title: Percutaneous bunionette correction: results of a 49-case retrospective study at a mean 34 months' follow-up.
abstract: BACKGROUND
  Bunionette consists in a lateral prominence of the head of the fifth metatarsal (M5), inducing a callus. Toe malpositioning determines the varus, supraductus or infraductus form.
  
  
  OBJECTIVE
  A percutaneous method without osteosynthesis was assessed in 38 patients suffering from this pathology.
  
  
  METHODS
  A continuous single-operator multicenter series operated on between May 2005 and January 2012 was analyzed with mean follow-up of 34 months. The inclusion criterion was bunionette with or without varus deviation. All patients were operated on percutaneously without tourniquet, on a day-care basis. All were clinically assessed, preoperatively and at latest FU, by visual analog pain scale (VAS), AOFAS and Coughlin scores, and callus status. Standard radiological assessment comprised monitoring of intermetatarsal (M4M5) and metatarsophalangeal (M5P1) angles.
  
  
  RESULTS
  VAS decreased from 8 (range, 6-9) preoperatively to 0.3 (range, 0-1) out of 10 at follow-up. AOFAS score increased from 58 (range, 52-75) to 97 (range, 80-100) out of 100. According to the Coughlin score, 97.5% of patients were satisfied or very satisfied. Deformity correction was systematic, with disappearance of preoperative callus. M4M5 and M5P1 angles decreased respectively from 10° (range, 6-13°) and 16.2° (range, 8-24°) preoperatively to 5.5° (range, 4-8°) and 4.3° (range, 2-9°). There was 1 case of complex regional pain syndrome and 1 delayed consolidation.
  
  
  CONCLUSIONS
  This procedure appeared reliable for correcting all types of bunionette deformity. Other minimally invasive methods with comparable results use pin fixation. The advantages over conventional techniques are the quality of results, low morbidity and absence of osteosynthesis material. The percutaneous technique should, we believe, be widely adopted in this indication.
  
  
  METHODS
  IV.
authors.affiliation: Clinique Geoffroy St Hilaire, 59, rue Geoffroy St Hilaire, 75005 Paris, France. Electronic address: olaffenetre@me.com.
authors.forename: O
authors.initials: O
authors.lastname: Laffenêtre
authors.affiliation: Clinique Geoffroy St Hilaire, 59, rue Geoffroy St Hilaire, 75005 Paris, France.
authors.forename: B
authors.initials: B
authors.lastname: Millet-Barbé
authors.affiliation: Hôpital d'instruction des armées Robert-Piqué, 351, route de Toulouse, 33550 Villenave d'Ornon, France.
authors.forename: V
authors.initials: V
authors.lastname: Darcel
authors.affiliation: Clinique Geoffroy St Hilaire, 59, rue Geoffroy St Hilaire, 75005 Paris, France.
authors.forename: J
authors.initials: J
authors.lastname: Lucas Y Hernandez
authors.affiliation: Clinique Geoffroy St Hilaire, 59, rue Geoffroy St Hilaire, 75005 Paris, France.
authors.forename: D
authors.initials: D
authors.lastname: Chauveaux
mesh_terms: D050489:Bunion, Tailor's / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008682:Metatarsal Bones / Q000293:injuries / Q000601:surgery*; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D010027:Osteotomy / Q000379:methods*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
keywords: Bunionette; Fifth metatarsal; Minimally invasive surgery; Percutaneous surgery; Quintus varus