Percutaneous, Intra-articular, Chevron Osteotomy (PeICO) for the Treatment of Hallux Valgus: A Cadaveric Study

Abstract

Background: Percutaneous surgery is experiencing sustained growth based on third-generation techniques. This cadaveric study was designed with the main goal of exploring the risk of iatrogenic tendon and neurovascular lesions and defining the safe zones in a percutaneous, intra-articular, chevron osteotomy (PeICO) procedure, as well as assessing the accuracy of the osteotomy itself. Methods: Eight feet from below-knee fresh-frozen specimens were selected. After the procedure, the specimens were dissected, and structures were inspected for damage. Results: The results of the safety measurements were as follows: (1) distance between portal 1 (P1) and the lateral border of the extensor hallucis longus (EHL) tendon: average 17.6 mm (range 12.7-21.3); (2) distance between P1 and the dorsomedial digital nerve (DMDN): average 7.2 mm (range 1.6-10.4); (3) distance between P1 and the metatarsophalangeal joint: average 15.7 mm (range 9.4-20.5); distance between portal 2 (P2), or the osteosynthesis portal, and the metatarsophalangeal joint: average 25.5 mm (range 22-30.4); distance between P2 and the lateral border of the EHL tendon: average 12.7 mm (range 8-16.7); and distance between P2 and the DMDN: average 4.1 mm (range 1.7-8.2). There were no iatrogenic injuries. The osteotomy angulation in the sagittal plane (reproducibility) average was 85.6 degrees. Conclusion: There were no iatrogenic injuries on this cadaveric study of PeICO. Clinical Relevance: This study will help orthopedic surgeons understand the risks of performing percutaneous surgery by mimicking an accepted open technique (chevron).

Percutaneous Transosseous Suture Fixation of the Akin Osteotomy and Minimally Invasive Chevron for Correction of Hallux Valgus

“…11,26 Another method is the percutaneous, intra-articular, chevron osteotomy (PeICO) that is a modification of the method of Bösch and employs internal fixation with an internal compression screw introduced from the dorsal-median approach. 12…”

“…11,26 Another method is the percutaneous, intra-articular, chevron osteotomy (PeICO) that is a modification of the method of Bösch and employs internal fixation with an internal compression screw introduced from the dorsal-median approach. 12 A somewhat different operative technique was employed by Chan et al 9 ; their method is based on creating the percutaneous subcapital chevron osteotomy of the first metatarsal and, following the translation of the distal bone fragment, achieving fixation with 1 screw introduced into the distal fragment from the medial-dorsal side. The study authored by Chan et al is a retrospective analysis of 13 feet (5 patients had simultaneous bilateral procedures) and demonstrates very good radiologic results (HVA improvement from 30.4 to 10.9 degrees and IMA, from 13.9 to 10.2 degrees), as well as clinical outcomes (the mean AOFAS score increased from 59.0 points to 93.7 points).…”

Letter Regarding: Biomechanical Comparison of Achilles Tendon Pullout Strength Following Midline Tendon-Splitting and Endoscopic Approaches for Calcaneoplasty

“…Finally, we want to mention that all the coauthors of this letter usually perform minimally invasive procedures 2,4 -6 on a regular clinical basis. Nevertheless, we would like to emphasize that these procedures must continue growing through safe steps and valid information to ensure their persistence in the future.…”

Comparison of two forced-air warming devices during foot and ankle surgery: a randomised controlled trial

“…A prospective, randomised study (Level of Evidence I) was conducted in which the effectiveness of the two methods of forced air heating during the intraoperative period was compared. We evaluated 35 patients (22 men and 13 women) undergoing foot and ankle surgery exclusively (Del Vecchio et al 2016, 2019, Yañez Arauz et al 2014). In 18 patients, forced air heating with blanket was used over body and in 17 patients with forced air heating with blanket under body.…”