The effect of temperature elevation during discontinuous use of rotatory burrs in the correction of hallux valgus.

The purpose of this study was 2-fold: to measure temperature elevation during exostectomy and osteotomies of the metatarsal head and the proximal phalanx in 78 patients (94 feet) with hallux valgus undergoing distal first metatarsal and proximal phalangeal osteotomies by minimal incision surgery; and to assess whether there was a relationship between working temperatures at operation and the overall thickness of the forefoot. The procedure included the use of rotary wedge burrs in discontinuous cutting bursts of less than 20 seconds for removal of the exostois, and the use of rotary triflute burrs used in discontinuous cutting bursts of less than 10 seconds for each osteotomy. The temperature of the bone surface was measured with a thermocouple and, when 38 degrees C was exceeded, the field was irrigated with saline solution. The temperature generated during the procedure was found to be significantly associated with the amount of bone removed from the metatarsal (Pearson's correlation coefficient, r = -0.101, P = .05). At the 6-week visit, thickness of the first metatarsal was greater in the group with temperature elevations > or =47 degrees C compared with the group with temperatures <47 degrees C. The Reverdin-Isham procedure by minimal incision surgery using rotatory triflute burs in discontinuous cutting bursts is an effective, reliable, and technically simple procedure for treating hallux valgus deformity. At follow-up, thickness of the foot at the level of the head of the first metatarsal was associated with heat generated during the use of rotary burs.