The operation here described is the result of an effort to overcome some of the difficulties which result from the more destructive operations for the relief of hallux valgus. . . . [R]econstruction of anatomical alignment may be accomplished without joint destruction. . . . This operation is suitable for any case except where there are marked changes in the articular surface, or extreme deformity, or in that of hallux rigidus. . . . [T]he conjoined tendon of the base of the outer aspect of the first phalanx is released from its attachment and transplanted into the head of the first metatarsal. The external sesamoid is removed if it is eroded, abnormal in shape, or displaced. The bursa and prominence on the medial aspect of the head of the metatarsal are then removed and an ideal yet conservative correction is obtained.
Why was this article selected as a classic orthopaedic reference?
Despite the fact that this brief report of a new surgical technique included no clinical results, it truly advanced the science of bunion care. Previous bunion surgery was ablational in nature, with either the Keller or the Mayo resection arthroplasty being the primary surgical treatment prior to this paper's appearance in 1928. One of the major contributions of this paper was the identification of the important role of the contracted muscles whose conjoined tendons insert onto the base of the lateral aspect of the proximal phalanx of the great toe. McBride's recommendation to release these tendons allowed restoration of the normal alignment of the metatarsophalangeal joint.
How has the information in the article withstood the "test of time"?
While many other bunion operations have been described since 1928, the principle of restoring congruency of the first metatarsophalangeal joint remains a very important surgical objective for most, if not all, bunion procedures.
How has our thinking changed with regard to this subject since the publication of this landmark work?
There have been some changes with regard to how this procedure is commonly performed at the present time. The most substantial modification of McBride's procedure is that the lateral sesamoid is no longer excised. The contracted soft tissues are simply released from the base of the proximal phalanx. Rarely are they reattached to the head of the first metatarsal.
J.D.H.