INTRODUCTION: Percutaneous distal metaphyseal osteotomy, a subcapital linear osteotomy of the fifth metatarsal performed through a minimally invasive percutaneous approach and stabilized with a single Kirschner wire, without soft-tissue procedures, enables the surgeon to achieve consistently good correction of a fifth metatarsal bunionette deformity. STEP 1 WIRE INSERTION: It is mandatory to place the wire in a parosteal position to allow medial displacement of the metatarsal head at the osteotomy site. STEP 2 SKIN INCISION: Make a short skin incision directly to the bone on the lateral side of the distal metaphysis of the fifth metatarsal. STEP 3 PERIOSTEAL DETACHMENT: Detach the periosteum surrounding the bone at the site of the planned osteotomy with a small scissors inserted percutaneously, dorsally initially and then plantarly. STEP 4 OSTEOTOMY: Perform the osteotomy with a micromotorized Lindemann bone cutter, avoiding damage to the surrounding structures by drilling the lateral cortex first and then the medial cortex, keeping the bone cutter in the same lateral entry hole and its tip inside the medullary canal. STEP 5 CORRECTION: The correction is usually satisfactory when contact between the lateral aspect of the metatarsal head and the medial cortex of the metatarsal neck is achieved in the frontal plane. STEP 6 STABILIZATION: Stabilize the osteotomy site with the 2-mm Kirschner wire, driven distal to proximal into the medullary canal of the fifth metatarsal as far as its base. STEP 7 POSTOPERATIVE CARE: Apply adhesive tape with a plantar, kidney-shaped pad. RESULTS: In our study of this technique24, the American Orthopaedic Foot & Ankle Society (AOFAS) score improved from a mean and standard deviation of 51.9 ± 10.2 points preoperatively to 98.4 ± 2.6 points at the time of final follow-up. In 73% of the feet, there was complete resolution of pain at the fifth metatarsophalangeal joint without any functional limitation (AOFAS score of 100). In 20% of the cases, the AOFAS score was 95 points with some decrease in function and a need to use comfortable shoes. In the remaining 7% of the patients, the AOFAS score was 93 points with mild asymptomatic malalignment. No nonunions or recurrences were observed. WHAT TO WATCH FOR: IndicationsContraindicationsPitfalls & Challenges.
INTRODUCTION: Percutaneous distal metaphyseal osteotomy, a subcapital linear osteotomy of the fifth metatarsal performed through a minimally invasive percutaneous approach and stabilized with a single Kirschner wire, without soft-tissue procedures, enables the surgeon to achieve consistently good correction of a fifth metatarsal bunionette deformity. STEP 1 WIRE INSERTION: It is mandatory to place the wire in a parosteal position to allow medial displacement of the metatarsal head at the osteotomy site. STEP 2 SKIN INCISION: Make a short skin incision directly to the bone on the lateral side of the distal metaphysis of the fifth metatarsal. STEP 3 PERIOSTEAL DETACHMENT: Detach the periosteum surrounding the bone at the site of the planned osteotomy with a small scissors inserted percutaneously, dorsally initially and then plantarly. STEP 4 OSTEOTOMY: Perform the osteotomy with a micromotorized Lindemann bone cutter, avoiding damage to the surrounding structures by drilling the lateral cortex first and then the medial cortex, keeping the bone cutter in the same lateral entry hole and its tip inside the medullary canal. STEP 5 CORRECTION: The correction is usually satisfactory when contact between the lateral aspect of the metatarsal head and the medial cortex of the metatarsal neck is achieved in the frontal plane. STEP 6 STABILIZATION: Stabilize the osteotomy site with the 2-mm Kirschner wire, driven distal to proximal into the medullary canal of the fifth metatarsal as far as its base. STEP 7 POSTOPERATIVE CARE: Apply adhesive tape with a plantar, kidney-shaped pad. RESULTS: In our study of this technique24, the American Orthopaedic Foot & Ankle Society (AOFAS) score improved from a mean and standard deviation of 51.9 ± 10.2 points preoperatively to 98.4 ± 2.6 points at the time of final follow-up. In 73% of the feet, there was complete resolution of pain at the fifth metatarsophalangeal joint without any functional limitation (AOFAS score of 100). In 20% of the cases, the AOFAS score was 95 points with some decrease in function and a need to use comfortable shoes. In the remaining 7% of the patients, the AOFAS score was 93 points with mild asymptomatic malalignment. No nonunions or recurrences were observed. WHAT TO WATCH FOR: IndicationsContraindicationsPitfalls & Challenges.
Authors: Roman Radl; Andreas Leithner; Wolfgang Koehler; Susanne Scheipl; Reinhard Windhager Journal: Foot Ankle Int Date: 2005-06 Impact factor: 2.827
Authors: Bruno Magnan; Riccardo Bortolazzi; Elena Samaila; Lorenzo Pezzè; Nicola Rossi; Pietro Bartolozzi Journal: J Bone Joint Surg Am Date: 2006-03 Impact factor: 5.284
Authors: Barry P London; Stephen F Stern; Mark A Quist; Robert K Lee; Edison K Picklesimer Journal: J Foot Ankle Surg Date: 2003 Jan-Feb Impact factor: 1.286