Bunions: Correction With Proximal Osteotomies

Bunions: Correction With Proximal Osteotomies

This video demonstrates the surgical repair of a bunion, utilizing an osteotomy, or cut in the bone, along with a plate and screws. Bunion deformities can be corrected utilizing a variety of surgeries.

In this cadaveric video, a cut in the portion of the metatarsal bone closer to the ankle, also known as the proximal portion of the bone, will be performed. The cut in the bone will be done in a chevron pattern. The entire procedure is called a proximal chevron osteotomy.

Here, the surgeon has already made an incision on the top of the foot next to the bunion. The surgeon loosens the tissue on the other side of the bunion to help relax the joint into its proper position. An incision will then be made along the inside of the foot from the base of the big toe joint toward the ankle. The incision will be held open with a retractor, so the surgeon can see all the structures for the procedure.

A deeper incision will be made to expose the bone. A small amount of the bone from the bunion deformity will be shaved off with a surgical saw. Attention will then be turned to the proximal metatarsal bone. Prior to deciding where to cut the bone, the surgeon will choose a plate and place it at the very end of the bone to use as a template. The surgeon will mark the area on the bone for the upcoming cut, based on the plate that will be used.

The plate will be removed, and the surgeon will draw out the chevron pattern for the cut. Again, a small bone saw will be used to cut the bone in the desired locations. Retractors are placed under the bone to protect the other structures from the saw. A clamp will be placed on the recently cut bone to place it in the proper position. Temporary wires will be placed to hold the new alignment.

The surgeon might have to remove extra bone so that the plate can sit flush. A temporary wire will be used to hold the plate in place. The surgeon will then use a drill to make a hole in the bone through the plate. Once the bone is drilled, the proper size screw is placed. The process is then repeated for the remaining screws.

Here you see the plate and screws holding the recently cut bone in place. The incisions will then be closed and the surgery is complete.