Early radiologic outcome and technical details of MIS
bunionectomy using a guided trajectory system is reported here.
From April 2022 to March 2023, 20 consecutive minimally invasive
bunionectomies were performed on 17 female patients (bilateral in 3
patients) with an average age of 63.6 (range: 46 to 82). The mean
IMA improved from 14.3 degrees (SD: 3.2) to 4.6 degrees (SD: 2.0),
HVA from 28.2 degrees (SD: 6.3) to 6.7 degrees (SD: 2.8), DMAA
from 16.6 degrees (SD: 5.6) to 6.6 degrees (SD: 1.8). Preoperatively,
17 feet (89.5%) were in TSP grades 2 and 3. Postoperatively, 19 feet
(95%) improved to either TSP grades 0 and 1. The mean duration of
operative time was 50 (SD: 9.25, range: 23 to 65) minutes. No
intraoperative complications were reported. Overall, this study
provides valuable insights into the benefits of using a guided trajectory
system to improve the success of bunion correction surgeries.
Level of evidence: Level 4.

Background: Recent literature highlights the importance of treating hallux valgus (HV) as a 3-dimensional (3D) deformity.
Although 3D printing may enhance visualization of the multiplanar aspects of HV, its influence on surgical planning remains unclear. This study assessed changes in surgical plans when surgeons sequentially reviewed 2D radiographs, 3D weightbearing computed tomography (WBCT), and 3D-printed models, hypothesizing that 3D printing would have the greatest impact.

Methods: A single HV case (a 40-year-old woman, intermetatarsal angle [IMA] 21 degrees, HV angle [HVA] 47 degrees) was evaluated by 30 surgeons in a masked, stepwise manner. Surgical plans were recorded at each stage. Surgeons rated the influence of WBCT and 3D printing using a 5-point Likert scale. A follow-up survey examined the effect of these technologies on correction amplitudes.

Results: The participants were mostly early career surgeons (median age 35.5 years, 2 years in practice). WBCT was accessible to 43.3% and used in 30% of HV cases, whereas 3D printing was accessible to 23.3% and used in 6.6%. Changes in the treatment algorithm occurred in 30% of cases after WBCT and in 43.3% after 3D printing. Significant differences (P < .05) were observed for the Lapicotton procedure between radiography and WBCT, and between WBCT and 3D printing. Surgeons performing <50 HV cases annually or with >70% Foot and Ankle specialization were more influenced by WBCT. Follow-up data (n = 23) indicated that WBCT and 3D printing influenced correction amplitudes, particularly for pronation and distal metatarsal articular angle (DMAA), more than for the IMA.

Discussion: Both WBCT and 3D printing influenced surgical planning, mostly explained by changes in first ray tarsometatarsal procedures. The rotational components (pronation and DMAA) were perceived as the most significantly affected. Future studies should explore cost-effectiveness, patient outcomes, and the utility of combining WBCT and 3D
printing in other deformities requiring multiplanar corrections.

Level of Evidence: Level IV, cross-sectional survey.

Background: Proximal fifth metatarsal fractures are common injuries that are classified into 3 zones according to their anatomical localization. While zone 1 and 2 fractures typically are traumatic, zone 3 fractures may be linked to foot alignment abnormalities, such as hindfoot varus and metatarsus adductus. The aim of the study was to explore the association between hindfoot alignment and different fracture zones, as well as the relationship between traumatic and atraumatic fracture origin and foot alignment.

Methods: We conducted a retrospective cohort study of patients with proximal fifth metatarsal fractures who had received a weightbearing computed tomography (WBCT) scan. Feet with zone 1 and 2 fractures were compared to zone 3
fractures and a healthy control group. Additionally, we compared feet with a traumatic fracture origin with those without.
Foot alignment parameters, including the foot and ankle offset (FAO) and the forefoot arch angle (FAA), were analyzed alongside data from semiautomated segmentation reports. P <.05 was considered significant.

Results: The study included 45 fractures (23 zone 1 and 2, 22 zone 3) and 19 controls. Zone 3 fractures showed a significant association with higher body mass index (P < .01), hindfoot varus (P < .01), and metatarsus adductus (P < .01) compared with zone 1 and 2 fractures, and they more frequently had a nontraumatic origin (P < .01). Zone 3 fractures also showed a significantly higher transverse arch (P < .01). No differences have been observed between zone 1 and 2 fractures and the controls. Fractures with atraumatic origin were significantly associated with hindfoot varus (P < .01), metatarsus adductus (P < .01), hindfoot varus (P < .01), and metatarsus adductus (P < .01).

Conclusion: Hindfoot varus, metatarsus adductus, and a high transverse arch were significantly associated with zone 3 fractures as well as fractures with atraumatic origin.

Background: Syndesmotic instability is a significant concern in the management of unstable ankle fractures, occurring
in approximately 10% to 13% of these cases. Early recognition and stabilization of syndesmotic injuries are essential to
ensure optimal long-term outcomes. Several techniques are currently in use, often involving complex procedure and/or
costly devices. Our study presents a syndesmosis fixation technique using K-wires that is both simple and cost-effective.

Methods: This is a retrospective single-center case series. Three hundred seventy-seven ankle fractures with intraoperative
syndesmosis instability and subsequent syndesmosis fixation with a K-wire were treated between 2002 and 2012. Of the
377 patients, 51 died and we were able to obtain long-term questionnaire completions from 94 patients (29% of presumed
living patients), with a mean follow-up of 10.6 ± 3.0 years.

Results: The mean age was 46.6 ± 18.5 years; 42% were Danis-Weber type B and 58% type C fractures. Syndesmosis
fixation failure was observed in 9 (2%) patients, and 5 (1%) patients had K-wire displacement without loss of syndesmosis
reduction. The Manchester-Oxford Foot Questionnaire (MOXFQ) was obtained 10±3 years after surgery. The mean
MOXFQ pain score was 25.9 ± 25.4, the mean functional score was 18 ± 24.8, and the mean social score was 13.7 ± 22.2.

Conclusion: We report long-term (10.6 ± 3 years) functional outcomes using a validated patient-reported questionnaire
in patients who underwent syndesmosis fixation with 2 K-wires for unstable ankle fractures. In the subset of patients we
were able to find in follow-up, we found low rates of syndesmosis fixation failure, low pain scores, and excellent functional
outcomes. The availability and low cost of these implants make this technique an accessible and cost-effective solution to
consider for syndesmosis fixation.

Level of Evidence: Level IV, retrospective case series.