BÖSCH TECHNIQUE FOR PERCUTANEOUS HALLUX VALGUS SURGERY: PRESENTATION OF 100 CASES AFTER ONE YEAR

Abstract

Introduction and purpose: According to general experience and our own personal experience, percutaneous surgery using the Isham technique for the correction of hallux valgus has been performed in our country with frequency and good outcomes. However, the results are not easily reproducible, especially in moderate to severe hallux valgus cases. Sesamoid dislocation tends not to change much and the first metatarsal usually remains shortened. Recent publications with results of the Bösch technique are very encouraging. We have started using this technique to determine its effectiveness and the cases when it is most appropriate.

Materials and methods: The study comprised 100 feet operated with Bösch’s technique. In 34 patients we operated both feet simultaneously. In 32 patients one foot had previously been operated using Isham’s technique and subsequently the other foot was operated using Bösch’s technique. Mean age was 68 years (range: 19–82). Patients were female in 91% of cases. Intravenous saline with prophylactic antibiotics was used. Local anesthesia was used on the foot (mepi-bupivacaine). Osteotomy of the first metatarsal was performed according to Bösch’s technique. A bandage, an offload insole and a rigid shoe were used. Patients were administered analgesic and antithrombotic medication.

Results: Skin infection due to the Kirschner wire made it necessary to withdraw the latter during the first 15 days with a loss of 70–80% of the correction. When the Kirschner wire was withdrawn at 4 weeks, in 18 cases there was a loss of correction of 30–60%. One osteotomy currently has the appearance of a painless non-union. The rest of the osteotomies healed satisfactorily at 6–8 weeks. There were no cases of metatarsal head necrosis. In 16 cases there was an undesirable shortening of the metatarsal. Reduction of sesamoid dislocation was achieved in 82% of cases. Joint metatarsalphalangeal movement was normal and painless in 82% of the cases.

Conclusions: Bösch’s technique is very effective for the treatment of moderate to severe hallux valgus. It is necessary to strictly comply with the technique to displace and correctly maintain the metatarsal osteotomy. Bösch’s osteotomy can lengthen, maintain or shorten the metatarsal bone. We currently only use Akin’s distal osteotomy for cases with evident interphalangeal hallux.