Use of Minimally Invasive Distal Metatarsal Osteotomy for Correction of Hallux Valgus

PurposeMinimally invasive surgeries have become increasing popular in Orthopaedics. This study evaluated the clinical and radiographic outcomes of application of the concept for correction of mild-to-moderate hallux valgus deformity.MethodsFrom November 2005 to Feb 2010, 20 patients with hallux valgus deformity had distal metatarsal osteotomy performed using the minimally invasive surgical techniques described by P. Bosch. Three patients had bilateral operation done at the same setting. The patient age ranged from 29 years to 75 years (mean 55.1 years) with 2 men and 18 women. One 2 mm Kirschner wire was used to splint the osteotomy site, which was removed after 4 weeks to 5 weeks. The mean follow-up time was 22 months.ResultsAll except one foot showed excellent to good grading using the American Orthopaedic Foot and Ankle Society Hallux Scale (total 100 points). The mean score improved from preoperative 53.0 points to postoperative 91.8 points. The hallux valgus angle improved from a preoperative mean of 31.3° to 15.7°, and the first intermetatarsal angle improved from 16.7° to 7.7°. There was no major complication encountered. All patients showed bony union with no avascular necrosis. Three patients had mild pin tract infection. Two patients had backing out of the K-wire and one of them required re-insertion. So far, no patients required reoperation due to recurrence.ConclusionGood clinical and radiographic results have been achieved with minimally invasive techniques for treatment of hallux valgus. This is an acceptable alternative operation for mild-to-moderate hallux valgus.

中文摘要目標骨科微創手術已日益流行。由於缺乏科學的驗證，這些概念應用在拇趾外翻的情況並不普遍。然而，有最近的研究顯示滿意的結果。本研究評估輕度至中度拇趾外翻畸形經皮遠端蹠骨截骨術治療後的臨床和影像學結果 。方法自2005年11月至2010年2月，20名有拇趾外翻畸形的病人接受Bosch技術的經皮蹠骨遠端截骨術治療。 3名病人接受雙側手術。病人的年齡介於 29至75歲（平均55.1歲），包括2名男性，18名女性。用一支2毫米的克氏針來固定截骨處。克氏針會在4至5週後拆除。平均跟進的時間為 22個月。結果根據美國足踝骨科協會拇趾級別，除了一個案例，其餘的病人都達到良好至優異評級，平均得分由手術前平均53.0分改善至91.8分（總分 100分）。拇趾外翻角度由手術前平均為 31.3度改善至15.7度。第一蹠骨間角由手術前平均為16.7度改善至7.7度。我們沒有遇到重大的併發症。所有患者都顯示骨癒合，及沒有缺血性骨壞死。3名病人有輕度針道感染。2名病人有克氏針回退現象，其中一位需要重新插入克氏針。到目前為止，沒有病人因為復發而需要再做手術。結論微創治療拇趾外翻技術已經取得了良好的臨床和影像學結果。它提供另一個選擇去治療輕度至中度的拇趾外翻。