Mitchell's Osteotomy With Mini-Plate and Screw Fixation for Hallux Valgus

Abstract

Background: The aim of this study was to evaluate the use of mini-plate and screw fixation to stabilize the first metatarsal osteotomy in patients undergoing Mitchell bunionectomy, with the outcomes of interest being radiological alignment and the time to bony union. Methods: We used mini-plates and screws in 43 feet of 25 patients to avoid cast immobilization and prevent osteotomy displacement. The mean age at operation was 45.4 +/- 13.4 years (range, 17.0-65.0 years). The mean follow-up was 16.9 +/- 3.6 months (range, 12.0-30.0 months). The hallux valgus angles, intermetatarsal angles, and American Orthopaedic Foot and Ankle Society (AOFAS) forefoot scores were evaluated preoperatively and at postoperative month 12. Results: The mean preoperative value for the hallux valgus angle was 35.9 +/- 4.4 degrees (range, 26.0-45.0 degrees) and for the intermetatarsal angle was 12.1 +/- 1.4 degrees (range, 10.0-15.0 degrees). The mean postoperative value for the hallux valgus angle was 16.0 +/- 2.12 degrees (range, 12.0-20.0 degrees) and for the intermetatarsal angle was 7.7 +/- 1.2 degrees (range, 5.0-10.0 degrees). The mean AOFAS score was 50.5 +/- 12.8 points (range, 30.1-76.0 points) preoperatively and 75.9 +/- 11.3 points (range, 43.3-92.3 points) at postoperative month 12. Improvement of range of motion of the metatarsophalangeal joint, pain relief, and satisfactory alignment of the first ray were achieved in 41 feet (95.3%). Conclusions: We recommend this fixation for Mitchell's bunionectomy because it provided stable fixation without the need for casting.