title: Minimally Invasive and Open Distal Chevron Osteotomy for Mild to Moderate Hallux Valgus.
abstract: BACKGROUND
  Minimally invasive surgical (MIS) techniques are increasingly being used in foot and ankle surgery but it is important that they are adopted only once they have been shown to be equivalent or superior to open techniques. We believe that the main advantages of MIS are found in the early postoperative period, but in order to adopt it as a technique longer-term studies are required. The aim of this study was to compare the 2-year outcomes of a third-generation MIS distal chevron osteotomy with a comparable traditional open distal chevron osteotomy for mild-moderate hallux valgus. Our null hypothesis was that the 2 techniques would yield equivalent clinical and radiographic results at 2 years.
  
  
  METHODS
  This was a retrospective cohort study. Eighty-one consecutive feet (49 MIS and 32 open distal chevron osteotomies) were followed up for a minimum 24 months (range 24-58). All patients were clinically assessed using the Manchester-Oxford Foot Questionnaire. Radiographic measures included hallux valgus angle, the intermetatarsal angle, hallux interphalangeal angle, metatarsal phalangeal joint angle, distal metatarsal articular angle, tibial sesamoid position, shape of the first metatarsal head, and plantar offset. Statistical analysis was done using Student t test or Wilcoxon rank-sum test for continuous data and Pearson chi-square test for categorical data.
  
  
  RESULTS
  Clinical and radiologic postoperative scores in all domains were substantially improved in both groups (P < .001), but there was no statistically significant difference in improvement of any domain between open and MIS groups (P > .05). There were no significant differences in complications between the 2 groups ( > .5).
  
  
  CONCLUSIONS
  The midterm results of this third-generation technique show that it was a safe procedure with good clinical outcomes and comparable to traditional open techniques for symptomatic mild-moderate hallux valgus.
  
  
  METHODS
  Level III, retrospective comparative study.
authors.affiliation: Department of Orthopaedics, Western Sussex NHS trust, Worthing Hospital, Worthing, United Kingdom.
authors.forename: Kit
authors.initials: K
authors.lastname: Brogan
authors.affiliation: Department of Orthopaedics, Western Sussex NHS trust, Worthing Hospital, Worthing, United Kingdom.
authors.forename: Edward
authors.initials: E
authors.lastname: Lindisfarne
authors.affiliation: Department of Orthopaedics, Western Sussex NHS trust, Worthing Hospital, Worthing, United Kingdom.
authors.forename: Harold
authors.initials: H
authors.lastname: Akehurst
authors.affiliation: Department of Orthopaedics, Western Sussex NHS trust, Worthing Hospital, Worthing, United Kingdom.
authors.forename: Usama
authors.initials: U
authors.lastname: Farook
authors.affiliation: Department of Orthopaedics, Western Sussex NHS trust, Worthing Hospital, Worthing, United Kingdom.
authors.forename: Will
authors.initials: W
authors.lastname: Shrier
authors.affiliation: Department of Orthopaedics, Western Sussex NHS trust, Worthing Hospital, Worthing, United Kingdom Simon.Palmer@wsht.nhs.uk.
authors.forename: Simon
authors.initials: S
authors.lastname: Palmer
mesh_terms: D006215:Hallux Valgus / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008683:Metatarsophalangeal Joint / Q000503:physiopathology / Q000601:surgery*; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D010027:Osteotomy / Q000379:methods*; D010147:Pain Measurement; D016896:Treatment Outcome
keywords: MIS; bunion; chevron; hallux valgus; minimally invasive