Abstract
Category:
Lesser Toes; Bunion
Introduction/Purpose:
There has been increasing interest in the use of percutaneous or minimally invasive osteotomy techniques for bunionette correction. The aim of this systematic review is to investigate the clinical and radiographic outcomes following percutaneous or minimally invasive surgery for bunionette deformity correction.
Methods:
A systematic review following PRISMA guidelines was undertaken. All clinical studies published in Medline, Embase, PubMed and the Cochrane Library Database from inception until December 2023 reporting on the use of a percutaneous or minimally invasive osteotomy techniques for bunionette deformity correction were included. The primary outcome was radiographic deformity correction. A meta-analysis of clinical and radiographic outcomes was performed to assess the mean difference following surgery. Risk of bias was assessed using the ROBINS-I tool.
Results:
A total of 942 potential studies were identified of which 18 were included encompassing 714 feet in 580 patients. There were no comparative studies identified. The majority of studies utilised an unfixed distal osteotomy technique. All studies showed a statistically significant improvement in clinical outcomes (AOFAS and VAS Pain) and radiological outcomes (4-5 intermetatarsal angle and fifth metatarsalphalangeal angle). Complication rates ranged from 0-21.4%. The non-union rate was 0-5.6%. Overall risk of bias was low-moderate. The most common complication was development of a hypertrophic callus which tended to resorb over time without needing further surgical intervention.
Conclusion:
Percutaneous techniques for bunionette deformity correction are clinically safe and effective with significant improvement in radiographic alignment and patient reported outcome measures.
