Percutaneous and minimum incision metatarsal osteotomies: a systematic review.

UNLABELLED: Percutaneous and minimum incision metatarsal osteotomies have received increasing recognition because of the perceived efficacy comparable to traditional open approaches but with purported less cost, fewer complications, and higher patient satisfaction. The use of these treatments has also been proposed for medically compromised patients who are not expected to recover well from traditional open approaches, a patient population that comprises a substantial proportion of the author's practice. Therefore, the author undertook a systematic review of electronic databases and other relevant sources to identify material relating to the use of percutaneous and minimum incision metatarsal osteotomies. Information from peer-reviewed journals, as well as that from non-peer-reviewed publications, abstracts and posters, textbooks, and unpublished works, was also considered. In an effort to procure the highest quality studies available, studies were eligible for inclusion only if they were prospective, involved consecutively enrolled patients undergoing the same percutaneous or minimum incision surgical treatment, evaluated patients at a mean follow-up of 12 months or longer duration, and included outcome measurements consisting of subjective patient satisfaction, radiographic measurements, and details of complications. Three studies involving percutaneous surgical treatment specific to hallux valgus were identified that met the inclusion criteria, all of which were case series of relatively poor methodological quality. Rather than providing strong evidence for or against the use of percutaneous minimum incision metatarsal osteotomies, the results of this review make clear the need for methodologically sound prospective cohort studies and randomized controlled trials that focus on the use of this form of surgical intervention. LEVEL OF EVIDENCE: 1.