Complete vs Incomplete Percutaneous Oblique Distal Closing Wedge Osteotomy for Bunionette (Tailor’s Bunion) Deformity Correction: A Retrospective Comparative Study

TL;DR

This study compares two types of minimally invasive surgery for correcting bunionette deformities and finds similar clinical outcomes despite differences in callus formation.

Contribution

The study introduces a minimally invasive technique for bunionette correction and evaluates the impact of complete versus incomplete osteotomy on outcomes.

Findings

Complete osteotomy resulted in significant hypertrophic callus formation at 6 weeks, which resolved by 12 months.

Incomplete osteotomy avoided significant callus formation without compromising clinical or radiographic outcomes.

Both osteotomy types improved patient-reported outcomes and reduced deformity angles significantly.

Abstract

There has been increasing interest in the use of percutaneous osteotomy techniques for bunionette (tailor’s bunion) correction. This study evaluated clinical and radiographic outcomes following an unfixed, percutaneous oblique distal metaphyseal-diaphyseal osteotomy and compared outcomes between complete and incomplete osteotomy groups.

A total of 43 feet (mean age 54.2 ± 17.1) underwent percutaneous oblique distal osteotomy by a single surgeon over a 4-year period. The primary outcome was the presence of significant postoperative hypertrophic callus at the osteotomy site (>150% of the width of the fifth metatarsal shaft), which decreases over time due to normal bone remodeling. Secondary exploratory outcomes included the radiographic parameters fourth-fifth intermetatarsal angle (IMA) and metatarsophalangeal angle (MPA), and patient-reported outcome measures (PROMs) of Manchester-Oxford Foot Questionnaire (MOXFQ), EuroQol 5-Dimension, 5-Level (EQ-5D-5L), and visual analogue scale (VAS) Pain (minimum 12 months’ follow-up).

Thirty feet had a complete osteotomy, and 13 feet had an incomplete osteotomy with the lateral cortex remaining intact. In the complete osteotomy group, 60% of patients (P = .001) had callus equivalent to >150% of the metatarsal width at 6-week follow up; this reduced to 19% (P = .31) at 6 months and 0% (P = 1) at 12 months. No significant hypertrophic callus was observed in the incomplete osteotomy group. All PROMs, except EQ-5D-5L VAS, showed significant improvements (P < .05). The IMA and MPA significantly decreased postoperatively across both groups (P < .001). There were no significant differences between the incomplete and complete osteotomy groups at follow-up radiographically and clinically, except for the MOXFQ Walking/Standing Domain (P = .014), where patients in the incomplete osteotomy group demonstrated greater improvement.

Unfixed, minimally invasive oblique distal osteotomy for bunionette deformity is a safe and effective procedure that is associated with significant improvement in radiographic and clinical outcomes. Whether or not the osteotomy is complete does influence hypertrophic callus formation but does not significantly affect the radiographic or clinical outcomes.

Level III, retrospective comparative study.

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