Radiographic and Clinical Results of Minimally Invasive Chevron Akin Osteotomy for Moderate to Severe Hallux Valgus Deformities

Kurashige, Toshinori

doi:10.1177/19386400211045911

Cited by 5 publications

(6 citation statements)

References 32 publications

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“…Three studies reported significant improvements in the Foot Function Index, Japanese Society for Surgery of the Foot Scale, and Manchester-Oxford Foot Questionnaire scores, which are comparable to the AOFAS score. 2 , 17 , 27 One study did not report AOFAS or any comparable score. 29 Preoperative and last follow-up visual analog scale (VAS) score was reported in 7 studies, and in 5 it was reported as statistically significant.…”

Section: Resultsmentioning

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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Section: Resultsmentioning

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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“…The preoperative HVA was 29.3 degrees and improved to 7.1 (4-12) degrees postoperatively. The mean IPA improved from 13.5 (9)(10)(11)(12)(13)(14)(15)(16) degrees to 4.7 (3-8) degrees postoperatively. The preoperative IMA, HVA, and IPA differences between the fracture and nonfracture group were not significant (P > .05).…”

Section: Primary Outcomesmentioning

confidence: 90%

“…Overall, studies have reported similar outcomes with effective deformity correction, short learning curve, low complication rate, low symptomatic recurrence, low postoperative opioid use, and high patient satisfaction. 3,9,[11][12][13][14][15]17,18,22 Although this study focused on a third-generation technique with rigid, permanent fixation, there are multiple techniques for the percutaneous Akin throughout the Reports of undesired lateral cortex fracture are ubiquitous throughout the literature. 1,[7][8][9] Lateral hinge fractures have been thought to contribute to osteotomy instability and secondary displacement.…”

Section: Discussionmentioning

confidence: 99%

“…3,9,[11][12][13][14][15]17,18,22 Although this study focused on a third-generation technique with rigid, permanent fixation, there are multiple techniques for the percutaneous Akin throughout the Reports of undesired lateral cortex fracture are ubiquitous throughout the literature. 1,[7][8][9] Lateral hinge fractures have been thought to contribute to osteotomy instability and secondary displacement. 16 However, Schilde et al 21 recently reported on minimally invasive and open Akin osteotomy techniques and found that disruption of the lateral cortex occurred more frequently in the minimally invasive group (51.6% vs 13.9%), but there was no significant delay in bone healing using their transcutaneous temporary K-wire technique.…”

Section: Discussionmentioning

confidence: 99%

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Fracturing the Lateral Hinge Improves Radiographic Alignment and Does Not Affect Clinical Outcomes of the Minimally Invasive Akin Osteotomy

Marciano,

Ashinsky,

Mysore

et al. 2023

Foot Ankle Int.

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Background: Intraoperative fracture of the lateral cortex is common during Akin osteotomy. In a recent study, lateral cortex fracture did not impede healing or result in loss of correction in a combined cohort of open and percutaneous osteotomies stabilized by K-wire fixation. We hypothesize that undesired lateral cortex fracture will not affect radiographic correction and patient-reported outcomes in a percutaneous cohort stabilized by permanent, rigid screw fixation. Methods: Consecutive patients with hallux valgus who underwent first metatarsal osteotomy and percutaneous Akin osteotomy stabilized by permanent, rigid screw fixation between May 2020 and January 2022 were retrospectively reviewed. Patients were stratified based on fractured lateral cortex (FC) or its absence (nonfractured cortex [NFC]). Visual analog scale (VAS) and Foot Function Index (FFI) were used to assess pain and patient-reported outcomes at 1-year follow-up. Patients were polled for satisfaction at 1-year follow-up by yes/no survey. Results: Ninety-eight patients (89% female) were reviewed (98 feet; 43 NFC, 55 FC). Mean age was 48.3 years (range, 18-83 years). Mean preoperative VAS score was 7.5 and 7.7 in NFC and FC groups, which significantly decreased to 0.6 ( P < .01) and 0.6 ( P < .01), respectively. Mean total FFI was 53.9 and 54.2 and decreased to 17.9 ( P < .01) and 17.2 ( P < .01) in the NFC group and FC group, respectively. Overall, 97.8% of the NFC group and 96.4% of the FC group reported satisfaction. Mean HVA improved from 27.2 (16-42) degrees to 10.7 degrees (4-12) postoperatively in the NFC group. And in the FC group, HVA improved from 29.3 (19-39) degrees to 7.1 (4-12) degrees postoperatively. Postoperative HVA was significantly lower in the FC group ( P < .05). Conclusion: In an exclusively percutaneous surgical cohort with correction maintained by rigid screw fixation, fracture of the lateral cortex is associated with improved postoperative radiologic alignment without detriment to patient-reported outcomes. Level of Evidence: Level III, retrospective cohort study.

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“…16 Potential limitations of these procedures include shortening of the metatarsal bone due to the thickness of the burr, imprecise bone cuts, thermal injuries to the bone and wound edges, injuries to proximal nerves (eg, the dorsal medial cutaneous nerve possibly due to the catching and "wrapping" of the nerve with the burr), and injuries to the metatarsal head vascular supply and the flexor and extensor tendons. Kurashige 20 studied the radiographic and clinical results after MICA for moderate-to-severe HV deformities. Overall results were satisfactory; however, they reported an overall complication rate of 32.5% and there were undercorrections and bony prominences in 7.5% of cases.…”

Section: Discussionmentioning

confidence: 99%

Minimally Invasive Transverse Distal Metatarsal Osteotomy (MITO) for Hallux Valgus Correction: Early Outcomes of Mild to Moderate vs Severe Deformities

Yoon,

Tang,

Shim

et al. 2023

Foot Ankle Int.

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Background: We compared the radiological and clinical outcomes of mild to moderate and severe hallux valgus (HV) treated with minimally invasive distal metatarsal transverse osteotomy (MITO) performed by a single surgeon. Methods: Eighty-four patients who underwent MITO between May 2018 and March 2020 were recruited and followed for at least 24 months. The severe group was defined as having a preoperative hallux valgus angle (HVA) >40 degrees or preoperative first-to-second intermetatarsal angle (1-2 IMA) >16 degrees; the mild to moderate group was defined as having an HVA <40 degrees and a 1-2 IMA <16 degrees. Pre- and postoperative measurements of the HVA, 1-2 IMA, distal metatarsal articular angle, and tibial sesamoid position were obtained. The visual analog scale for pain, the Foot and Ankle Outcome Score, and the Medical Outcomes Study Short Form Health Survey–36 physical component summary were used to assess clinical outcomes. Results: A total of 116 feet were included in this study and median follow-up period of 29.0 months (range, 24-52 months). Both groups showed significant improvements in all radiologic parameters postoperatively, with the degrees of correction greater in the severe group than in the mild to moderate group. All clinical scores improved significantly from the preoperative to the last follow-up visit. Final clinical outcomes and degrees of improvement were comparable in both groups. Conclusion: This study showed that short-term radiographic results for patients with either mild to moderate or severe HV treated with MITO were favorable. Overall clinical outcomes were comparable to those of conventional treatments. In this series, we found MITO with screw fixation to be a satisfactory surgical option for patients with mild to severe HV deformities. Level of Evidence: Level III, retrospective comparative study.

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Radiographic and Clinical Results of Minimally Invasive Chevron Akin Osteotomy for Moderate to Severe Hallux Valgus Deformities

Cited by 5 publications

References 32 publications

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

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

Fracturing the Lateral Hinge Improves Radiographic Alignment and Does Not Affect Clinical Outcomes of the Minimally Invasive Akin Osteotomy

Minimally Invasive Transverse Distal Metatarsal Osteotomy (MITO) for Hallux Valgus Correction: Early Outcomes of Mild to Moderate vs Severe Deformities

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