Percutaneous Chevron Osteotomy: A Prospective Randomized Controlled Trial.

Area of Science:

• Orthopedic Surgery
• Foot and Ankle Surgery

Background:

• Minimally invasive surgical (MIS) techniques are increasingly adopted for hallux valgus due to benefits like smaller scars and reduced complications.
• Limited evidence exists comparing MIS and open chevron osteotomy in our region.

Purpose of the Study:

• To compare the outcomes and complications of minimally invasive (MIS) versus open chevron osteotomy for hallux valgus.
• To evaluate clinical and radiological results at 12 months post-surgery.

Main Methods:

• Prospective, randomized, controlled, single-center study (October 2017 - December 2020).
• Patients randomized to MIS or open chevron osteotomy (OC).
• Clinical assessment using Visual Analogue Scale (VAS) for pain and American Orthopaedic Foot and Ankle Surgery (AOFAS) score for function. Radiological assessment of hallux valgus angle (HVA) and intramedullary angle (IMA).

Main Results:

• Both MIS and OC groups showed significant improvements in IMA and HVA without significant differences at 12 months.
• The MIS group demonstrated significantly lower VAS scores at discharge, 3 weeks, 6 weeks, and 6 months post-surgery.
• No significant differences in AOFAS scores were observed between groups. Screw prominence occurred in 3 MIS cases, and metatarsalgia in 1 OC case.

Conclusions:

• Minimally invasive chevron osteotomy yields comparable functional and radiological results to open chevron osteotomy for hallux valgus.
• MIS approach shows superior early pain reduction.
• Longer surgical time and radiation exposure were noted in MIS. Further studies are needed for complications and recurrence evaluation.