Background: Lesser toe metatarsophalangeal (MTP) joint instability is a frequent cause of forefoot pain and may progress to fixed dorsal dislocation. No consensus exists regarding the optimal management of chronic MTP dislocations, and traditional reconstructive techniques such as plantar plate repair or Weil osteotomy remain technically demanding. The purpose of this study was to evaluate the outcomes of percutaneous Kirschner-wire (K-wire) MTP arthrorisis combined with minimally invasive distal metatarsal osteotomy for chronic lesser toe MTP dislocation. Methods: We retrospectively reviewed 48 consecutive patients (57 feet) treated between November 2020 and April 2024 for chronic lesser toe MTP dislocation graded 3 or 4 according to the Borne and Myerson classifications. All patients underwent extensor tenotomy, MTP capsular release, and percutaneous K-wire arthrorisis combined with distal metatarsal minimally invasive osteotomy or distal oblique metatarsal minimally invasive osteotomy. Outcomes included the European Foot and Ankle Society (EFAS) score, the Simple Foot and Ankle Value (SFAV), patient satisfaction, footwear accommodation, radiographic consolidation, residual deformity, and complications. Minimum follow-up was 24 months. Results: At a mean follow-up of 45.1 months (SD 11.6; range, 26-63), the mean EFAS score was 21/24 (SD 4.1) and the mean SFAV was 81% (SD 19%). Return to normal footwear was achieved in 37 patients (77.1%), and 45 patients (93.8%) reported they would undergo the same procedure again. Osteotomy consolidation was confirmed in 56 feet (98.2%). Residual dislocation occurred in 3 feet (5.3%). No floating toe and no transfer metatarsalgia were observed. Complications included 1 wound complication (1.8%), 3 superficial infections (5.3%), 1 complex regional pain syndrome (1.8%), and 19 postoperative stiffness (39.6%). Conclusion: Percutaneous K-wire MTP arthrorisis combined with minimally invasive distal metatarsal osteotomy was associated with reliable stabilization of chronic lesser toe MTP dislocation, with high satisfaction and no floating toe at nearly 4 years’ follow-up in 57 feet. Level of Evidence: Level IV, retrospective case series.
Background: Monitored anesthesia care (MAC) combined with regional anesthetic techniques is commonly used for open reduction and internal fixation (ORIF) of unstable ankle fractures. When compared to general anesthesia (GA), MAC with regional anesthesia has been associated with reduced systemic adverse effects and shorter recovery times, although regional anesthesia carries additional costs and potential complications of its own. A new technique involving the infiltration of high-volume, low-concentration (VL) local anesthetic was therefore developed. When used in conjunction with MAC, we refer to this technique as MAC-VL. This study evaluates outcomes and recovery metrics following outpatient ankle ORIF performed under GA vs MAC-VL without regional anesthesia. Methods: An IRB-approved retrospective cohort study was conducted including 159 adults who underwent outpatient ankle ORIF between February 1, 2023, and January 31, 2026. Patients were identified using standardized diagnostic and procedural codes and grouped according to anesthesia type. All patients received a standardized injection of local anesthetic around the proposed operative sites before the procedure; anesthesia type was MAC (n = 48) or GA (n = 111). The primary outcome was time to discharge, defined as the interval from incision closed to hospital discharge. Secondary outcomes were considered exploratory and included tourniquet, operative, anesthesia time, time in room, Post Anesthesia Care Unit length of stay, conversion from MAC to GA, reported postoperative nausea and vomiting, admissions, and postoperative emergency department visits. Results: Among 160 procedures for which no significant difference in case mix could be detected with the numbers available, MAC-VL was associated with a significantly shorter time to discharge—reducing discharge time by 55.2 minutes ( P < .001) following adjustment for demographic, clinical, and operative covariates—and shortened total anesthesia and operating room time compared with GA. With the numbers available, no significant difference was detected for the remaining secondary outcomes. Conclusion: The MAC-VL protocol was associated with shorter operating room and recovery times and may improve health care resource use. Level of Evidence: Level III, retrospective cohort study.
