Single- vs. Dual-Screw Fixation of First MTH in MICA for Hallux Valgus Correction: A Retrospective Comparative Case Series

Background: The optimal fixation strategy for hallux valgus correction using the Minimally Invasive Chevron and Akin (MICA) procedure remains debated despite ongoing advances and active discussion at recent international surgical congresses. While du-al-screw fixation is commonly employed to prevent malunion, single-screw fixation may suffice in select cases. Methods: From 2019 to November 2023, a single-surgeon case series was conducted, including 105 patients with mild to moderate HV who had failed nonoperative management and underwent MICA correction. Patients were divided into two groups: Group 1 (n = 49) received single-screw fixation; Group 2 (n = 56) received du-al-screw fixation. Pre- and postoperative weight-bearing radiographs were used to assess hallux valgus angle, intermetatarsal angle, and distal metatarsal articular angle. Postoperative CT scans were obtained when complications were suspected. Outcomes included complication rates, operative time, fluoroscopy duration, and radiation exposure, with clinical follow-up of at least 3 months for all patients. Results: Clinical outcomes were comparable between groups. A significant difference in osteotomy translation was observed between single- and dual-screw cohorts. One case of delayed union occurred in the single-screw group, and one case of delayed union with loss of correction was noted in the dual-screw group. Operative time, fluoroscopy duration, and radiation exposure were significantly lower with single-screw fixation. Conclusions Effective and reproducible correction with low complication rates can be achieved with both fixation methods. Single-screw fixation is generally safe and sufficient for moderate cases, but dual-screw fixation remains mandatory when large osteotomy translation or poor bone quality is present.