Radiographic and Cadaveric Analysis of Minimally Invasive Bunionectomy Osteotomy Position—“MIS Bunion Sweet Spot”

Abstract

Minimally invasive surgery (MIS) is a growing technique that favors faster recovery and cosmetic results. We propose a recommended osteotomy position or “MIS Sweet Spot” to make the procedure more reproducible and lessen the learning curve to improve outcomes. A total of 211 patients from 3 surgeons between 2 different study centers were included in a retrospective radiograph measurement analysis and a cadaveric dissection to confirm the safety of nearby anatomical structures. An average distance of 2.2 cm proximal from the first metatarsophalangeal joint was found as the “Sweet Spot” to perform the transverse osteotomy. At this distance, neurovascular and tendinous structures were unharmed and the osteotomy remained extracapsular. Furthermore, an average of 10.7° of intermetatarsal angle reduction and a reduction of tibial sesamoid position of 3 points were achieved. A predictable and measurable distance for osteotomy placement will help to provide more confidence in producing the bunionectomy osteotomy with the specialized tools used in MIS and can help to reduce operative time and improve results. Level of Clinical Evidence (LOCE): 3

Improving the Accuracy of Metatarsal Osteotomies in Minimally Invasive Foot Surgery Using a Digital Inclinometer: Preliminary Study

“…The realm of minimally invasive foot surgery (MIS) is already recognized for its multitude of advantages, including swifter recovery periods [4][5][6] and less scarring [10,17]. The introduction of this innovative technology into MIS procedures holds the promise of further enhancing clinical outcomes for patients undergoing such interventions.…”

“…The surgical approach involves performing osteotomies on the affected metatarsal bones [2,3]. Capital osteotomy, performed by minimally invasive surgery, represents a modern surgical procedure, widely employed to treat a variety of forefoot pathologies [2], offering significant advantages in terms of postoperative recovery [4][5][6] compared to traditional surgical approaches [7].…”

Fourth Generation Hallux Valgus Correction

“…At this site, neurovascular and tendinous structures can be avoided, and the osteotomy remains extracapsular while also avoiding the sesamoid articulation. 4 A 3 to 5 mm incision is made with blunt deep dissection down to the bone. The periosteum is elevated dorsally and plantarly and the osteotomy is performed with a 2 mm Shannon burr.…”

“…Major improvements in MIS are distinctly separated into 3 generations. The original, first-generation technique of MIS notably lacked internal fixation 4 . Reports of inconsistent outcomes and significant complications as a result of this lack of internal fixation led to a lack of early adoption of this technique 5,6 .…”

“…The osteotomy site is generally in the mid-sagittal plane on the medial aspect of the first metatarsal, ~2.5 cm proximal to the first metatarsophalangeal joint. At this site, neurovascular and tendinous structures can be avoided, and the osteotomy remains extracapsular while also avoiding the sesamoid articulation 4 …”