Chevron Osteotomy of the First Metatarsal Stabilized With an Absorbable Pin : Our 5-year Experience

Background: The potential requirement for hardware removal originally fueled the development of bioabsorbable pins as an alternative to metal screws for fixing osteotomy sites in foot surgery. More recently, the concern regarding the adverse effects of metal implants may provide further grounds for using bioabsorbable rather than metal fixation. Methods: This is a prospective study of 383 consecutive patients (439 feet) who underwent a chevron osteotomy to correct a hallux valgus deformity performed between 2005 and 2010. In the study group of 251 patients (285 feet), the distal metatarsal osteotomy was fixed with a bioabsorbable pin made of poly-L-lactide and poly-DL-lactide (70:30 ratio). In the control group of 132 patients (154 feet), the osteotomy was fixed with a metal screw. The average follow-up was 27 months for the study group and 31 months for the control group. Results: We observed statistically significant improvements in the mean intermetatarsal angle of 6.1 ± 2.7 degrees in the study group and 5.2 ± 1.6 degrees in the control group (P < .001) and in the mean hallux valgus angle of 14.8 ± 4.7 degrees and 15.5 ± 3.7 degrees, respectively (P < .001). The mean ± SD improvement on the American Orthopaedic Foot and Ankle Society 100-point scale was 45 ± 11 points for the study group and 49 ± 15 points for the control (P < .001). Our complication rate was 0.7% for the study group. Conclusion: Our study found that fixation with a bioabsorbable pin was as reliable as fixation with a metal screw and allowed major angular corrections. The bioabsorbable polymer was well tolerated, and the complication rate was low.