Fourth generation minimally invasive hallux valgus surgery: A technical variation on two-screw fixation and case series

<h2>Abstract</h2> Minimally invasive bunion surgery (MIBS) is an increasingly popular choice in the treatment of hallux valgus. While it is not a new concept, advancements in surgical technique and equipment have reinvigorated the excitement around the procedure. The fourth generation of MIBS traditionally consists of two screws oriented parallel in a transverse or horizontal relationship. The aim of this study is to describe a technical variation in MIBS screw orientation with a sagittal or vertical orientation and evaluate the potential benefits. The authors performed MIBS on 50 feet across 48 patients according to the fourth generation technique with both standard horizontal screw orientation and a vertical screw orientation variation. Patient outcomes, VAS scores, radiographic foot widths, and complications were recorded and compared between the two groups. Vertical screw orientation demonstrated similar results compared to horizontal screw orientation in all categories. Vertical screw orientation had the additional benefit of maintaining or decreasing the midshaft width. The authors believe fourth generation MIBS performed with a vertical screw orientation variant is a viable technique with additional benefits compared to traditional horizontal screw orientation, although further follow up studies are required.