One Versus Two Screw Fixation in Minimally Invasive Hallux Valgus Surgery: A Systematic Review
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Le résumé fourni par la source
Minimally invasive surgery (MIS) for hallux valgus has evolved significantly, with ongoing debate about optimal fixation methods. Fourth-generation techniques typically use two metatarsal screws; however, single screw fixation may reduce operative time, radiation exposure, and cost. This systematic review compares clinical outcomes, radiographic results, and complications between one- and two-screw metatarsal fixation in minimally invasive hallux valgus correction. A systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was conducted across MEDLINE, EMBASE, PubMed, and Cochrane databases from inception to March 2025. Studies comparing single versus two screw fixation in minimally invasive hallux valgus surgery were included. Risk of bias was assessed using the Risk Of Bias in Non-randomized Studies of Interventions (ROBINS-I) tool. Primary outcomes included radiographic parameters (Hallux Valgus Angle (HVA), Intermetatarsal Angle (IMA), Distal Metatarsal Articular Angle (DMAA)) and clinical outcomes (American Orthopaedic Foot & Ankle Society Score (AOFAS), Visual Analog Scale (VAS), Manchester-Oxford Foot Questionnaire (MOXFQ)). Secondary outcomes included operative details, complications, and revision surgery rates. Five studies met inclusion criteria: two clinical (n = 153 patients, 162 feet) and three biomechanical studies. Clinical studies showed comparable radiographic correction and patient-reported outcomes between fixation methods. Single screw fixation demonstrated significantly shorter operative time and reduced fluoroscopy exposure. Hardware-related complications requiring removal were higher in two-screw groups (32% vs. 3% in one study; 1.9% vs. 0% in another). Biomechanical studies revealed that single screw fixation may provide insufficient rotational stability, while two-screw configurations demonstrated improved construct stability. Current evidence suggests that single screw fixation may reduce radiation exposure, surgical time, and hardware removal rates, but offers reduced biomechanical stability compared to a two-screw construct in patients undergoing minimally invasive hallux valgus surgery. However, the high risk of bias, limited comparative data, methodological heterogeneity, and relatively short follow-up periods in existing studies preclude definitive conclusions. Current evidence is insufficient to establish definitive recommendations, and fixation strategy should be individualised based on deformity characteristics and patient factors.
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Le contrôle bibliographique ouvert
DOI retrouvé dans Crossref DOI retrouvé ; titre concordant.
- Titre Crossref
- One Versus Two Screw Fixation in Minimally Invasive Hallux Valgus Surgery: A Systematic Review
- Date Crossref
- 27/11/2025
- Éditeur
- Springer Science and Business Media LLC
- Type
- journal-article
Ce recoupement confirme des métadonnées liées au DOI. Il ne confirme ni la méthode ni les conclusions de l’étude, et il ne compte pas comme une seconde source scientifique indépendante.
Où se fait cette recherche
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American Orthopaedic Foot and Ankle Society pays non établi dans la noticeOrganisation à but non lucratif
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Royal National Orthopaedic Hospital NHS Trust Trauma and Orthopaedic Surgery pays non établi dans la noticeÉtablissement de santé
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University College London pays non établi dans la noticeUniversité ou école supérieure
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Mount Sinai Medical Center pays non établi dans la noticeÉtablissement de santé
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University of South Carolina Orthopaedic Surgery pays non établi dans la noticeUniversité ou école supérieure
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Duke University Duke Orthopaedics pays non établi dans la noticeUniversité ou école supérieure
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Duke University Hospital pays non établi dans la noticeÉtablissement de santé
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National University Hospital Orthopaedic Surgery pays non établi dans la noticeÉtablissement de santé
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Gundersen Health System pays non établi dans la noticeÉtablissement de santé
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King's College Hospital NHS Foundation Trust Trauma and Orthopaedics pays non établi dans la noticeÉtablissement de santé
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Foot and Ankle Surgery pays non établi dans la noticeInstitution
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Columbia University Orthopaedic Surgery pays non établi dans la noticeUniversité ou école supérieure
American Orthopaedic Foot and Ankle Society, Trauma and Orthopaedic Surgery — Royal National Orthopaedic Hospital NHS Trust et University College London, avec 9 autres affiliations.
Une affiliation ne permet pas de déduire la nationalité d’un auteur.