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http://www.podiatrytoday.com/guide-percutaneous-bunionectomy

Dr. Noman Siddiqui's article provides a wonderful description of a version of the SERI (Simple, Effective, Rapid, Inexpensive) procedure. I had planned a similar article, but he beat me to the punch.

I first learned about this option from one of my my all time idols, the amazing Dr. LaPorta and his PRESENT lecture. Entitled 'Percutaneous Bunion Correction: are you kidding me?' I fully anticipated an expose to highlight the deficiency of this approach. I could not have been more wrong.

I watched the lectures a few more times. Soon after that I asked my, then, residency director if we can try this out and give it a go. He listened to what I had learned. Blessed with an inquiring, and open mind, he was receptive. In the surgical center, we re-examined our patient and studied again the x-rays. "OK, let's do this", was his response. I talked with our OR tech to know if we have the materials we need. The requirement is modest: A 2mm Steinman pin and the usual equipment, that's it.

There are several variations to the SERI. Our surgery center does not have the MIS bone drill (OSADA, low speed, high torque) and Shannon burr attachment which can be used. No matter, Dr. LaPorta favors a slightly bigger 1.5-2cm medial incision. That way the anatomical structures can be visualized and there is access for the sagittal saw.

The procedure is straightforward and easy to execute for anyone familiar with open bunion surgery. It is entirely extra-capsular. Soft tissue (capsule, ligaments and tendons) is not violated. Once the osteotomy is completed the capital fragment is translated and the construct is stabilized with the pin. The pin does not pass through the joint. This is, in essence a 'simple'- but incredibly versatile, effective in all three planes- Hohman osteotomy. Under different circumstances I would not recommend this inherently unstable osteotomy design. The unique pin stabilization, however, renders the construct surprisingly stable and the patient can be walked immediately after surgery in a surgical show.

Once the operator is familiar with the technique the entire operation is completed in 10-15 minutes. Dr. LaPorta states this can be done in 7 minutes. The indications are wide, provided this is a flexible deformity. The primary indicator for a successful outcome is the hallux valgus angle (surprisingly the IMA is not so important).

Of course, as with any other procedure there are some pearls. The lateral translation that can be achieved is powerful and the novice might be wary and inclined to under-correct.

We carefully followed our first patient. We are encouraged by our success with this surgical option and soon hit double digit patient numbers.

I can recommend the skeptic to take a closer look at SERI. You, and your patients, will not be disappointed.

 

Percutaneous forefoot surgery for treatment of hallux valgus deformity: an intermediate prospective study
Crespo Romero, E., Peñuela Candel, R., Gómez Gómez, S. et al.
Musculoskelet Surg (2017). doi:10.1007/s12306-017-0464-1

 

Thank you for posting this article. There are numerous studies, mostly from Europe showing the opposite to the conclusion drawn from these authors.

Conclusion: not all MIS surgery is alike, not all MIS surgeons are equal.