Stabilization of the Mitchell First Metatarsal Osteotomy Using an Intramedullary K-wire

Abstract

The Mitchell distal first metatarsal osteotomy is an effective procedure for mild-to-moderate hallux valguS. 3,4,6,10 This osteotomy is less inherently stable than the chevron osteotomy" and the transosseous suture fixation technique, as originally described," is technically demanding. This has led to the use of a variety of alternative fixation techniques, including temporary K-wire fixation,5,9 and permanent internal fixation with a variety of screws and staples.':" Temporary K-wire fixation is associated with increased risk of infection, and internal fixation is more expensive and technically difficult. A simple, safe and reliable alternative technique is described using a permanent intramedullary K-wire to stabilize the osteotomy. No particular steps are taken to prevent K-wire migration. There has been no evidence of migration in any of the 20 feet in which this has been used. Operative TechniqueA distal first metatarsal osteotomy is performed and displaced as described by Mitchell." An approximately 5-cm length of 1.6-mm K-wire is then cut and inserted into the metatarsal intramedullary canal and impacted proximally, leaving a t-ern spike of wire protruding. The metatarsal head is then gently levered onto this spike in the displaced position and impacted so that the wire engages in the capital bone. Thus, rotational stability is provided by the step and translational stability by the K-wire.The remaining protruding metaphyseal flare is then excised. A rolled swab is then placed into the first web space, and the medial capsule is repaired with absorbable sutures. The skin is closed in a routine fashion. A temporary plaster-of-Paris sideslab is applied.

Mitchell’s Osteotomy With Mini-Plate and Screw Fixation for Hallux Valgus

“…In summary, the complications related to HV surgery were usually related to osteotomy fixation. 4,5,13,17,18,29 In recent years, different fixation methods of the osteotomy have been reported using metal screws 32 with or without plates, 28 K-wires, 4,13 staples, 15 and bioabsorbable pins 1,7,12 and screws. 28,30 Nowadays, most surgeons prefer using any one of these fixation types to prevent loss of fixation and avoid cast immobilization.…”

“…2,9 The use of a Kirschner wire (K-wire) to stabilize the osteotomy fragments has been described by some auth ors. 4,8,13,25,26 Alcelik et al 1 reported that bioabsorbable pins provide satisfactory stabilization of the Mitchell's metatarsal osteotomy. The aim of this study was to evaluate the use of mini-plate and screw fixation performed to stabilize the first metatarsal osteotomy in patients undergoing Mitchell bunionectomy, with the outcomes of interest being radiological alignment and the time to bony union at the site of osteotomy.…”

Mitchell osteotomy with herbert bone screw fixation: A retrospective analysis of 35 procedures in 22 patients with hallux valgus

“…There were no infections with buried chromic suture fixation. One group inserted a 1.6mm Kirschner wire 5 cm in length, into the first intramedullary canal and impacted the capital fragment onto the Kirschner wire with 1 cm of wire protruding [13]. The wire was left intact and the patient was casted for six weeks or until the osteotomy was stable and healed.…”