Introduction Percutaneous distal metaphyseal osteotomy, a subcapital linear osteotomy of the fifth metatarsal performed through a minimally invasive percutaneous approach and stabilized with a single Kirschner wire, without soft-tissue procedures, enables the surgeon to achieve consistently good correction of a fifth metatarsal bunionette deformity.
Step 1: Wire Insertion It is mandatory to place the wire in a parosteal position to allow medial displacement of the metatarsal head at the osteotomy site.
Step 2: Skin Incision Make a short skin incision directly to the bone on the lateral side of the distal metaphysis of the fifth metatarsal.
Step 3: Periosteal Detachment Detach the periosteum surrounding the bone at the site of the planned osteotomy with a small scissors inserted percutaneously, dorsally initially and then plantarly.
Step 4: Osteotomy Perform the osteotomy with a micromotorized Lindemann bone cutter, avoiding damage to the surrounding structures by drilling the lateral cortex first and then the medial cortex, keeping the bone cutter in the same lateral entry hole and its tip inside the medullary canal.
Step 5: Correction The correction is usually satisfactory when contact between the lateral aspect of the metatarsal head and the medial cortex of the metatarsal neck is achieved in the frontal plane.
Step 6: Stabilization Stabilize the osteotomy site with the 2-mm Kirschner wire, driven distal to proximal into the medullary canal of the fifth metatarsal as far as its base.
Step 7: Postoperative Care Apply adhesive tape with a plantar, kidney-shaped pad.
Results In our study of this technique24, the American Orthopaedic Foot & Ankle Society (AOFAS) score improved from a mean and standard deviation of 51.9 ± 10.2 points preoperatively to 98.4 ± 2.6 points at the time of final follow-up. In 73% of the feet, there was complete resolution of pain at the fifth metatarsophalangeal …
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