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Minimally Invasive Distal Metatarsal Metaphyseal Osteotomy of the Lesser Toes: Learning Curve
Sabine Krenn1,2, Sascha Albers1,2, Peter Bock1,2
1Orthopaedic Hospital Speising Vienna, Vienna, Austria (SK, PB, CM, MC, HJT).
Background:
Minimally invasive surgery has a shorter surgical time, and in this study we focus on minimally invasive distal metatarsal metaphyseal osteotomy (DMMO). The operation seems to be less complex but requires a high learning curve. We report on our first patients to underline the need for extensive training and great awareness for the risks in the early learning stages.
Methods:
We evaluated 27 patients (mean age = 60.9 years) with a mean follow-up time of 7.2 months. Indication was metatarsalgia, intractable plantar keratosis, and the (sub-)luxation of the metatarsophalangeal joint. Clinical results were evaluated with the 12-item Short Form (SF-12), Foot Function Index (FFI), Foot and Ankle Ability Measure (FAAM), and the American Orthopaedic Foot and Ankle Score (AOFAS). Radiographs and pedobarographic analysis were obtained.
Results:
Scores ranged closely to standard value (AOFAS 88.07 points; FFI 93%; FAAM 36.4 points; SF-12 31.27 points). Pedobarography showed significant differences in several forefoot areas. We encountered nonunion/malunion and necrosis of the metatarsal head.
Conclusions:
The aim of this study was to demonstrate the need for intensive training before practicing DMMO. Results show that minimally invasive DMMO requires a high learning curve. Correct handling of the burr is associated with a lot of training. Wrong handling can lead to nonunion/malunion or necrosis.
Levels Of Evidence:
Therapeutic, Level IV: Case series.
Insights
Minimally invasive distal metatarsal metaphyseal osteotomy (DMMO) shows promising results but has a steep learning curve. Extensive training is crucial to avoid complications like nonunion or necrosis.
Area of Science:
- Orthopedic Surgery
- Minimally Invasive Procedures
- Foot and Ankle Surgery
Background:
- Minimally invasive surgery (MIS) offers shorter surgical times.
- Distal metatarsal metaphyseal osteotomy (DMMO) is an MIS technique.
- DMMO presents a significant learning curve despite its apparent simplicity.
Purpose of the Study:
- To highlight the necessity of comprehensive training for DMMO.
- To emphasize the risks associated with the early learning stages of DMMO.
- To report on initial patient outcomes and surgical challenges.
Main Methods:
- A case series of 27 patients undergoing DMMO (mean age 60.9 years).
- Evaluation included clinical scores (SF-12, FFI, FAAM, AOFAS), radiographs, and pedobarographic analysis.
- Indications included metatarsalgia, plantar keratosis, and metatarsophalangeal joint instability.
Main Results:
- Clinical outcome scores were comparable to standard values (e.g., AOFAS 88.07).
- Pedobarographic analysis revealed significant forefoot pressure alterations.
- Complications such as nonunion/malunion and metatarsal head necrosis were observed.
Conclusions:
- Minimally invasive DMMO demands a substantial learning curve.
- Proper burr handling, achieved through extensive training, is critical.
- Inadequate training can result in severe complications, including bone union issues and avascular necrosis.
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