Bunions: Minimally Invasive Surgery Correction With Distal Osteotomies

Bunions: Minimally Invasive Surgery Correction With Distal Osteotomies

This is a cadaveric right foot specimen, and the surgeon will be performing a minimally invasive bunionectomy. The surgeon starts with a small incision next to the large joint in the big toe. A small burr is used to cut through the metatarsal bone. The surgeon will use real-time x-ray to make sure the cut will be in the right spot and that it is all the way through the bone.

Previously, this cut would be done through a larger open incision with a larger saw blade. The cut allows the surgeon to rotate the bone back into its proper place to realign the toe and correct the bunion. A small shifting guide is placed on the 2 bone segments. The goal will be to shift the end of the bone towards the other toes and then fix it into place with screws.

The bone is rotated into position and a wire is drilled to hold the guide in place. The surgeon checks the placement of the guide and wire as well as the position of the bones on x-ray before moving forward with the procedure. The next step is turning the small knob on the shifting guide to push the bone towards the other toes and offset the bone about 50%-75%.

Once the surgeon is happy with the alignment, they will lock a drill guide in place and start using pins and drills that will help set the final screws that hold everything in place. A temporary guide wire is placed first. This wire stabilizes the drill guide. Once the surgeon is ready to drill for screws, small incisions are made at those sites.

Two pins are drilled into the bone fragments. These are the locations of where the final screws will be. The surgeon will check the length of the pins on these guides to choose the right length of the screws. Drill holes are made, and screws are placed by hand. The surgeon always checks with x-ray to make sure the screw is not too long or too short.

In order to complete the realignment, the surgeon will sometimes do a small bony procedure called an osteotomy to the next bone down the toe and place one small screw to hold that in place while the entire toe heals. Although the toe looks crooked, functionally, the toe is straightened out and the tendons are pulling on the toe in line.

There is typically a small shelf of bone on the side of the toe that needs smoothing out, so it does not bother the patient. The final x-rays are taken from the top down and from the side. The small incisions are closed, and the patient is headed to the recovery room.