Minimally Invasive Plate Osteosynthesis for Management of Minimally Invasive Bunion Nonunion

Introduction Minimally invasive bunion surgery (MIBS) has become increasingly popular, demonstrating outcomes comparable to open hallux valgus correction. Although complications such as recurrence, hardware irritation, and infection are reported, nonunion remains rare, occurring in fewer than 1% of cases. Standard revision typically involves an open approach with hardware removal, bone grafting, and plating, which compromises the advantages of minimally invasive techniques. Purpose This case report presents the surgical technique for a MIBS symptomatic nonunion reconstruction utilizing the MIPO technique. Case Report This report presents the case of a 25-year-old female with symptomatic nonunion following fourth-generation MIBS. At 6 months postoperatively, the patient reported persistent pain despite appropriate postoperative management. Imaging demonstrated maintained alignment and intact hardware, with computed tomography confirming the absence of osseous union. After failed conservative treatment, revision surgery was performed using a minimally invasive plate osteosynthesis (MIPO) technique. Surgical Technique Revision involved partial hardware removal, percutaneous re-drilling of the osteotomy, and augmentation with autologous cancellous bone graft, bone marrow aspirate, and recombinant human bone morphogenetic protein-2. A low-profile mini-fragment plate was inserted percutaneously and secured with a combination of locking and non-locking screws. Postoperatively, the patient progressed through staged weightbearing and returned to full activity with minimal pain. Radiographs confirmed complete osseous union and stable fixation. Conclusion Nonunion following MIBS surgery is rare, and treatment options commonly involve open revision surgery. This surgical technique describes a minimally invasive revision option utilizing the MIPO technique.