Stryker mobile bus, fly to memphis, or have arthrex fly you to naples
Minimally Invasive Surgery (MIS)
- Thread starter DexterMorganSK
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You can go to the weekend classes for Crossroads (Synthes) labs in TX, FL, etc... other companies, etc for MIS.
If you did met osteotomies, you did "MIS"... just add jig for cut and screws.
That is the whole (main) allure of it: simple surgery, "fast recovery" (forgets Lapidus is fast too).
Year 2035: "Would they benefit from an Austin? Then they didn't benefit from MIS."
If you did met osteotomies, you did "MIS"... just add jig for cut and screws.
That is the whole (main) allure of it: simple surgery, "fast recovery" (forgets Lapidus is fast too).
You'd think so, wouldn't you? 🙂
Year 2035: "Would they benefit from an Austin? Then they didn't benefit from MIS."
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It’s just a percutaneous way of doing distal metatarsal and proximal phalanx work that allows for a greater degree of correction. It’s nothing like Cartiva. It’s similar to lapiplasty in the sense that someone found a better or more consistent/reproducible way to do something that has been around for decades. Feli will tell you about all of the horror stories of non-residency trained DPMs doing these procedures without fluoro or fixation in clinic and make some sort of false equivalency (it’s like clockwork), but you should take your rep up on the offer and see if it’s something you’d like to offer patients. You can always go back to fusing a perfectly healthy joint with an expensive jig and plate construct if you aren’t a fan after training.
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Nah, it's just that I think MIS does nothing different from Scarf, base wedge, crescent base, Austin supershift, etc.
I though it was in this thread, but I guess it's the other one.
For people who are 70 or 80 or whatever and minimally active, MIS (or basically any bunion procedure) probably works.... but I think the docs doing these MIS on 30, 40, 50, etc active pts with moderate/flexible HAV will not look good down the line (just like Austins and base wedge that need later revision/fusion of some type due to recur HAV and/or mpj OA). MIS revisions will be a fair bit harder due to the bigger screws. Time will tell.
Follow up is the undoing of a lot of cool ideas (Brostrom with just suture, TightRope, OBWO, absorb fixation, etc etc).
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Go do the course. Even if you don't like it and don't want to do bunions that way you'll learn something.
I did zero distal osteotomies in residency. I branched out and tried them over the past few years. Some went well, some less so. I thought it would make my life better, but it just made my life different. Then I started doing them MIS. They have their own new issues, but there really is something funny about having post-op visits where there is no incision to manage. It jokingly takes the first 3 weeks of the recovery out of the picture. You start asking yourself questions like why is the patient here and how many visits does someone really need.
I did zero distal osteotomies in residency. I branched out and tried them over the past few years. Some went well, some less so. I thought it would make my life better, but it just made my life different. Then I started doing them MIS. They have their own new issues, but there really is something funny about having post-op visits where there is no incision to manage. It jokingly takes the first 3 weeks of the recovery out of the picture. You start asking yourself questions like why is the patient here and how many visits does someone really need.
D
deleted1162946
Same boat. Barely did any Austin’s in residency but feel like I want mis in the arsenal for distal osteotomies.
I’m going to do the course
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Just gotta get over the initial hurdle of distal osteotomies always looking weird on X-rays but the patient is happy. To this day I still think an immediate post op X-ray or intraop flouro of an Austin looks janky.
There were decades where people fixed bunions without hardware. Proper patient selection goes a long way
There were decades where people fixed bunions without hardware. Proper patient selection goes a long way
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Had some experience in residency but never skin to skin unless it was easy stuff like exostectomy / floating met osteotomies.
Coresident is doing them in their practice- so far good results
Mostly cadaver labs thrown by reps.
Arthrex, Paragon, Stryker
C arm, burr + whatever system, cadaver to get a feel for it.
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Do some courses. Stryker or Arthrex. Or both. Make your reps pay for you to get trained. MIS has been a vital addition to my practice especially when it comes to Charcot reconstructions which I primarily do all MIS at this point in time. I do MIS bunions, hammertoes, calc osteotomies and do elective non diabetic fusions MIS.
What do you all do for bunions in patients with metatarsus adductus? I’ve been telling patients I would have to straighten the mets to fix the bunion which makes it a big surgery and so far it has scared everyone off of doing it.
For those fixing the mets - are you doing met osteotomy or TMT fusion?
For those fixing the mets - are you doing met osteotomy or TMT fusion?
D
deleted1162946
Have had this issue a lot. Been scared to fix them personally because I never fixed met adductus in residency. Treace has a system and that has been suggested to me….. but just watching the vids it seems more complicated than I’d like
We did one and it was a mess of a case with that Treace system. First one the attending was doing too though and it was a revision case.
Honestly been trying to talk everyone out of bunion surgery unless they have exhausted everything and have had pain for years.
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deleted1162946
I think when possible you just have to do a first MTP arthrodesis on these met adductus cases. I’ve had the bad luck of having 20-35 year olds with severe bunions and met adductus though. I’ve had to refer them out which feels a little shameful
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For met adductus you can still do it MIS. Just MIS lesser metatarsal osteotomies and let them fly laterally. Then do you MIS bunion.
If lesser MIS osteotomies are still not your thing you could just approach it as a midfoot fusion and just take a lateral wedge out of the metatarsal bases and fuse them with staples. Then attack your bunion via MIS.
If lesser MIS osteotomies are still not your thing you could just approach it as a midfoot fusion and just take a lateral wedge out of the metatarsal bases and fuse them with staples. Then attack your bunion via MIS.
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ADDUCTOPLASTY. This is easy. No brainer bro. No reason to be scared of metadductus. And don't listen to Feli. You have to move the lesser Mets to fix the bunion. Honestly it doesn't change your post op. If you want to add an extra week NWB. 1 weeks NWB lapidus but heel ok to transfer. Add an extra week for 2nd/3rd TMT fusion. Fixation is strong.
