Minimally invasive hallux valgus correction may yield bony union at 6 months
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Key takeaways:
- Minimally invasive hallux valgus correction surgery may yield bony union, with three cortices present on X-rays at 6 months.
- Degree of displacement and cortical formation may not be associated with union rates.
According to presented results, patients who undergo minimally invasive hallux valgus correction surgery may expect complete bony union at 6 months, regardless of postoperative cortical formation or degree of displacement.
“We know that the nonunion rates [of hallux valgus correction] are low, but there's not a lot of literature showing how long it takes these osteotomies to heal and what the radiographic value findings [are] that constitute what healing really is,” Wade Massey, MD, orthopedic fellow at Baptist Health South Florida, said in his presentation at the American Orthopaedic Foot & Ankle Society Annual Meeting.
Massey and colleagues performed a retrospective study of data from 72 patients (average age, 56.6 years) with moderate to severe hallux valgus deformity who underwent minimally invasive, first distal metatarsal and Akin osteotomy between 2019 and 2022. They assessed the association between postoperative cortical formation, degree of displacement between the proximal and distal portions of the first metatarsal, overall union rate and time to union. They analyzed postoperative weight-bearing X-rays at 6 weeks, 3 months, 6 months and 1 year. They also grouped patients based on percentage of metatarsal displacement.
“We defined complete union as the presence of three cortices on the [anteroposterior] AP and lateral views,” Massey said. “We also noted the time it took for one and two cortices to be unionized.”
Overall, Massey and colleagues found most patients did not achieve full union at 3 months. However, they found most patients achieved full union at 6 months. They noted four cortices were observed in all patients at 6 months and 1 year.
According to the abstract, Massey and colleagues found no association between degree of displacement and delays in cortical formation, with an average time to union of 26.9 weeks for all patients.
Massey noted two cortices were observed at an average of 16.9 weeks and three cortices were observed at an average of 26.8 weeks. In addition, Massey noted two cortices were observed at an average of 20.14 weeks for patients with displacements greater than 50%, while two cortices were observed at an average of 13.17 weeks for patients with displacements of less than 30%.
“Are three cortices really necessary or not?” Massey said. “What we saw is plenty of patients with two cortices or even one [cortex] who showed up and they had absolutely no symptoms. They're doing fantastic. They're back to all their activities that they previously had been doing.”
“Whether or not it's biomechanically as strong, it's hard to say,” Massey concluded. “A CT scan would also help with knowing how many cortices are there.”
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Fanfan D, et al. Radiographic evaluation of time to union in minimally invasive hallux valgus correction. Presented at: American Orthopaedic Foot & Ankle Society Annual Meeting; Sept. 11-14, 2024; Vancouver, British Columbia, Canada (hybrid meeting).
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