First Metatarsal Osteotomy Nonunion and Malunion

Radiographic Results After Percutaneous Distal Metatarsal Osteotomy for Correction of Hallux Valgus Deformity

“…The reported incidence of osteonecrosis of the metatarsal head after a distal chevron osteotomy has ranged from 0% to 20%. 1,6,12,13,14,18 Jones et al 8 analyzed 11 clinical studies evaluating the long-term outcome after distal chevron osteotomy and found no cases of osteonecrosis after 2089 procedures. Magnan et al 11 did not find any evidence of osteonecrosis after 118 percutaneous distal metatarsal osteotomies.…”

“…The rate of malunion with this procedure is unacceptably high when compared to a 0% to 2% incidence noted in a chevron osteotomy. 12,17,18 The occurrence of malunion in a chevron osteotomy is typically related to lack of fixation or failure of fixation. The 2-week postoperative malunion noted in our series is likely related to the inherent stability from the vertical osteotomy despite crossed Kirschner wire fixation and use of intraoperative fluoroscopy.…”

Screw Versus Plate Fixation of Proximal First Metatarsal Crescentic Osteotomy

“…17,32 However, this osteotomy is inherently unstable and can be difficult to fixate, which can result in a high rate of malunion. 5,9,11,26,27,31 In these cases, the first metatarsal heals in dorsiflexion, predisposing patients to painful callosities and transfer lesions over the lesser metatarsals. 6,13,14,16,20,27,31 Due to the intrinsic instability of the proximal crescentic osteotomy, successful treatment of forefoot deformities with this procedure relies on the stability of internal fixation to maintain the position of the osteotomized fragment until healing occurs.…”

The Modified Subcapital Metatarsal Osteotomy in the Treatment of Hallux Valgus Recurrence

“…Also, retrograde pinning across the first tarsometatarsal joint provides adequate stability of the construct to allow bone callus formation of the osteotomy. 60 The authors describe fatigue fracture of the proximal end of the k wire, migration of the k wire, and problems related to rotation stability of the osteotomy. These concerns are reported in the complications paragraph.…”