TY  - JOUR
T1  - Percutaneous Distal Osteotomy of the Fifth Metatarsal for Correction of Bunionette
AU  - Magnan, Bruno
AU  - Samaila, Elena
AU  - Merlini, Michele
AU  - Bondi, Manuel
AU  - Mezzari, Silvio
AU  - Bartolozzi, Pietro
Y1  - 2011/11/16
N1  - 10.2106/JBJS.J.01177
JO  - The Journal of Bone & Joint Surgery
SP  - 2116
EP  - 2122
VL  - 93
IS  - 22
N2  - Background: 
  Distal osteotomy of the fifth metatarsal is indicated in the surgical treatment of bunionette and varus deformities of the fifth toe in patients with a valgus deviation of the fifth metatarsal. The aim of this study was to evaluate the results of a subcapital percutaneous osteotomy of the fifth metatarsal in the treatment of this disorder.Methods: 
  From 1996 to 2006, thirty consecutive percutaneous distal osteotomies of the fifth metatarsal were performed in twenty-one patients for the treatment of a painful prominence of the head of the fifth metatarsal. Combined procedures were performed, including a first metatarsal osteotomy in sixteen feet for hallux valgus treatment and a distal open osteotomy of the second metatarsal for painful dorsal dislocation of the second metatarsophalangeal joint in eight feet. The patients were assessed at a mean of ninety-six months with a radiographic and clinical protocol that made use of the American Orthopaedic Foot & Ankle Society (AOFAS) Lesser Toe Metatarsophalangeal-Interphalangeal Scale.Results: 
  The AOFAS score improved from a mean and standard deviation of 51.9 ± 10.2 points preoperatively to 98.4 ± 2.6 points at the time of final follow-up. In 73% of feet there was complete resolution of pain at the fifth metatarsophalangeal joint without any functional limitation (AOFAS score of 100). In 20% of the cases the AOFAS score was 95 points with some decrease in function and a need to use comfortable shoes. In the remaining 7% of patients the AOFAS score was 93 points with mildly asymptomatic malalignment. No nonunions or recurrences were observed.Conclusions: 
  The percutaneous procedure described here is a reliable technique to perform a distal transverse osteotomy of the fifth metatarsal to correct a painful varus fifth-toe deformity with prominence of the fifth metatarsal head. The clinical results are comparable with those reported with traditional open techniques, with the advantages of a minimally invasive surgical procedure, substantially shorter operating time, and a reduced risk of complications.Level of Evidence: 
  Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
SN  - 0021-9355
M3  - doi: 10.2106/JBJS.J.01177
UR  - http://dx.doi.org/10.2106/JBJS.J.01177
ER  -