Surgical complications can happen despite the
best planning and technique. However, my problem
is there are some who portray MIS osteotomies as
some "new" revelation to be delivered to our
patients. This is easy to do since many of the
previous patients who experienced this technique
in the 70-80s are no longer of this world.
Sorry ... "been there and seen that!"
And for your information, at the expense of the
reputation of this field for many years which
took much time to overcome. Having an osteotomy
being non-fixed and allowing weight-bearing
stresses to such site(s) can impede healing,
create the risk of delayed union, mal-unions and
non-unions. They also create higher incidences
of transfer metatarsalgia to adjacent
metatarsals.
Dr. Kobak, you are entitled to your opinion, but
NOT your version of the facts.
1. Higher incidences and complications have
developed as the result of minimal incision
surgical osteotomies that are non-fixed.
Statistically, this has been seen with
malpractice claims by insurance carriers.
A "good" surgeon understands that in a non-
perfect world NOT all patients turn out to be
compliant in their post-operative phases of
treatment. Not all remain non-weight-bearing or
wear their off-loading walkers/surgical shoes
consistently despite our best efforts to provide
post-operative instruction to the patient.
Thereby, a "good" surgeon understands this
potential in the development of post-operative
complications and may be able to anticipate some
problems which may be encountered. Incidences of
osteotomy shifts and dislocation can happen with
osteotomies not being fixed under these post-
operative circumstances by non-compliant
patients.
2. You state that "one should respect others
that have a different opinion based on
collective experience and abilities." Well, I
look at not only podiatric but orthopedic
medical literature regarding the acceptance of
MIS in regard to non-fixation of osteotomies. It
appears that the literature sustaining such
position on the matter is "light." In fact, the
odds are an orthopedist would call this
a "diversion from the standard of care" in a
malpractice case.
3. Some "spin out" this "newly rediscovered
magical technique" to patients as a marketing
gimick that healing is "quicker." An osteotomy
via MIS heals quicker that an open osteotomy
with fixation. Who knew? Who knew that such Laws
of Physics could be "turned on their head?" And
yet, this has not been my experience seeing non-
fixed osteotomies heal "quicker," despite the
arguments by some that there is less periosteal
dissection via MIS that would account for this.
Healing time of an osteotomy or fracture is
dependent on it's immobilization.
4. Your contention that MIS non-fixation of
osteotomies as a "local" standard is somehow
equal to a "national" standard of care is purely
incorrect. The standard of care that IS
nationally recognized and presented in
malpractice cases is that failure to fix an
osteotomy, in this day and age, is a diversion
of the standard of care. You don't have to fix
an osteotomy, but if a complication develops,
one will have a very difficult time securing a
credible defense expert in such case.
John Powell stated it best .... "The only real
mistake is the one from which we learn nothing!"
Gino Scartozzi, DPM, New Hyde Park, NY,
Gsdpm@aol.com
