Bunionectomy Types: Identifying the Non-Bunionectomy Procedure
The Mumford procedure is NOT a type of bunionectomy, as it is actually a procedure for the shoulder (distal clavicle excision) rather than a foot procedure.
Understanding Bunionectomy Procedures
Bunionectomy refers to surgical correction of a bunion (hallux valgus), which is a deformity affecting the first metatarsophalangeal joint. The three other procedures mentioned are all legitimate bunionectomy techniques:
Valid Bunionectomy Types:
Keller Bunionectomy
- Involves resection of the base of the proximal phalanx
- Often used in elderly patients with limited mobility requirements
- May be considered for patients with arthritis of the first MTP joint
Mitchell Bunionectomy
- Distal metatarsal osteotomy with lateral displacement of the head
- Used for moderate bunion deformities
- Includes step-cut osteotomy with lateral displacement and rotation
Silver Bunionectomy
- A type of distal soft tissue procedure
- Addresses the soft tissue components of bunion deformity
- Often combined with other osseous procedures
Other Common Bunionectomy Procedures
Several other bunionectomy techniques are commonly performed:
Chevron Bunionectomy: A V-shaped distal metatarsal osteotomy that improves both intermetatarsal angle (IMA) and hallux valgus angle (HVA) 1
Lapidus Bunionectomy: Fusion of the first tarsometatarsal joint, often with an intermetatarsal screw to increase stability 2
Minimally Invasive Bunion Surgery (MIBS): Newer techniques using fluoroscopic guidance, specialized instrumentation, and procedure-specific hardware 3
Proximal Chevron Osteotomy: Used for moderate to severe bunion deformities, showing improvement in hallux valgus angle by an average of 19 degrees 4
Minimally Invasive Bunionette Correction: Used for fifth metatarsal deformities (tailor's bunion), involving percutaneous osteotomy without internal fixation 5
Clinical Considerations for Bunionectomy Selection
The choice of bunionectomy procedure depends on several factors:
- Severity of deformity (intermetatarsal angle and hallux valgus angle)
- Patient age and activity level
- Presence of arthritis in the first MTP joint
- Surgeon experience and preference
- Patient comorbidities and healing potential
Potential Complications
Bunionectomy procedures can be associated with complications including:
- Recurrence of deformity
- Hallux varus (overcorrection)
- Metatarsalgia
- Delayed union or nonunion of osteotomies
- Avascular necrosis of the metatarsal head
- Nerve injury
- Infection
Key Takeaway
While Keller, Mitchell, and Silver procedures are all valid types of bunionectomy surgeries for correcting hallux valgus deformities, the Mumford procedure is completely unrelated to foot surgery and instead refers to distal clavicle excision in the shoulder.