Chirurgie percutanée de l’hallux valgus : étude anatomique de son innocuité et de son efficacité - 01/10/22

Percutaneous hallux valgus surgery: Anatomical study of its safety and effectiveness

Doi : 10.1016/j.rcot.2022.02.036

Ester Navarro-Cano ^a,^b,^⁎ , Ana Carrera ^b, Marko Konschake ^c, Kerbi Alejandro Guevara-Noriega ^d, Francisco Reina ^b
^a Orthopaedic Surgery Department, Sant Celoni Hospital, Sant Celoni, Spain
^b Department of Medical Sciences, Research Group on Clinical Anatomy, Embryology and Neuroscience (NEOMA), Faculty of Medicine, University of Girona, 77 Emili Grahit St, 17003 Girona, Spain
^c Institute of Clinical and Functional Anatomy, Medical University of Innsbruck, Innsbruck, Austria
^d Vascular Surgery Department, Parc Taulí University Hospital, Sabadell, Spain

^⁎Auteur correspondant.

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Saturday 01 October 2022
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Abstract

Background and hypothesis

Although percutaneous hallux valgus surgery is increasing in popularity, concerns about safety regarding neurovascular and tendinous structures remain. The first aim of this body-donor study was to evaluate the safety of three common percutaneous portals. Secondly, to evaluate percutaneous surgery effectiveness in completing adductor tendon release and first ray osteotomies.

Patients and methods

Twenty body-donor feet were included and underwent three percutaneous procedures, which are commonly performed in combination: distal metatarsal osteotomy, proximal phalanx osteotomy and adductor tendon release. After surgery, the distance between surgical portals and relevant neurovascular structures was measured. Damage to this neurovascular structures, tendons or articular cartilage was noted. Completion of adductor tendon release and osteotomies was verified.

Results

The medial dorsal digital nerve of the hallux was damaged in two specimens. Mild peritendon damage was observed in two feet. The rest of neurovascular and tendinous structures were intact. No cartilage damage was observed. The distance between the adductor tenotomy portal and the lateral dorsal digital nerve of the hallux and the first dorsal metatarsal artery was 3.3mm (SD 1.4) and 2.4mm (SD 1.8), respectively. Complete adductor tenotomy was achieved in 14 feet.

Conclusions

The structure with the highest risk of damage during percutaneous hallux valgus surgery is the medial dorsal digital nerve. The lateral dorsal digital nerve and the first dorsal metatarsal artery might be at risk due to the small distance to the adductor tendon release portal. A deep anatomical knowledge and a meticulous surgical technique are required to avoid lesions to neurovascular and tendinous structures.

Level of evidence

V, Cadaveric study.

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Keywords : Hallux valgus, Percutaneous surgery, Minimally Invasive, Foot Surgery

☆	Cet article peut être consulté in extenso dans la version anglaise de la revue Orthopaedics & Traumatology: Surgery & Research sur Science Direct (sciencedirect.com) en utilisant le DOI ci-dessus.