12/27/2016    Don Peacock, DPM, MS

The MIS SERI Procedure (Dieter J Fellner, DPM)

I agree with all the points made by Dr.
Fellner. I have also performed the SERI
procedure and what I find most desirable about
the procedure is the ability to rotate the
distal fragment in the frontal plane allowing
for better repositioning of the sesamoids.

That being said, I am not fully convinced that
we should position the sesamoids back to proper
placement in all cases. Let me explain. I found
that in some instances trying to reposition the
sesamoids under the metatarsal head resulted in
post-operative sesamoiditis. This is
particularly true with severely malpositioned
sesamoids pre-operatively.

In discussion with other surgeons they have
said that the sesamoids and/or the cristae
can become arthritic and in these cases
placing the sesamoid under the original area
may lead to pain. I am not sure if this is
academically correct but I have seen this in
clinic.

The thought which prevails now is that the
sesamoids actually do not move out of place but
they are positioned in our radiographs
laterally because of the rotation of the
frontal plane deformity seen within the bunion
deformity itself. The SERI procedure allows for
directly addressing this particular issue.
It's hard to say whether or not
radiographically we always have a true
correlation with clinical subjective outcomes
with respect to sesamoid position.

Unfortunately and also sometimes frustratingly,
good subjective outcomes cannot always be
explained. Most bunion procedures when put to
the test of outpatient subjective outcomes fair
pretty well with both the MIS procedures and
the open procedures despite less than perfect
radiographic results in many cases. There may
never be a perfect answer for this dilemma.

I really like Dr. Fellner's post and he makes
very good points from academic standpoint and
he is right on target.

Don Peacock, DPM, MS, Whitesville, NC

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