The management of non-union following minimally invasive bunion surgery

As the use of minimally invasive surgery (MIS) becomes more prevalent for the correction of hallux valgus deformity, there is increased information on complications following the procedure, including non-union. However, there remains a gap in literature relating to the management of symptomatic non-union following MIS. This retrospective, multicenter study investigates the incidence, risk factors, and outcomes of symptomatic non-union following MIS bunion surgery. Among four orthopedic institutions, 17 cases of symptomatic non-union were identified after MIS bunion surgery between June 2018 and January 2024, representing an estimated prevalence rate of 0.3 %. Risk factors including smoking, Vitamin D deficiency, and comorbidities such as diabetes and Lyme disease were noted in some cases, although no obvious risk factors were found to contribute to the development of non-union after MIS bunion surgery performed using a distal metatarsal osteotomy and proximal phalanx osteotomy. Both open and MIS approaches were employed for revision surgeries, with 67 % performed as open surgeries. 14 of 17 (82 %) non-union cases achieved complete healing following revision surgery, with an average time to union of 11 weeks. This study highlights both open and MIS techniques as preliminary treatment protocols for symptomatic non-union following MIS bunion surgery, providing guidance for surgeons on how to manage this rare, but challenging, complication.