Comparing Transverse vs. Chevron MIS Osteotomies

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My name is Brian Loder. I am DPM in northeast Michigan area, just northeast of Detroit. I've been here for approximately 30 years. I did my residency at St. John Hospital in Harrison Township. I currently am the medical director of the residency program here at Henry Ford and I also will starting a fellowship in Auburn on minimally invasive foot and ankle surgery.
 
Has the literature provided any guidance on the superiority of transverse vs. chevron MIS osteotomies?
 
The purpose of this research was because there was a void in this technique. There's a lot of discussion on the podium with presentations on whether a transverse or chevron osteotomy is more beneficial. After hearing these discussions and arguing back and forth from each side, I decided to run this randomized study to finally prove to individuals whether there was or wasn't a difference. So far this is the first publication that puts these two different osteotomies head-to-head.
 
We did not track the sesamoid position on this study. We did hallux valgus angles and IM angles only because a lot of MIS surgeons agree on the fact that the sesamoid position is not the ultimate decision maker, although rotation can be corrected with both osteotomies, the study proves, and therefore the IM and hallux valgus angle is corrected. We've left the sesamoid position out because we didn't think it was as important.
 
What should surgeons know about the key differences between the techniques?
 
I think the most important thing that we can get out of this literature is the outcomes are comparable when doing 100 or 80% to 100% shift of the osteotomy. The nuance has changed a little bit when your shift is less than 100%. You can't get as much rotation at the metatarsal head with the chevron when the shift is less than 80%. So I would recommend in such where the shift is gonna be less than 80% that you go ahead and do a transverse osteotomy, but when you do 100% shift, a transverse or chevron will work just as well.
 
It should be noted that when you use a chevron, your screws have to be above the plantar cut in order for you to get as much fixation as possible. So also we recommend maybe for novice surgeons whose wires are not exactly parallel and down the center of the metatarsal, sticking with the transverse osteotomy, we'll have a little bit better outcome.