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Comparison of 2 Oblique Fifth Metatarsal Osteotomies for the Management of a Bunionette.

BACKGROUND: A bunionette is a painful prominence of the fifth metatarsal head. This study aimed to compare the clinical outcome of 2 corrective osteotomies, namely, the Mau-type and Ludloff-type osteotomies. We report results with regard to correction, healing, complications, and patient-reported outcomes.

METHODS: Thirty-two patients who underwent bunionette corrective surgery from March 2011 to May 2017 were included in the study. All patients had pre- and postoperative radiographs. The pre- and postoperative fourth-fifth intermetatarsal angles (IMAs) and postoperative fifth metatarsal bowing angle were measured. Radiographic union was assessed at 12 weeks. All patients completed the Self-Reported Foot and Ankle Score (SEFAS) questionnaire to assess clinical outcome. Thirty-two patients (43 feet) were available for follow-up and completed the SEFAS score. Twenty-two Mau-type and 21 Ludloff-type osteotomies were performed.

RESULTS: The mean pre- and postoperative IMA for Mau was 10.5 and 4.3 degrees, respectively, and for the Ludloff was 10.2 and 4 degrees, respectively, with no statistically significant difference between the 2 groups. The Mau caused more bowing with a mean of 9.8 degrees as compared to a mean of 3.5 degrees with the Ludloff. No patients in the Mau group reported clinical problems related to the increased bowing. All osteotomies united. The Mau cohort had a mean SEFAS score of 45 and the Ludloff cohort a mean of 46. No feet had fair or poor outcome scores.

CONCLUSION: Patient satisfaction after bunionette correction with an oblique shaft rotational osteotomy was good. Orientation of the osteotomy did not affect outcomes. Postoperative bowing of the fifth metatarsal was greater with the Mau-type osteotomy. Postoperative fifth metatarsal bowing had no negative clinical effects. The trend in our unit has been a preference toward the Mau-type osteotomy as it is perceived to be more stable.

LEVEL OF EVIDENCE: Level III, retrospective comparative series.

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