The Unspoken Complication Following MIS Bunion Surgery

Category: Bunion; Midfoot/Forefoot Introduction/Purpose: Hallux valgus (HV) is a common orthopedic foot and ankle condition involving deformity and subsequent pain and dysfunction of the first ray. Surgical interventions, such as open and minimally invasive surgery (MIS), are frequently utilized if nonoperative management is insufficient . In recent years, MIS has been increasingly used and has been regarded as one of the most innovative surgical interventions for HV. As with all new surgical techniques complications can occur. The most common complications after MIS bunion surgery are infections and hardwear removal. Nonunion after MIS bunion correction can be surgically challenging. Recent publications report 1% of non-unions after MIS bunion correction. Despite this prevalence the orthopedic literature is lacking information about how to treat patients who have non-unions after MIS bunion surgeries. Methods: We would like to present our experience and treatment protocol for non- union after MIS bunion surgery. Treatment Protocol: 1. Nonunion definition- No signs or minimal signs on consecutive x-rays or CT scan of bony union at the osteotomy site 6 months or more after index MIS bunion surgery. 2. Rull out reversible causes for nonunion. 3. Surgery- An open surgery is performed. Removal of MIS screws, debridement and refreshing of the osteotomy site, adding bone graft (autologous/synthetic), fixing the nonunion site with a dorsal plate and a lag screw if needed. 4. Post op protocol- non-weight bearing for 2 weeks followed by 4 weeks of partial weight bearing in a post-op shoe. All patients receive Vit D supplements for 3 months after surgery. (1000 IU per day). 5. Follow up in clinic with x rays at 6 weeks, 3 months and 6 months after revision surgery. Results: We would present a case sereis of 6 cases of nonunions following MIS bunion surgery treated according to the presented treatment protocol and achieved full union 3 months after the revision surgery. Conclusion: Nonunion after MIS bunion correction can be surgically challenging. The suggested treatment protocol shows high union rates for revision cases.