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.
ABSTRACT Purpose: to describe the profile of specialization courses in the field of Orofacial Motricity in Brazil. Methods: an exploratory descriptive study conducted between 2024 and 2025. Data were collected from the e-MEC Platform, filtering for "active" courses in the field of Orofacial Motricity. The analyzed variables included institution type (private or public), teaching modality (distance or in-person), course nomenclature, total, theoretical, and practical workload (for in-person courses), course duration, and geographic distribution. Descriptive analysis was performed using Jamovi software (version 2.3.28). Results: a total of 46 courses was identified, of which 14 (30.43%) were active and offered by institutions. Most courses were provided by private institutions (n=13; 92.86%) and through distance learning (n=8; 57.14%). In-person courses were mainly concentrated in the Northeast region (n=3; 50%). "Orofacial Motricity" was the most commonly used course title (n=6; 42.9%). The average total workload was 544 hours, higher for distance-learning courses (μ: 579 hours) than in-person courses (μ: 497 hours). Course duration ranged from 4 to 25 months (μ: 13.7 months). Conclusion: the study highlighted variations in course availability, modality, workload, and inconsistencies in course nomenclature, emphasizing the need for standardization and transparency.
In this technical report, we describe an intracortical “inside-out” technique for percutaneous medial exostectomy performed as a final step during modern minimally invasive hallux valgus correction. Contemporary third-generation minimally invasive Chevron-Akin (MICA/PECA) and fourth-generation metaphyseal extra-articular transverse constructs (META) provide powerful multiplanar correction with rigid fixation. However, residual medial bony prominence following distal fragment translation may persist and contribute to postoperative medial irritation. Traditional percutaneous exostectomy is commonly performed in an outside-in fashion and may increase the risk of capsular trauma or inadvertent articular injury when performed close to the first metatarsophalangeal (MTP) joint. Our technique uses the same 2.0-2.2 mm Shannon burr employed for the metatarsal osteotomy, introduced intraosseously through a minimal cortical entry. The medial prominence is progressively resected from cancellous bone toward the medial cortex under fluoroscopic and tactile guidance, while maintaining an outward safety vector away from the articular surface. We hypothesize that this approach provides a reproducible method to contour residual medial prominence while preserving medial capsuloligamentous structures.
RESUMO Objetivo: descrever o perfil dos cursos de especialização na área de Motricidade Orofacial no Brasil. Métodos: estudo descritivo exploratório, conduzido entre 2024 e 2025. Os dados foram coletados na Plataforma e-MEC, com filtro para cursos "ativos" na área de Motricidade Orofacial. Foram analisados: tipo de instituição (privada ou pública), modalidade de ensino (a distância ou presencial), nomenclatura do curso, carga horária total, teórica e prática para cursos presenciais, duração do curso e distribuição geográfica. A análise descritiva foi realizada utilizando o software Jamovi (versão 2.3.28). Resultados: foram identificados 46 cursos, sendo 14 (30,43%) ativos e em oferta pelas instituições. A maioria dos cursos estão em instituições privadas (n=13; 92,86%) e na modalidade a distância (n=8; 57,14%). Os cursos presenciais estão concentrados em sua maior parte na região Nordeste (n=3; 50%). A nomenclatura “Motricidade Orofacial” foi a mais utilizada (n=6; 42,9%). A carga horária média é de 544 horas, maior nos cursos a distância (μ: 579 horas) do que nos presenciais (μ: 497 horas). O tempo de duração varia de 4 a 25 meses (μ: 13,7 meses). Conclusão: o estudo destacou variações na oferta, modalidade, carga horária e fragmentação na nomenclatura dos cursos, reforçando a necessidade de padronização e transparência.
Study Design: Cross-sectional comparative imaging study. Objectives: To evaluate magnetic resonance imaging–based positional changes in anatomical structures relevant to lateral lumbar interbody fusion (LLIF) in prone, right lateral decubitus, and left lateral decubitus positions, and to assess implications for surgical corridor optimization and safety in single-position surgery. Methods: Twenty-eight patients underwent lumbar spine magnetic resonance imaging in three different decubitus positions. Quantitative measurements included lumbar plexus position, vascular proximity, peritoneal content area, viable surgical corridor, and segmental and global lumbar lordosis. Positional differences were analyzed using generalized estimating equations with robust and jackknife variance estimation to account for repeated within-patient measurements. Multiple comparisons were adjusted using a false discovery rate method. Results: Prone positioning produced consistent posterior displacement of the lumbar plexus, most notably at L3–L4 and L4–L5, resulting in a significantly larger viable surgical corridor from L2–L5 compared with both lateral decubitus positions. Although iliac vessel position varied according to side of decubitus, prone positioning preserved acceptable vascular clearance while increasing corridor availability. Peritoneal content area adjacent to the surgical approach was significantly greater in the prone position across lumbar levels, whereas lateral decubitus positions demonstrated smaller peritoneal volumes. L1-S1 lordosis and proximal lordosis from L1–L4 were significantly greater in prone position, increasing by approximately 8.1° and 4.6°. Conclusions: Patient positioning substantially modifies anatomical relationships relevant to LLIF. Prone positioning may improve surgical corridor availability, lumbar plexus clearance, and sagittal alignment, whereas lateral decubitus may reduce peritoneal content along the retroperitoneal pathway.
