Minimally Invasive Osteotomy with Intramedullary Plating for the Correction of Hallux Abducto Valgus: A Multicenter Retrospective Radiographic Review.

BACKGROUND Minimally invasive bunion surgery continues to be a rapidly growing area of interest and growth, relative to a traditional approach with numerous approaches and techniques that seek to accomplish similar goals of deformity correction, aiming for superior outcomes but with added efficiency. Various techniques describe implementing the use of a wire, single or dual screw fixation, with a distinct approach utilizing an intramedullary plating technique.

PURPOSE The primary objectives of this study were to examine the outcomes of minimally invasive bunion surgery with intramedullary plating in the setting of the surgical management of hallux abducto valgus, focusing on radiographic parameters related to and commonly measured in this deformity. The secondary objectives of this study were to report on various abnormal radiographic parameters STUDY DESIGN: Retrospective Cohort Review METHODS: The radiographs from 341 patients (346 feet) who underwent minimally invasive distal metatarsal osteotomy with application of an intramedullary plating technique system from August 1, 2016 to May 31, 2025 at participating centers were retrospectively evaluated. Patients in the study were assessed for pre- and post-operative radiographic parameters with a primary focus on intermetatarsal angle, hallux abductus angle and tibial sesamoid position.

RESULTS A significant reduction in intermetatarsal angle (IMA), hallux abductus angle (HAA), and tibial sesamoid position (TSP) (Preoperative IMA:13.4 ° ± 4.6 ° (range 2.1 ° - 37.7 °), final postoperative IMA:1.5 ° ± 2.4 ° (range -5.0 ° - 13.2 °); Preoperative HAA: 23.7 ° ± 11.1 ° (range 1.0 ° - 58.0 °), final postoperative HAA: 5.9 ° ± 5.0 ° (range 0.1 ° - 31.2 °). Preoperative TSP: 4.8 ± 1.6 (range 1 - 7), final postoperative TSP: 1.4 ± 0.9 (range 1 - 7). Overall correction was found to be 88.7 %, 75.2 %, and 70.8 % in these groups, respectively; p < 0.001 to all groups) was found.

CONCLUSION The use of an intramedullary plate in a minimally invasive approach to address a spectrum of hallux valgus deformity showed promising, reproducible results across a multicenter setting for the reduction and prolonged correction when assessing radiographic outcomes without significant complications.