Percutaneous Surgery for Severe Hallux Valgus

A Modified Minimally Invasive Osteotomy for Hallux Valgus Allows Reduction of Malpositioned Sesamoid Bones

“…The minimally invasive technique that was introduced by Vernois and Redfern [9] is composed of three basic elements: A percutaneous V-shaped distal osteotomy, a lateral displacement of the head and a xation of the new fragment con guration. These steps can be accompanied by a bunion osteo-resection and an akin osteotomy, and are conducted via skin cuts that are several millimeters long.…”

“…[5] In addition, since the skin cuts are minimal, there are less skin compilations and smaller scars. [20] The V-shaped osteotomy [9] enables to correct both mild and severe deformities, but it restricts the surgeon to a single-plane correction. The derotation of the MT1 head and, thereby, sesamoid position correction are not possible in cases where the metatarsophalangeal center of rotation shift was insu cient for sesamoid reorientation.…”

“…The original percutaneous chevron osteotomy was described previously. [9] In the modi cation presented herein, the osteotomy was performed in a straight line, perpendicular to the metatarsal axis on the sagittal view, as shown in Fig. 1.…”

“…[5] However, the reported outcomes of these procedures have varied. [1,[6][7][8][9] Among these techniques, the minimally invasive chevron and akin (MICA) procedure, which was described primarily by Vernois and Redfern, [9] has become widely used. The main advantage of this procedure is that it is extraarticular, which probably reduces the incidence of postoperative complications affecting range of motion and plantar exion power.…”

Surgical treatment of moderate and severe hallux valgus: 30 cases undergoing surgery using the percutaneous Chevron technique

“…Embora haja relatos de que a osteotomia de Chevron distal combinada ao realinhamento dos tecidos moles da articulação metatarsofalangiana possibilite o seu uso também para os casos graves (15)(16)(17) , há uma preocupação quanto à perda de estabilidade e risco aumentado de necrose avascular da cabeça metatarsal quando a translação desta excede os 30% de sua área de contato (13,(16)(17) . Com o advento das técnicas minimamente invasivas para a correção do hálux valgo, Vernois idealizou a osteotomia de Chevron percutânea (18) . Nessa técnica, devido à menor agressão às partes moles e à vascularização da cabeça metatarsal, permitem-se translações laterais de até 100% da área de contato da osteotomia, mantendo-se apenas o contato da cortical medial da cabeça com a cortical lateral da região metadiafisária.…”