12/29/2016    Dieter J Fellner, DPM

The MIS SERI Procedure (Don Peacock, DPM, MS)

Thank you, Dr. Peacock for the additional
information and references, specifically in
regard to the SERI procedure as described and
advocated by Dr. G. LaPorta whose teachings I
follow. This is a hybrid modification for
minimally invasive surgical correction of
bunion deformity with a small medial incision
large enough to accommodate a power saw.

The controversy referred to, with concerns of
stability, is not born out in a series of 64
consecutive feet, by Radwan & Monseur (2012)
Arch Orthop Trauma 132: 1539-1546. The authors
report no case of instability, no osteotomy
non-union, no cases of AVN and no case of
dorsal malunion. Other, lesser complications
are listed.

The SERI procedure, as described by Radwan &
Monseur, can provide for excellent mechanical
stability, in spite of the fact this is
essentially a Hohman osteotomy. The osteotomy
location is well within metaphyseal bone and
the prospective surgeon is cautioned against
too proximal, diaphyseal osteotomy placement.
The diaphyseal osteotomy increases the risk for
poor healing and suboptimal stability. The
diaphyseal osteotomy may allow for greater
inter-fragmentary instability. A closer look at
papers citing this complication is revealing,
for this finding.

A patients is allowed full weight-bearing, with
the customary surgical shoe. Dr. LaPorta, in
his series of 135 cases reports 2 dislocated
capital fragments, 1 non-union and 3 delayed
unions. I find this reassuring, since any
author claiming zero complication will not
provide a credible account for a reader. In our
own, less extensive series of double-digit SERI
bunion operations we report no instability,
malunion or non-union concerns, as yet.

Addressing, briefly, Dr. Shavelson's concerns.
The principles I outlined are, in part, the
product of a wealth of anecdotal experience in
their application over thousands of cases. More
pertinently, this knowledge can be found in the
work of the orthopedic surgeon, Samuel L
Barouk, MD. A well-published, world expert, in
the surgical management of the bunion
deformity. His textbook can be found on Amazon,
for the interested reader, along with multiple
articles in peer reviewed, orthopedic
literature.

Dieter J Fellner, DPM, NY, NY

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