetatarsal angle (IMA) correction, time to bone union, and complication rates were assessed in all patients. Results: Mean follow-up was 24.1 months (range, 14-39 months). Both radiographic parameters and patient-reported outcome measures significantly improved after DMMO procedure. The average fourth-to-fifth IMA improved from 12.2 degrees, preoperatively, to 4.4 degrees, postoperatively ( P < .001). Patient outcomes reflect the overall outcomes of the combined surgeries on a per-patient basis. Preoperatively, patients had a mean VAS score of 7.6, which improved to 0.6 at the last follow-up ( P < .001). Furthermore, the average FFI significantly decreased from pre- to postoperation from 19.2 to 4.4, respectively ( P < .001). Overall, 108 of 111 patients reported being satisfied with the outcomes of the procedure. Average bone union was achieved at 12.6 weeks postoperation, with a minimum of 12 and a maximum of 25 weeks. The complication rate was 1.5%, including 1 case of an asymptomatic cock-up deformity and 1 case of lateral fifth metatarsal shaft bone overhang pain, which resolved with an exostectomy. Conclusion: The results of this study of patients who had minimally invasive surgery from an experienced surgeon suggest that percutaneous DMMO of the fifth metatarsal without internal fixation or postoperative immobilization or strapping can be effective at improving radiographic alignment, pain, function, and overall satisfaction with minimal rates of complication. Level of Evidence: Level IV, case series.

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Section: Introductionmentioning

confidence: 99%

Percutaneous Fifth Metatarsal Osteotomy for Bunionette Deformity Without Fixation or Strapping: A Retrospective Study

Al Ramlawi,

Patel,

Ashinsky

et al. 2023

Foot Ankle Int.

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“…The Shannon burr is also used in other procedures such as percutaneous bunionette correction, percutaneous calcaneal osteotomy, and lesser toe procedures. 11 , 18 , 19 , 25 , 26 …”

Section: Introductionmentioning

confidence: 99%

“…The Shannon burr is also used in other procedures such as percutaneous bunionette correction, percutaneous calcaneal osteotomy, and lesser toe procedures. 11,18,19,25,26 Considering the recent influx of research on the topic of MIS hallux valgus correction, prior systematic reviews still include many procedures that did not use a Shannon burr but traditional saws. Additionally, many of these studies looked at proximal and distal osteotomies and first-and second-generation MIS instrumentation and osteotomies that may or may not have had fixations.…”

Section: Introductionmentioning

confidence: 99%

Minimally Invasive Surgery Using a Shannon Burr for the Treatment of Hallux Valgus Deformity: A Systematic Review

Gonzalez

Encinas

Johns

et al. 2023

Foot & Ankle Orthopaedics

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Background: Recently there has been an increase in minimally invasive surgery (MIS) for the correction of hallux valgus deformity. This systematic review aims to evaluate and present the current literature on MIS hallux valgus correction in studies reporting the use of the Shannon burr with distal metatarsal osteotomies to help establish evidence-based guidelines for surgeons using this technique. Methods: Two independent authors performed a systematic literature search using the following databases: PubMed, Embase, and the Cochrane library. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) protocol and the Cochrane Handbook guidelines were followed. All studies included were published from 2008 to 2022 and included the use of the Shannon burr during distal metatarsal osteotomies MIS for hallux valgus and at least 12-month follow-up. The MINORS score criteria was used to evaluate the strength and quality of 17 studies by 3 authors. Statistical analysis and meta-analysis were not performed because of the heterogeneity of the included studies and the data being descriptive. Results: A total of 17 studies were reviewed. A total of 911 subjects were included, and 1088 MIS procedures were performed. The average follow-up was 23.8 (12-59.1) months. American Orthopaedic Foot & Ankle Society scale and visual analog scale scores improved from 52.1 (41-62.5) to 90.3 (83.3-97.1) and 4.9 (3-8.2) to 0.8 (0-1.9). Satisfaction rates were very high among the studies that reported it. The hallux valgus angle, intermetatarsal angle, and distal metatarsal articular angle improved from 31.4 (23.5-44.1) to 11.1 (7-17.2), 13.4 (8.1-18.6) to 7.3 (4.2-10.3), and 12.3 (9-16.3) to 4.1 (1-6.7), respectively. The complication rate was 16.6%, and recurrence was 2.2%. Nonunion comprised 0.4%, infections 1.1%, nerve injury 2.2%, avascular necrosis 0%, hallux varus 0.09%, transfer metatarsalgia 0.1%, and hardware removal 6.2%. Conclusion: MIS for the treatment of hallux valgus using the Shannon burr appears to be a safe and effective therapy, with appropriate correction of the hallux valgus deformity, improvement in functional outcomes, high patient satisfaction, low recurrence, and acceptable complication rates. Level of Evidence: Level II, systematic review.

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“…The treat ment involves footwear changes, or use of insoles and/ or orthoses, presenting satisfactory results in mild cases (7) . Surgical treatment can be considered in patients with refractory symptoms (8) . Surgical techniques include lateral condylectomy, metaphyseal osteotomy (distal or proximal), and fifth metatarsal open or percutaneous diaphyseal osteotomy (9) .…”

Section: Introductionmentioning

confidence: 99%

Postoperative outcomes of oblique osteotomy and capsuloplasty for the treatment of bunionette in the fifth metatarsal neck

et al. 2022

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Objective: Present the outcomes of oblique osteotomy and capsuloplasty based on the pre-/postoperative American Orthopaedic Foot & Ankle Society (AOFAS) scores and demonstrate the possibility of correcting all four types of bunionette through a single technique. Methods: Descriptive observational study performed through medical records assessment based on the pre-/postoperative AOFAS scores. Results: Fifty-three feet were operated on, 28 on the right side and 25 on the left, predominantly female (n=34) and one male. The mean age was 44.8 years (range 19-77). The improvement in the AOFAS score occurred in all patients, the preoperative mean was 53.7 (44-57), and the postoperative mean was 77.4 (65-80). The distal oblique osteotomy of the fifth metatarsal associated with capsuloplasty was used. Conclusion: The technique used in our study presents a significant improvement in all cases, corroborating with the outcomes in the literature. Level of Evidence IV; Descriptive Observational Study.

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Consensus in percutaneous bunionette correction

Cited by 13 publications

References 19 publications

Percutaneous Fifth Metatarsal Osteotomy for Bunionette Deformity Without Fixation or Strapping: A Retrospective Study

Percutaneous Fifth Metatarsal Osteotomy for Bunionette Deformity Without Fixation or Strapping: A Retrospective Study

Minimally Invasive Surgery Using a Shannon Burr for the Treatment of Hallux Valgus Deformity: A Systematic Review

Postoperative outcomes of oblique osteotomy and capsuloplasty for the treatment of bunionette in the fifth metatarsal neck

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