A modified minimally invasive osteotomy for hallux valgus enables reduction of malpositioned sesamoid bones

Abstract

Background: Current minimally invasive distal metatarsal osteotomy for hallux valgus (HV) is V-shaped, which prevents correcting the rotational metatarsal head deformity and reduction of sesamoid bones. We aimed to determine the optimal method for sesamoid bone reduction in HV surgery.Methods: We reviewed the records of 53 patients who underwent HV surgery by a single surgeon from 2017 to 2019 according to one of three techniques: open chevron osteotomy (n=19), minimally invasive V-shaped osteotomy (n=18) and a modi ed, straight minimally invasive osteotomy (n=16). Sesamoid position was graded using the Hardy and Clapham method based on standing radiographs.Results: Postoperative sesamoid position scores were signi cantly lower (better) following the modi ed osteotomy than following open chevron osteotomy and V-shaped osteotomy (1.44±0.81, 3.74±1.48 and 4.61±1.09, respectively, P<0.001); and the mean change in score was greater (P<0.001).Conclusion: Modi ed minimally invasive osteotomy was superior to the two other techniques, in the correction of HV deformity in all planes, including sesamoid reduction.the deformity and pain while walking. [13,14] Therefore, proper reduction of the sesamoid bones is essential in HV surgery.As described by Vernois and Redfern, the minimally invasive distal metatarsal osteotomy is V-shaped. This con guration does not enable the surgeon to correct the rotational deformity of the MT1 head. Recently, we developed a modi cation of the procedure, by which a straight osteotomy, perpendicular to the MT1 shaft, is done instead of the V-shaped cut (Figure 1). This enables de-rotating the MT1 head, and thereby reducing the sesamoid bones into their normal position under the MT1 head. In this study, we compared the positions of the postoperative sesamoid bones following three surgical techniques: open chevron, minimally invasive V-shaped osteotomy, and the modi ed "straight" minimally invasive osteotomy. We aimed to determine the optimal method for sesamoid bone reduction in HV surgery. MethodsWe reviewed the records of 53 patients who underwent HV surgery by a single surgeon during the years 2017 to 2019. The patients were operated using one of three surgical techniques. During 2017, an open * The sesamoid bone position is scored on a 7-point scale, as originally presented by Hardy and Clapham. 7Abbreviations: MICA, minimally invasive chevron and akin; SD, standard deviation; IMA, inter-metatarsal angle; HVA: hallux valgus angle.