FH Orthopedics

The mini-invasive treatment of Hallux Valgus and associated hammer toes corresponds to a complementary surgical solution to classic open surgery.

The recommended indications are very specific, and there must, as a result, be careful patient selection.

This MIS treatment must satisfy the same specifications as the open surgery.

The main technique does not include fixation of the metatarsal and phalangeal osteotomies, which are instead held in place by post-operative bandages for the first week, and then by an orthoplasty for the next two or three weeks. In certain cases, however, so-called “mixed” surgery can be envisaged to fix one or other of the osteotomies (e.g. screwed Akin).

Specific instruments are, of course, necessary for performing this MIS technique.

Indications

Mini-invasive surgery of the forefoot can only be proposed in cases of first intention, non arthritic deformities with a congruent 1st rayon (pathological DMAA angle >7°) and a metatarsus varus of less than or equal to 16°.

The acts associated with lateral and/or small toe rayons can be performed using the same procedure, such as:

• 2, 3 or even 4 retrograde osteotomies of the metatarsal heads,
• Tenotomies, multiple capsulotomies of the small toes,
• Multiple osteotomies of the small toes.
  

The concept

The so-called “mini-invasive” surgical approach to Hallux Valgus has the same objectives as open surgery :

• reducing the medial volume of the 1st metatarsal head,
• reorienting the distal articular surface of the A816 metatarsal and correcting the DMAA by reducing the angle,
• lateral arthrolysis of the metatarsophalangeal joint of the 1st rayon and lengthening its adductor,
• reorienting the diaphysis of P1 by varus osteotomy, so as to reposition the first phalange on the M1 head.
  

The basis for this surgery are the use of specific material (hand-held instruments, mini-image intensifier and an adapted motor) making it possible to make incisions of 3 mm (mini-approaches).
Characteristics

Products characteristics

The Be POD MIS hand-held instrument set corresponds perfectly to the specificities of this type of surgery :

- Beaver blade holder (ref: 254 327) + blade (ref: 248 435)
Indications : it must make it possible to perform mini-approaches.

This is a 75 mm-long blade holder, and the Beaver blades used have the advantage of incising in the axis of the blade at a width of around 3 mm.

Rasp width 1.5 mm (ref: 253 279) / Rasp width 3 mm (ref: 253 280)
Indications : these instruments are designed to extract bone debris (and not to shave the bone) from the reduction in the volume of the 1st metatarsal head. A mini rugine tip is placed on the end of the rasp.
They have several different orientations (angle 15°) and come in 2 different widths (1.5 mm and 3 mm).

Rugine (ref: 248 437) / Elevator (ref: 253 937)
Indications : they must separate the soft tissue from the bone so as to be able to work on contact.

2 instruments are available: 1 elevator and 1 rugine.

The motor and the drills : the motor must include a hand part (Jacob mandrin embout)
The drills must be used carefully, respecting one golden rule: the rotation speed must be minimum, between 1,500 and 8,000 rpm maximum (using a couple reductor is highly recommended). Excessive speed can burn the soft tissue and damage the bone.

6 specific drills are available :
Depending on their shape, they make it possible to perform osteotomies or bone resections.
The drills are presented in single, sterile packs, allowing them to satisfy the very strictest traceability standards.

GRECMIP website - Research and study group for mini-invasive foot surgery