Background: Fluoroscopy has become essential in orthopedic surgery, particularly with the rise of minimally invasive surgery (MIS) techniques. Despite its advantages, it raises concerns about radiation exposure to both patients and surgical staff. This study evaluated fluoroscopy time and radiation dose associated with open versus MIS bunion correction, comparing the modified Lapidus procedure (open) and the MIS distal transverse osteotomy. Additionally, we compared these procedures to historical controls of common orthopedic surgeries to understand relative exposure risk. It was hypothesized that MIS procedures would be associated with increased radiation exposure and fluoroscopy time however compared to historically controls, both procedures would be significantly less.

Methods: A retrospective review was conducted for patients who underwent a bunion correction between January 2021 and June 2025 by one of two fellowship-trained foot and ankle surgeons at a single academic institution. A total of 294 patients met inclusion criteria. Of these, 258 patients underwent a MIS distal transverse osteotomy and 36 underwent a modified Lapidus procedure. Fluoroscopy time (minutes) and radiation dose (mGy) were compared between groups. Historical controls utilized were intramedullary tibial nailing and distal radius plating.

Results: A mean fluoroscopy time of 2.13±1.27 (range, 0.06-7.05) minutes and radiation dose of 2.02±1.30 (range, 0.05-7.52) mGy was observed in the MIS distal transverse osteotomy cohort. An average fluoroscopy time of 1.63±1.83 (range, 0.08-7.70) minutes and a radiation dose of 1.31±1.43 (range, 0.07-5.98) mGy was observed in the modified Lapidus cohort. There was no significant difference in fluoroscopy time (p=0.123), but the MIS group demonstrated a higher radiation dose (p=0.007). Compared to other orthopedic procedures, the MIS cohort showed significantly lower radiation doses than intramedullary tibial nailing, which requires an average dose of 137.00±111.00 (range, 41.00-378.00) mGy (p=<0.001) and distal radius plating, which requires an average dose of 17.00±10.00 (range, 3.30-26.00) mGy (p=0.007).

Conclusion: MIS distal transverse osteotomies result in higher radiation exposure than open modified Lapidus procedures, though both remain substantially below levels seen in other orthopedic surgeries. Despite MIS distal transverse osteotomies generating an average radiation dose of 2.02 mGy per case, surgeons receive only 0.50% of the dose; thus, nearly 1,980 procedures would be required to exceed the 20.00 mGy annual occupational limit. Over a 30 year career, performing 50 such cases annually would increase lifetime cancer risk by 0.075%. These findings suggest that concerns about radiation exposure should not deter providers from performing MIS distal transverse osteotomies for bunion correction.