The distal metatarsal screw is not always necessary in third-generation MICA: a case–control study

Abstract

Introduction To evaluate the clinical and radiological results after fixation of the first metatarsal head (MTH) with one or two screws as part of the third-generation minimally invasive Chevron–Akin osteotomy (MICA) for hallux valgus deformities. Materials and methods Between August 2020 and November 2021, 55 MICA procedures (50 patients, male:female = 7:43), 22 with two (MICA2), 33 with one screw (MICA1) were performed for mild to severe hallux valgus deformities. Exclusion criteria were a concomitant pes adductus (Sgarlato angle > 20°) or hindfoot/midfoot deformities requiring treatment. In 27 cases, additional procedures on the forefoot (small toe corrections or metatarsal osteotomies II–V) were necessary. Pre- and post-operatively, hallux valgus angle (HVA) and intermetatarsal I/II angle (IMA) were measured. Clinically, subjective satisfaction, range of motion (ROM) of the first metatarsophalangeal joint (MTPJ), and pain level (NRS score) were evaluated. The minimum follow-up was 12 months. Results Displacement of MTH was 70–90% on average, all osteotomies showed full consolidation at latest follow-up. In one case of either group, a slight subsidence of MTH was documented. The radiological and clinical parameters showed no differences between the groups. The pain level improved by an average of three points. The mobility of the MTPJ showed a slight reduction in nine cases after three months (4 MICA2, 5 MICA1) which persisted in three cases. Fifty-two of 55 patients (95%) would opt again for the operation. Conclusions Fixation of the first MTH with a single bicortical screw in MICA with moderate lateralization of MTH shows stable anchoring and good clinical results. The routine use of a second metatarsal screw can be omitted.

Fourth-Generation Minimally Invasive Hallux Valgus Surgery With Metaphyseal Extra-Articular Transverse and Akin Osteotomy (META): 12 Month Clinical and Radiologic Results

“…Comparing third-generation MIS techniques is challenging given that there are a broad spectrum of techniques 3,6,19,22,26,37 used with different osteotomies, 17 different zones of fixation (eg, percutaneous intra-articular chevron osteotomy [PEICO] vs minimally invasive chevron and Akin osteotomy [MICA]), number of screws, and different inclusion/exclusion criteria, which are all considered “third-generation.” Even when procedures are described using specific acronyms, surgeons cannot agree on what constitutes the important aspects of the procedure. 16,47,53 This makes drawing comparisons between different techniques difficult.…”

“…5,21,24,28,29,[31][32][33]35,42,45,50 Studies have suggested the radiographic deformity correction that can be achieved using certain MIS techniques in severe deformities is potentially greater than reported in a range of open techniques with similar complication rates. 7,12,31,35 Comparing third-generation MIS techniques is challenging given that there are a broad spectrum of techniques 3,6,19,22,26,37 used with different osteotomies, 17 different zones of fixation (eg, percutaneous intra-articular chevron osteotomy [PEICO] vs minimally invasive chevron and Akin osteotomy [MICA]), number of screws, and different inclusion/ exclusion criteria, which are all considered "third-generation." Even when procedures are described using specific acronyms, surgeons cannot agree on what constitutes the important aspects of the procedure.…”

Defining the Cortical Purchase Zone in New Minimally Invasive Bunion Surgery. A Retrospective Study of 638 Cases.

“…Also in 2022, Harrasser and colleagues provided the first published retrospective comparative analysis with a prospective follow-up study comparing 2-screw versus 1-screw fixation of chevron-MIBS in 50 patients (33 feet with 2-screws, and 22 feet with 1-screw). 23 Their criteria for using dual metatarsal fixation was "the surgeon's perception of stability at the osteotomy site. " groups, and statistically more patients were dissatisfied with the implants with the 2-screw fixation than 1-screw (32% versus 3%, respectively).…”

Machbarkeit und Sicherheit der minimal-invasiven Kalkaneusosteotomie (MICO) über einen medialen Zugang: eine Fall-Kontroll-Studie

“…[ 9 ] 2015 29 MICO patients Minimum 6 weeks No wound complications Radiological and clinical union occurred in all cases (100%) No neurovascular injuries Jowett et al. [ 7 ] 2015 9 MICO cadaveric specimens Minimum 6 months Uninjured neurological structures in all 9 specimens 35 MICO patients Radiological and clinical union occurred in all 35 patients (100%) No neurovascular complications No wound complications MICO minimally invasive calcaneal osteotomy

Fig. 5 X‑ray lateral ( left ) and MRI axial images ( right ) after flatfoot reconstruction.

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“…On the other hand, this is not possible in our study as MICO was only one part of other procedures (Table 2 ), and therefore, it cannot be stated which amount of the whole clinical outcome is the result of the MICO. Additionally, although PROMs may be valuable in comparison of various surgical treatments and differences between distinct population groups, clinical interpretation of these differences can sometimes be misleading [ 7 ]. Nonetheless, these limitations must be considered before conclusions about daily practical actions are drawn.…”