Abstract
Mitchell – Hawkins osteotomy is a widely used technique for correction of mild to moderate hallux valgus. Several authors have recognised that, for a good result, the osteotomy must be stable enough to prevent excessive shortening or displacement of the distal fragment. Several fixation techniques have been proposed: sutures, staples, K-wires and screws. The aim of the study is to define whether the use of a screw could give better results than a single K-wire in the fixation of the osteotomy. We studied prospectively 30 patients with moderate hallux valgus operated on consecutively at our institute using the Mitchell osteotomy. In 15 patients (Group A) fixation was achieved with a single K-wire inserted through the tip of the toe and driven medial to the metatarsal head into the first metatarsal shaft, while in the others (Group B) a Herbert screw was used. All procedures were identical except for the fixation device and were carried out by the same surgeon. Weight bearing was allowed from the first day after surgery with a postoperative shoe. The K-wire was removed at the fifth postoperative week. In Group B the correct position of the great toe was maintained with a dressing, renewed weekly for 8 weeks after surgery. Patients were evaluated clinically with the AOFAS score and radiologically either before surgery and at the follow-up. The mean follow-up time was 10 months. We did not find any difference between the groups in correction of the intermetatarsal angle and of the valgus angle or in the improvement of the AOFAS score. No symptomatic displacement of the distal fragment occurred in either group. Five patients of Group A complained of a pin tract infection of the K-wire, which was treated successfully with oral antibiotics. No deep infection occurred. All the patients were satisfied with the treatment received but the majority of those of Group A (10/15) complained of discomfort in leaving the K-wire in place for such a long time. The Mitchell – Hawkins osteotomy can be fixed either with a K-wire or a screw with similar results in terms of angle correction and clinical scores. Patients felt more comfortable without protruding fixation devices, but for a successful procedure with the use of a screw, repeated dressing of the foot is required, which is time-consuming for both the surgeon and the patient.
