The Filament Union Sign: Prevalence and Clinical Outcomes of Incomplete Bone Remodeling Following Percutaneous Hallux Valgus Surgery

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Abstract
Background: Minimally invasive hallux valgus surgery can rarely result in a distinct radiologic finding termed the “Filament Union sign,” characterized by a thin, filamentous bone bridge at the osteotomy site .05. Preoperative hallux valgus angle was significantly associated with filament union (odds ratio 1.08, 95% CI 1.02-1.15, P = .006). All cases in the filament union group achieved bony union, with 1 case of nonunion observed in the nonfilament group. No instances of fracture or metalwork failure were observed in the filament union group. Conclusion: The filament union sign is an uncommon radiographic finding following percutaneous hallux valgus surgery, occurring in 3% of cases. Although its presence was associated with statistically significant decreased functional outcomes, this difference did not meet the threshold for clinical significance and was also not associated with an increased rate of mechanical failure/fracture or revision surgery rate. Further research is needed to fully understand the mechanical and biological factors contributing to this pattern of bone healing.

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