Minimally Invasive Corrective Osteotomy (MICO) of the Hand a Novel Technique

Abstract

Introduction: Patients facing post-traumatic malunion or congenital hand differences often contend with functional and cosmetic issues. Traditional correction methods involve open osteotomy, marked by drawbacks like scarring, non-union risks, prolonged rehabilitation, and adhesions. We therefore introduce a novel minimally invasive technique called Minimally Invasive Corrective Osteotomy of the Hand (MICO), which can be performed under local anesthesia. MICO employs a low-speed, high-torque burr to address finger malunions and congenital anomalies.

Case report: A 49-year-old male patient, generally healthy and right hand dominant, presented with a post-traumatic left middle finger, middle phalanx malunion who underwent the MICO procedure, with a 1-year post-operative follow-up.

Conclusion: Our findings suggest that MICO offers a straightforward, reproducible, and delicate solution for correcting hand malunions and congenital finger deformities, potentially mitigating the well-established disadvantages and complications associated with the traditional open approach. Although early results of MICO are promising, a larger case series is needed to evaluate the superiority of this technique compared with current open corrective osteotomy methods.Level of Evidence: IV.

Keywords: Osteotomy; finger deformity; minimal invasive surgery.

Figure 1

A pre-operative photograph of the patient’s hand, revealing a left middle finger that is radially deviated at the middle phalanx level.

Figure 2

The osteotomy process using a fine 12 × 2 mm Shannon burr, attached to an electric motor-driven machine with variable speed (NSK Surgic Pro, NSK, IL, USA).

Figure 3

Intraoperative fluoroscopy image after the osteotomy.

Figure 4

Anterior-posterior radiograph displays fixation at the osteotomy site and temporary pinning of the distal interphalangeal joint using retrograde Kirshner wires.

Figure 5

Clinical photographs reveal well-aligned finger positioning, nearly imperceptible scars from the stab incisions and full tip-to-palm flexion of the operated middle finger.