Distal percutaneous osteotomy of the first metatarsal bone for the correction of Hallux Valgus: SERI versus percutaneous chevron technique. A cadaveric study

Abstract

Abstract Background: Distal first metatarsal osteotomy is used to correct mild or moderate Hallux Valgus (HV), and multiple surgical techniques have been described. Percutaneous surgery for HV uses small skin incisions to correct the forefoot deformity, and shorter recovery times and fewer complications have been reported. Distal first metatarsal osteotomy is used for the correction of mild or moderate HV, and multiple surgical techniques have been described. We designed a cadaveric study to compare the resistance to axial load between two distal first metatarsal osteotomies, SERI and percutaneous chevron, both of which are non-fixated techniques. The first aim of this study was to develop a systematic technique for measuring the sagittal displacement on lateral foot X-ray. Our second objective was to measure the resistance to axial load in both these osteotomies. Methods: Ten pairs of freshly frozen cadaveric feet were randomly assigned to one of the two techniques investigated. Pre- and post-operative X-rays were obtained. After surgery, the feet were placed under progressive axial loads up to 60 kg. Joint angles and bone distances were measured and differences between the two techniques were statistically assessed. Results: SERI osteotomy gave a significantly higher plantar displacement when the axial load was under 30 kg. From over 30 kg there were no significant differences between the two techniques. Metatarsal head displacement under axial load was less variable with chevron osteotomy. Plantar angulation was increased in both techniques. Conclusions: Although the chevron technique confers higher stability regarding fragment displacement during axial loading, both techniques increase the plantar angulation of the metatarsal head. Level of Evidence Cadaveric study. Level V.