Daniel Sonnewend Proença

Aims: Minimally invasive hallux valgus (HV) correction techniques, including minimally invasive chevron and Akin osteotomy (MICA) and metaphyseal extra-articular transverse and Akin osteotomy (META), offer favourable outcomes but are associated with unpredictable first metatarsal fractures. This study identifies predictive factors for first metatarsal fractures following minimally invasive HV surgery. Methods: This retrospective case-control study analyzed 370 patients (499 feet) who underwent minimally invasive HV correction between November 2017 and August 2024 at a tertiary orthopaedic centre. Cases from the learning curve, revision procedures, and patients lost to follow-up were excluded. Patients were classified according to the presence or absence of a first metatarsal fracture, and logistic regression analysis was conducted to determine the associated risk factors. Results: First metatarsal fractures occurred in 5.4% (27 of 499 feet), with type II fractures being most common (40.7%). On multivariable logistic regression, both older age and simultaneous bilateral surgery were independently associated with fracture. The odds of fracture increased by 8.6% per year of age (OR 1.086 (95% CI 1.032 to 1.150); p = 0.003) and were higher in patients undergoing bilateral versus unilateral surgery (OR 4.02 (95% CI 1.75 to 9.80); p = 0.001). Bone mineral density of the femur and lumbar spine was not associated with fracture risk. Conclusion: Advanced age and bilateral surgery are key predictive factors for first metatarsal fractures following minimally invasive HV correction. Tailoring surgical and postoperative strategies, especially in elderly patients, may help mitigate fracture risk. Further research should explore metatarsal-specific bone density, surgical biomechanics, and younger patient cohorts. Cite this article: Bone Joint J 2026;108-B(3):361–368.

Objective Radiographically evaluate the quality of reduction over six weeks of follow-up in patients with surgically treated deviated acetabular fractures who underwent rehabilitation with immediate loading as tolerated and compare this with the results of the unloaded protocol. Methods We retrospectively evaluated the records of 137 patients with deviated acetabular fractures treated with open reduction and internal fixation. Sixty-six (48.2%) patients underwent postoperative rehabilitation with immediate loading as tolerated, while 71 (51.8%) patients completed rehabilitation using a no-load protocol. The quality of the reduction was assessed radiographically by measuring the fracturing step and gap on radiographs taken immediately after surgery and three and six weeks after surgery. Results Comparing the joint step, group 1 had an average of 0.44 ± 1.4 mm, 0.47 ± 1.5 mm, and 0.51 ± 1.6 mm immediately, three and six weeks after surgery, respectively. Group 2 had a mean step of 0.24 ± 0.8 mm, 0.27 ± 0.9 mm, and 0.37 ± 1.2 mm immediately, three, and six weeks after surgery. No statistically significant differences were observed between the groups. With a joint gap, group 1 had a mean of 1.89 ± 1.7 mm, 2.12 ± 1.8 mm, and 2.36 ± 2.1 mm; and group 2 had a mean of 2.16 ± 2.4 mm, 2.47 ± 2.6 mm, and 2.67 ± 2.8 mm in the immediate postoperative period, three, and six weeks, respectively. There was also no statistical difference between groups in these measurements. Conclusion Immediate loading after surgical treatment of deviated acetabular fracture had no negative impact on radiographic reduction parameters and had similar results to the protocol without weight bearing. Level of evidence III; Therapeutic Retrospective Cohort Study.