Retrospective Review of Fluoroscopy Exposure Comparing Open vs MIS Bunionectomy Procedures

Research Type: Level 3 - Retrospective cohort study, Case-control study, Meta-analysis of Level 3 studies Introduction/Purpose: Hallux valgus is a common forefoot pathology. Minimally Invasive Chevron-Akin (MICA) procedure is a common surgical technique that has been shown to reduce post operative complications, preserve soft tissues, and improve recovery. Minimally invasive techniques are gaining popularity in orthopedics. Disadvantages include heavy reliance on fluoroscopy, which increases exposure to radiation. In foot and ankle procedures, the mini C-arm is more commonly used, which can significantly reduce radiation. The objective of this study is to compare the time and quantity of radiation exposure when utilizing fluoroscopy in open versus minimally invasive bunionectomy procedures. Methods: This is a retrospective review of all orthopaedic foot and ankle patients that were treated operatively at Memorial Hermann over the past 5 years. Inclusion criteria included patients older the age of 18 undergoing hallux valgus correction procedures identified under CPT code 28299 and procedures done using the mini C-arm. Exclusion criteria included patients younger than 18 years old, patients undergoing bilateral hallux valgus correction procedures, procedures without a dose summary, and use of a large C-arm. Results: Forty eight patients were included in the study. Out of the 48 patients, 30 underwent open procedures and 18 underwent MIS Chevron-Akin (MICA) procedures. The average time under fluoroscopy for patients undergoing an open procedure was 2 minutes and 27 seconds with an average dose total DAP 428.78 and average dose total air kerma 1.53. This is in contrast with patients undergoing MIS procedures, which showed an average time of 4 minutes and 56 seconds under fluoroscopy with average dose total DAP 900.11 and average dose total air kerma of 4.52. Conclusion: In conclusion, patients undergoing MIS Chevron-Akin (MICA) procedures were exposed to double the amount of time under fluoroscopy with over two times the radiation dose. While MICA procedures are becoming increasingly more popular due to their improved post operative outcomes in terms of soft tissue healing and patient recovery, as well as greater cosmetic appeal, it does lead to increased radiation exposure to both the patient and the surgeon. There is also a learning curve with becoming technically adept at this technique, which may lead to greater radiation exposures as surgeons first begin to learn how to implement these skills.