Comparative study of internal fixation and external fixation after osteotomy of hallux valgus: A protocol for meta-analysis of comparative studies

Hallux valgus (HV) is a common clinical deformity of the forefoot, primarily a deformity of the 1st metatarsophalangeal joint in which the bunion is deflected laterally relative to the 1st metatarsal, often in combination with a medial bunion or pain at the head of the 1st metatarsal. For HV bunions that do not respond to conservative treatment, surgical intervention is required, which generally involves osteotomy of the first metatarsal or the first phalanx. However, the choice of fixation method after osteotomy is controversial. Most scholars choose screws or plates for internal fixation (IF) to achieve strong and reliable fixation, while some experts do not perform IF after osteotomy, but reposition the osteotomized end and perform external fixation (EF) with a figure-of-eight bandage between the 1st and 2nd toes, which has been advocated by some scholars because it requires only local anesthesia and has the characteristics of minimally invasive and no additional material for IF, and has achieved good clinical results. Therefore, it is necessary to compare the choice of IF or EF after HV osteotomy to evaluate whether there is a difference between the 2 and to conduct a meta-analysis to provide a reliable basis for clinical guidance. METHODS: We will search articles in 7 electronic databases including Chinese National Knowledge Infrastructure, Wanfang Data, Chinese Scientific Journals Database, Chinese databases SinoMed, PubMed, Embase, and Cochrane Library databases. All the publications, with no time restrictions, will be searched without any restriction of language and status, the time from the establishment of the database to October 2022. We will apply the risk-of-bias tool of the Cochrane Collaboration for randomized controlled trials to assess the methodological quality. Risk-of-Bias Assessment Tool for Non-randomized Studies was used to evaluate the quality of comparative studies. Statistical analysis will be conducted using RevMan 5.4 software. RESULTS: This systematic review will evaluate the functional outcomes and radiographic results of internal versus EF after HV osteotomy. CONCLUSION: The findings of this study will provide evidence to determine whether IF or external fixation is more effective after HV osteotomy.