Aims. The aim of this retrospective cohort study was to assess and investigate the safety and efficacy of using a distal tibial osteotomy compared to proximal osteotomy for limb lengthening in children. Methods. In this study, there were 59 consecutive tibial lengthening and deformity corrections in 57 children using a circular frame. All were performed or supervised by the senior author between January 2013 and June 2019. A total of 25 who underwent a distal tibial osteotomy were analyzed and compared to a group of 34 who had a standard proximal tibial osteotomy. For each patient, the primary diagnosis, time in frame, complications, and lengthening achieved were recorded. From these data, the frame index was calculated (days/cm) and analyzed. Results. All patients ended their treatment with successful lengthening and deformity correction. The frame index for proximal versus distal osteotomies showed no significant difference, with a mean 48.5 days/cm (30 to 85) and 48.9 days/cm (28 to 81), respectively (p = 0.896). In the proximal osteotomy group, two patients suffered complications (one refracture after frame removal and one failure of regenerate maturation with subsequent valgus deformity) compared to zero in the distal osteotomy group. Two patients in each group sustained obstacles that required intervention (one necessitated guided growth, one fibula lengthening, and two required change of wires). There was a similar number of problems (pin-site infections) in each group. Conclusion. Our data show that distal tibial osteotomies can be safely employed in limb lengthening for children using a circular frame, which has implications in planning a surgical strategy; for example, when treating a tibia with shortening and distal deformity, a second osteotomy for proximal lengthening is not required. Cite this article: Bone Joint J 2022;104-B(11):1273–1278

Many surgical techniques based on a distal osteotomy are used for the treatment of the symptomatic hallux valgus. We review the results of percutaneous distal osteotomy retrospectively. Between 1998 and 2003, 52 patients were operated on using a distal osteotomy for symptomatic hallux valgus. We investigated 35 females and nine males for a mean follow-up time of 4.6 years. We performed a percutaneous distal osteotomy (PDO) with a 2-mm Kirschner wire. Radiological analysis consisted of measuring the hallux valgus angle (HV) and the angle between the first and the second metatarsal (M). Clinical evaluation was performed with the AOFAS scale. Good bony contact was achieved and all the osteotomies united and no aseptic necrosis was found. According to the questionnaire, the pre-operative AOFAS score was 44.3 and 92.5 at the follow-up examination. Radiological analysis showed that the pre-operative HV angle was 13.7° and 9.8° at follow-up. The pre-operative M angle was 24.1° and 13.6° at follow-up. The PDO technique gives good results at a mean follow-up of 4.6 years. The positive aspects of this technique are: short surgical time, low incidence of complications and high patient compliance. A single 2-mm Kirschner wire is enough to achieve adequate stabilisation of the osteotomy, is less expensive than other surgical instruments for hallux valgus and is very easy to remove

The intermetatarsal angle is widely used to determine whether a basal or distal metatarsal osteotomy should be used to correct a hallux valgus deformity. We have noticed that the point of intersection of the long axes of the first and second metatarsals on standard pre-operative weight-bearing AP radiographs consistently predicts the type of osteotomy required. A basal osteotomy is generally recommended if the inter-metatarsal angle is ≥14°, whereas a distal osteotomy is usually sufficient if the angle is less than 14°. Sixty standardised pre-operative AP weight bearing in-patients undergoing hallux valgus correction were included in our study. The intermetatarsal angle was measured in a standard fashion. The point of intersection in the foot was recorded in terms of the distance from the talonavicular joint. Using a Pearson’s Correlation coefficient, our study revealed that an intermetatarsal angle of 14° or more consistently intersected either within the talar head or distal to thetalonavicular joint. We propose that this as an accurate and simple method of pre-operatively determining the choice of metatarsal osteotomy

Introduction. Hallux valgus is a common orthopaedic complaint with multiple surgical options. There are many methods available for assessing whether sufficient translation of the first metatarsal can be achieved with a metatarsal translational osteotomy alone. None of the current methods take into account the breadth of the metatarsal. With current PACS technology a radiograph can be zoomed to any size and we postulate that by using the surgeon's thumb (or any suitable digit), as a sizing tool, a safe clinical decision can be made concerning whether a translational metatarsal osteotomy alone will provide sufficient correction. Method. We reviewed the preoperative radiographs (weightbearing AP) of twenty patients who had scarf and akin osteotomies and twenty patients with a deformity too great for scarf and akin osteotomies. The senior author (CC) taught the rule of thumb to one consultant and two registrars (total two registrars and two consultants). The radiographs were blindly randomised and the participants assessed each radiograph and decided whether sufficient translation could be achieved with a translational metatarsal osteotomy alone. The process was repeated three months later. Twenty patients were deemed sufficient for intra-user variability and significance based on a recent JBJS(A) article concerning radiographic measurements post proximal crescentic osteotomy (Shima et al. 2009). Results. Good inter- and intra- user variability was demonstrated and using the rule of thumb is a safe way of determining whether a distal osteotomy alone will provide sufficient correction

Introduction: Distal osteotomy of the first metatarsal is indicated in the surgical treatment of mild-to-moderate hallux valgus deformity. The aim of this study was to evaluate the results of a subcapital distal osteotomy of the first metatarsal using a percutaneous technique. Methods: From 1996 to 2001 118 consecutive percutaneous distal osteotomies of the first metatarsal were performed in 82 patients for the treatment of painful mild-to-moderate hallux valgus. Patients were assessed at a mean follow-up of 35.9 months employing a clinical and radiographic protocol. The American Orthopedic Foot and Ankle Society’s hallux-metatarsophalangeal-interphalangeal scale was used for the clinical assessment. Results: in 107 of the 118 cases (90.7%), patients were satisfied with the procedure. The mean score obtained in the clinical assessment using the AOFAS scale was 88.2 ± 12.9. The radiographic assessment showed significant changes (P< 0.05) in the values of the hallux valgus angle, first intermetatarsal angle, distal metatarsal articular angle and the sesamoid position at the postoperative assessment compared to preoperative values. Recurrence of the valgus deformity was observed in 3 cases (2.5%), non-painful stiffness of the first metatarsophalangeal joint in 7 (5.9%) and a deep infection resolved by antibiotic therapy in 1 (0.8%). Conclusions: The percutaneous procedure proved to be a reliable technique for the correct execution of a distal linear osteotomy of the first metatarsal for the correction of painful mild-to-moderate hallux valgus deformity. The clinical results appear to be comparable to those obtainable with the traditional open techniques, with the additional advantages of a minimally invasive procedure, substantially shorter operating times and a reduced risk of complications related to surgical exposure

Distal osteotomy of the first metatarsal can be performed by a percutaneous minimally invasive procedure when indicated for the surgical treatment of hallux valgus. The intermediate-term results of percutaneous distal uniplanar osteotomy of the first metatarsal were assessed in 118 feet in 82 patients (36 bilaterally) to determine the effectiveness of the percutaneous procedure. A modified Lamprecht – Kramer – Boesh technique was performed under distal nerve trunk anaesthesia (ankle block) without a tourniquet, using a K-wire for stabilisation of the osteotomy. No surgical approaches and no soft-tissue procedures were required. Post-operatively adhesive tape was applied and immediate weight-bearing allowed. The patients were followed for an average of 36 months (range 24 to 78 months). Clinical assessment was based on the American Orthopaedic Foot and Ankle Society, hallux-metatarsal-phalangeal-interphalangeal (AOFAS) scale. Anteroposterior and lateral weight-bearing radiographs were performed pre- and post-operatively, and the hallux valgus angle, the first intermetatarsal angle, the distal metatarsal articular angle (DMAA) and the position of the sesamoid were recorded. The average score according to the AOFAS scale was 86.6±12.9. Patients were satisfied with the result of the procedure in 90.7% of cases. The results confirm the effectiveness of the percutaneous procedure to achieve a satisfactory distal osteotomy of the first metatarsal without the need for soft-tissue procedures in the surgical management of symptomatic hallux valgus

Though there are many techniques utilised in the correction of hallux valgus (HV), no single approach has been reported to be ideal for all patients to date. A great deal of controversy remains concerning the type of osteotomy, method of fixation, and inclusion of soft tissue procedures. Herein, we compared the outcomes of two different operative techniques, the minimally-invasive modified percutaneous technique and the distal chevron osteotomy, used to treat mild to moderate hallux valgus. This study was conducted in line with the CONSORT 2010 guidelines. 41 patients (58 feet) with mild to moderate hallux valgus were randomly assigned by computer to two different groups. The first group containing 24 patients (33 feet) was treated by the modified percutaneous technique, whereas the second group included 17 patients (25 feet) treated by distal chevron osteotomy. In the modified percutaneous group, after a mean follow up of 43 months, the mean correction of hallux valgus angle (HVA) was 26.69° (P=0.00001), the mean correction of intermetatarsal angle (IMA) was 9.45° (P=0.00001), and the mean improvement of AOFAS score was 47.94 points (P=0.00001). In the chevron osteotomy group, after a mean follow up of 44 months, the mean correction of hallux valgus angle was 26.72° (P=0.00001), the mean correction of intermetatarsal angle was 9° (P=0.00001), and the mean improvement of AOFAS score was 44.76 points (P=0.00001). In our study, the modified percutaneous technique proved to be equally effective as the distal chevron osteotomy, but with fewer complications and a higher rate of patient satisfaction

This study was designed to investigate distal radial osteotomy performed from a volar approach for dorsal deformity. In the past conventional dorsal approaches have led to extensor tendon synovitis and a volar approach was thus appealing. A prospective analysis of 8 consecutive patients with distal radial malunions with residual dorsal angulation was performed. In each case a volar approach was used and a locked distal radial plate was applied. Laic crest bone graft was used. In each case an acceptable correction was obtained. Union occurred in 6–8 weeks. Pain and grip strength were improved in all 8 cases. The author concludes that a volar approach and locked plate fixation is useful for the correction of dorsal deformity in distal radial malunions. Implant problems with this approach

A prospective trial is reported which compares distal osteotomy of the first metatarsal with Keller's arthroplasty in the treatment of adult hallux valgus. A total of 33 patients attended for review at least three years after operation. Symptomatic improvement, as assessed by patient satisfaction, pain relief, cosmetic improvement and restoration of function, was similar in the two groups. Objective measurement showed that the range of movement of the metatarsophalangeal joint was better maintained after osteotomy, as was the relationship of the sesamoid bones to the head of the first metatarsal. Correction of the valgus deformity also was significantly better in the patients who underwent osteotomy and in these patients the first intermetatarsal angle was reduced to within normal limits. There was no evidence that initial degenerative changes or subluxation at the metatarsophalangeal joint compromised a successful result from osteotomy

We reviewed the outcome of distal chevron metatarsal osteotomy without tendon transfer in 19 consecutive patients (19 feet) with a hallux varus deformity following surgery for hallux valgus. All patients underwent distal chevron metatarsal osteotomy with medial displacement and a medial closing wedge osteotomy along with a medial capsular release. The mean hallux valgus angle improved from −11.6° pre-operatively to 4.7° postoperatively, the mean first-second intermetatarsal angle improved from −0.3° to 3.3° and the distal metatarsal articular angle from 9.5° to 2.3° and the first metatarsophalangeal joints became congruent post-operatively in all 19 feet. The mean relative length ratio of the metatarsus decreased from 1.01 to 0.99 and the mean American Orthopaedic Foot and Ankle Society score improved from 77 to 95 points. In two patients the hallux varus recurred. One was symptom-free but the other remained symptomatic after a repeat distal chevron osteotomy. There were no other complications. We consider that distal chevron metatarsal osteotomy with a medial wedge osteotomy and medial capsular release is a useful procedure for the correction of hallux varus after surgery for hallux valgus

Aims. The mainstay of surgical correction of hallux valgus is first metatarsal osteotomy, either proximally or distally. We present a technique of combining a distal chevron osteotomy with a proximal opening wedge osteotomy, for the correction of moderate to severe hallux valgus. Patients and Methods. We reviewed 45 patients (49 feet) who had undergone double osteotomy. Outcome was assessed using the American Orthopaedic Foot and Ankle Society (AOFAS) and the Short Form (SF) -36 Health Survey scores. Radiological measurements were undertaken to assess the correction. The mean age of the patients was 60.8 years (44.2 to 75.3). The mean follow-up was 35.4 months (24 to 51). Results. The mean AOFAS score improved from 54.7 to 92.3 (p < 0.001) and the mean SF-36 score from 59 to 86 (p < 0.001). The mean hallux valgus and intermetatarsal angles were improved from 41.6. o. to 12.8. o. (p < 0.001) and from 22.1. o. to 7.1. o. , respectively (p < 0.001). The mean distal metatarsal articular angle improved from 23. o. to 9.7. o. The mean sesamoid position, as described by Hardy and Clapham, improved from 6.8 to 3.5. The mean length of the first metatarsal was unchanged. The overall rate of complications was 4.1% (two patients). Conclusion. These results suggest that a double osteotomy of the first metatarsal is a reliable, safe technique which, when compared with other metatarsal osteotomies, provides strong angular correction and excellent outcomes with a low rate of complications. Cite this article: Bone Joint J 2016;98-B:1202–7

Purpose of the study: Different metatarsal osteotomies performed via a percutaneous approach can be used to correct hallux valgus. The purpose of this work was to analyse the clinical and radiographic results of percutaneous treatment of hallux valgus using a distal wedge osteotomy of the metatarsal. Material and methods: This was a consecutive prospective series of 125 cases of hallux valgus treated by the same surgical technique, distal wedge osteotomy of the metatarsal without fixation. Percutaneous lateral arthrolysis and percutaneous varus correction of the first phalanx were associated. The AOFAS function score for the forefoot was determined preoperatively and at last follow-up. Time to normal shoe wearing and to resumption of occupational activities were also noted. Angle correction was determined on the anteroposterior weight-bearing image. All patients were reviewed at mean 20 months (range 12–40). Results: The AOFAS forefoot function score was 46/100 preoperatively and 87/100 at last follow-up. Mean motion of the metatarsophalangeal joint was 95 preoperatively and 80 postoperatively. Mean metatarsophalangeal valgus was 30 preoperatively and 12 at last follow-up. The mean intermetatarsal angle improved from 13 to 8 and the orientation of the joint surface of the first metatarsal (DMAA) improved from 11 to 7. The metatarsophalangeal joint of the first ray was congruent in 45% of the feet preoperatively and in 88% postoperatively. Mean time to wearing normal shoes was seven weeks for the treatment of hallux valgus alone and three months for surgery of the first ray and lateral rays. Discussion: Percutaneous treatment of mild to moderate hallux valgus by distal wedge osteotomy of the metatarsal enables good clinical and radiographic improvement. The surgical technique requires experience with percutaneous surgery of the forefoot to avoid the main complications: secondary displacement in elevates and excessive shortening of the first metatarsal. This technique restores metatarsophalangeal congruence of the first ray compared with Isham-Reverdin osteotomy

Seventy-two Mitchell distal metatarsal osteotomies for hallux valgus performed over a period of 10 years have been reviewed. Sixty-six (92 per cent) were graded as excellent or good. Retrospective radiographic analysis of 29 of these cases showed that the operation had reduced the intermetatarsal angles to within normal anatomical limits. No patient experienced a worsening of symptoms as a result of the operation

Purpose of the study: The purpose of using distal metaphyso-epiphyseal osteotomy to shorten the ulna is to reduce healing time compared with diaphyseal shortening and to adapt the osteotomy to the distal radioulnar anatomy and associated conditions by using a variably oblique cut. Material and methods: Oblique metaphyso-eiphyseal osteotomy of the distal ulna was performed in sixteen patients since 2000. Fourteen presented ulnocarpal pain. Among these, eight had associated distal radioulnar pain. Two patients had pain essentially limited to the distal radioulnar area. Radiographically, there was ulnocarpal impingement in fourteen wrists, and signs of early-stage distal radioulnar osteoarthritis in five. Local regional anesthesia was used in thirteen patients who underwent surgery in an outpatient clinic. The dorsoulnar approach was used. The direction of the osteotomy cut depended on the individual condition, and distal radioulnar anatomy and stability. Two headless canulated screws were used for fixation. The elbow and wrist were immobilized for three weeks followed by self-education of pronosupination beginning with a removable orthesis to stabilize the wrist. Results: Outcome was assessed at maximum follow-up of four years. Preoperative pain had totally resolved in fourteen wrists with residual pain at forced pronosupination in two. Wrist motion was not modified in the frontal and sagittal planes. Complete pronosupination range of motion was achieved in thirteen patients, two patients had supination limited to 20° and one had pronation and supination limited to 30°. Force was 90% compared to the opposite side. Bone healing was achieved in all patients, in 3–4 weeks for fourteen wrists and after two months of elbow and wrist immobilization in two. Discussion: Oblique metaphyso-epiphyseal osteotomy of the distal ulna reduced the healing time compared with diaphyseal shortening osteotomies. This technique enables adaptation of the direction and orientation of the ulnar cut to the individual distal radioulnar anatomy. Favorable clinical outcome in patients with early-stage distal radioulnar osteoarthritis has led us to progressively abandon certain indications for distal resection of the ulna and the Sauvé-Kapankji operation

In the correction of hallux valgus, there are many different treatments with the aim to resume angular values I MF (metatarsal-phalangeal), I IM (intermetatarsal), PASA (proximal articular set angle), sesamoid position, to improve transferring metatarsal pain and the aesthetics of the forefoot. From November 2001 to November 2003, in the 1. st. Clinica Ortopedica at Bari University, 40 patients were treated for hallux valgus (nine males and 31 females). The age ranges from 17 to 82 years of age (median age: 50 years). The correction technique is based on a distal metatarsal osteotomy (modified Chevron techniques) and fixation with ‘hallux splint’ interfragmentation dynamic and compression device (Waldemar Link GmbH & Co Hamburg, Germany). This technique give intra-operative stability of the osteotomy, giving free weight-bearing from the beginning in the post-operative phase and the complete resumption of daily activities in a short period of time. At a median follow-up of 2 months, a significant improvement in the angular values is shown by radiological evaluation. Therefore, the result shows that this surgical technique is valid in the correcting hallux valgus

Introduction: The main goal of surgical correction of hallux valgus is the morphological and functional rebalance of the first ray and correcting all the characteristics of the deformity. Historically, distal metatarsal osteotomies and SCARF have been indicated in cases of mild or moderate deformity with inter-metatarsal angles up to 20° and are procedures widely used for correction of hallux valgus. The aim of this study is to compare a distal metatarsal osteotomy recently described (SERI) with SCARF osteotomy in a clinical prospective randomised study. Methods: 20 patients with bilateral hallux valgus similar on both sides regarding clinical and radiographic assessment were included. Clinical evaluation using American Orthopaedic Foot and Ankle Score (AOFAS) and radiographic assessment were considered before surgery up to 2 years follow-up. All patients were operated bilaterally in the same surgical sitting, and received at random SCARF osteotomy on one side, and on the other a SERI osteotomy performed through a 1 cm skin incision under tdirect view control and fixed with one Kirschner wire. Duration of surgery was recorded. Postoperative care was similar in both groups and consisted of gauze bandage and weight bearing with talus shoes for 30 days. Results: No statistical differences were observed in preoperative HVA, IMA, DMAA in both groups. Average surgical time was 17 minutes in SCARF and 3 minutes in SERI (p< 0.0005). No complications were observed in the series, with no wound dehiscence. All osteotomies healed uneventfully. At 2 year follow up, no statistical differences were observed in HVA, IMA, DMAA comparing SCARF with SERI. Average AOFAS score was 87±12 in SCARF and 89±10 in SERI (p=0.07). Conclusions: Both SCARF and SERI techniques proved effective in the correction of hallux valgus, however SERI, performed with a shorter skin incision, in less surgical time, fixed with a cheaper device (one Kirschner wire), resulted in a better clinical outcome

Aims: The purpouse of the study is to review a series of hallux valgus treated by minimally invasive distal metatarsal osteotomy with a simple, effective, rapid, inexpensive (SERI) technique. Methods: 54 consecutive feet in 37 patients, aged 48 ± 23 years affected by hallux valgus deformity less than 40û with an intermetatarsal angle up to 20û were reviewed at 5 years follow up. Surgical technique consisted of a 1 cm medial incision at the metatarsal neck, then an osteotomy was performed using an oscillating saw. With a direct line of vision, all characteristics of the deformity (HVA, IMA, DMAA) were corrected by lateral displacement of the metatarsal head; contemporary plantar or dorsal displacement was performed according to insufþciency or overloading of the þrst ray. The osteotomy was stabilized by a 2 mm Kirschner wire. All patients were clinically (AOFAS score) and radiographically checked at an average follow up of 5 years. Results: The clinical score at follow up was (91±12). The pre-op hallux valgus angle was 32.5±9, while post-op it was 22±7 (p< 0.0001), pre-op inter-metatarsal angle was 13±3, while post op it was 9±3 (p< 0.0001), the pre-op distal metatarsal articular angle was 19±10, while post-op it was 9±7 (p< 0.0001). Conclusions: Clinical and radiographic þndings showed that SERI osteotomy permitted an adequate correction of all the pathologic characteristics of the deformity, and this factor is responsible for our satisfactory results

Purpose: We compare the accuracy and precision of patient-specific plastic guides versus computer-assisted navigation for distal radius osteotomy (DRO). We hypothesize that guides would provide similar accuracy and precision compared to computer-assisted surgery, and that they would be faster to use than navigated surgery. Method: We used CT scans, computer models, and planned corrections of radii from seven patients who had previously received computer-assisted DRO. The planned correction included the locations and directions of the screw holes for the fixation plate on the intact deformed radius. Using computer-assisted technique, the surgeon drills the holes for the fixation plate using computer navigation before performing the osteotomy; after cutting the radius, the plate is fixated to the distal radius, and the distal radius is distracted until the holes in the proximal radius align with the holes of the fixation plate. A patient-specific guide can be manufactured that fits on the intact deformed radius to guide the drilling of the screw holes. The guide is designed so that it mates exactly with the dorsal surface of the radius. Each guide was designed using custom software and manufactured in ABS plastic using a 3D printer. The surgeon places the guide on the radius and uses a metal drill sleeve in each guide hole to guide the drilling of the plate screw holes. We manufactured urethane plastic phantoms of the seven deformed radii. Our laboratory experiment had six surgeons each perform four computer-assisted and four patient-specific guide procedures on the phantom radii; the specimen and type of guidance were randomly chosen. The time from the start of the procedure to when the shaping of the distal radius was completed was recorded; we did not record the time required to cut and fixate the radius because this time does not depend on the type of guidance used. The plated phantoms were assessed for errors in ulnar variance, radial inclination, and volar tilt as compared to the planned correction. Results: The results for the computer-assisted procedures were: ulnar variance error (−0.2 +/ − 2.0 mm), radial inclination error (−0.9 +/ − 6.1 deg), volar tilt error (−0.9 +/ − 1.9 deg). The results for the customized jig procedures were: ulnar variance error (−0.7 +/ − 0.6 mm), radial inclination error (−1.0 +/ − 1.4 deg), volar tilt error (−0.4 +/ − 2.2 deg). There were no significant differences detected in the means of the measurements (significance level 0.05) using the two-sample t-test. Significant differences were detected in the variances of the ulnar variance and radial inclination errors (significance level 0.05) using Levene’s test. It took (705 +/ − 144 sec) to perform the computer-assisted procedures and (214 +/ − 98 sec) to perform the customized guide procedures. The differences between the means and variances were statistically significant. Conclusion: Patient-specific guides are as accurate, more precise, and require less time than computer-assisted navigation for DRO

Purpose: The purpose of this clinical trial was to investigate the accuracy of a novel method for computer-assisted distal radius osteotomy, in which computer-generated patient-specific plastic guides were used for intra-operative guidance. Our hypothesis was that these guides combine the accuracy and precision of computer-assisted techniques with the ease of use of mechanical guides. Method: In a consecutive series of 9 patients we tested the accuracy of the proposed method. Prior to surgery, CT scans were obtained of both radii and ulnae in neutral rotation. Three-dimensional virtual models for both the affected and unaffected radius and ulna were created. The models of the unaffected radius and ulna were reflected to serve as a template for the correction. Custom-made software was used to plan the correction. The locations of the distal and proximal drill holes for the plate were saved and the locations of the distal holes before the osteotomy were determined. The design of a patient-specific instrument guide was calculated, into which a mirror image of intra-operative accessible bone structure of the distal radius was integrated. This allowed for unique positioning of the guide intra-operatively. For each planned drill location a guidance hole was incorporated into the guide. A plastic model of the guide was created using a rapid prototyping machine. Intra-operatively, a conventional incision was made and the guide was positioned on the distal end of the radius. The surgeon drilled the holes for the plate screws into the intact radius. The guide was removed and the surgeon performed the osteotomy using the conventional technique and shaved the bone from the distal radius fragment to accommodate the plate. Using the pre-drilled holes the plate was affixed to the distal radius fragment. The distal fragment was reduced until the proximal screw holes in the plate aligned with the pilot holes in the bone. To analyze the accuracy of the intra-operative procedure we compared the post-operative alignment of the radius with the planned alignment. A lateral and an A/P digitally reconstructed radiograph (DRR) of the plan were calculated. These DRRs were used to evaluate the radial inclination, the volar tilt and the ulnar variance of the planned alignment. Post-operative lateral and A/P X-Rays were used to determine the same three post-operative radiographic indices. The post-operative values were compared with the planned values. Results: We found an average deviation for the radial inclination of 0.5°(StDev 1.8), for the volar tilt of 0.7°(StDev 2.3), and for the ulnar variance of 0.8mm (StDev 1.9). Conclusion: These results show that the computer-generated instrument guides accurately achieved the planned alignment. The guides were easy to integrate into the surgical workflow and eliminated the need for intra-operative fluoroscopy for guidance of the procedure

INTRODUCTION: Distal metatarsal osteotomies have been described for surgical treatment of hallux valgus with good results. The aim of this study is to review the results of our first 1000 consecutive hallux valgus cases treated by minimally invasive distal metatarsal osteotomy, SERI (Simple Effective Rapid Inexpensive). MATERIAL AND METHODS: 1000 feet in 641 patients (359 bilateral), aged between 20 and 65 years (mean 49) affected by hallux valgus without arthritis were studied. Inclusion criteria were deformity less than 40° and intermetatarsal angle up to 18°. A 1-cm medial incision at the metatarsal neck, and a complete osteotomy were performed using an oscillating saw. With the naked eye all characteristics of the deformity were corrected by displacement of the metatarsal head (HVA, IMA, PASA, dorsal or plantar displacement). The osteotomy was stabilized by a 2-mm Kirschner wire. Immediate weight bearing was allowed with gauze bandage and talus shoes for 4 weeks. All patients were checked at an average follow-up of 37 months. RESULTS: All osteotomies healed, delayed consolidation was observed in 25 feet. Slight stiffness was observed in 31 feet. Mean AOFAS score was 48+15 pre-op and 89+13 at follow up. The pre-op HVA was 32+8, while at follow-up it was 18+8 (p< 0.005), pre-op IMA was 14+3, while at follow-up it was 6+4 (p< 0.005), the pre-op PASA was 21+9, while at follow-up was 9+8(p< 0.005). DISCUSSION AND CONCLUSION: SERI osteotomy was simple, effective, rapid and inexpensive in correcting hallux valgus deformity. Clinical and radiographical findings showed an adequate correction of the deformity