Early Postoperative Implant Failure of Commercial Intramedullary Locking Plates for Hallux Valgus Correction: A Case Series and Literature Review

Background: Hallux valgus is a multiplanar deformity of the first metatarsophalangeal (MTP) joint, often requiring surgical correction through osteotomies, arthrodesis, or implants such as screws and plates. However, complications such as hardware failure and loss of correction remain a concern, highlighting the need for alternative fixation strategies such as the intramedullary system, which may offer improved stability and reduced complication rates. Objectives: This case series evaluates an innovative intramedullary device for hallux valgus correction, focusing on implant failure modes and associated clinical and radiological outcomes. Materials and Methods: The authors conducted a retrospective case series on patients who underwent hallux valgus correction with the intramedullary device over the past four years, assessing implant failure mode, radiographic outcomes, and functional results. Radiographic measurements included hallux valgus angle, intermetatarsal angle, distal metatarsal articular angle, medial sesamoid grades, distal screw insertion angles, and lateral angulation angle, whereas functional outcomes were evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) Hallux scale and the Grading Hallux MTP-Interphalangeal scale. Results: During the follow-up period, 72 feet underwent hallux valgus correction, with a mean patient age of 49.57 ± 14.88 years and a mean follow-up of 7.46 ± 4.27 months; implant failure occurred in five cases, including three proximal screw pullouts and two distal screw breakages with bone fragment displacement. Among these five cases, the mean age was 62.60 ± 7.37 years, the mean time to implant failure was 2.00 ± 1.00 months, and the mean postoperative AOFAS score was 74.80 ± 10.85. Conclusion: This case series reports a 6.94% implant failure rate for hallux valgus surgery using the intramedullary device, with all patients achieving fair to good AOFAS scores and no need for revision surgery. These findings highlight the need for surgeons to remain vigilant for potential complications and to exercise careful judgment in patient selection and surgical technique when adopting novel fixation devices.