Technique for Preventing Troughing in Scarf Osteotomy

Comparative effects of modified rotary scarf osteotomy and traditional scarf osteotomy in treating moderate to severe hallux valgus: a retrospective cohort study

BACKGROUND

Traditional Scarf osteotomy (TSO) is an effective procedure with a good record in moderate to severe hallux valgus (MSHV) surgery. In order to overcome shortcomings of TSO, Modified Rotary Scarf osteotomy (MRSO) was introduced in this study, which aimed to compare the clinical and radiological outcome in the patients treated with MRSO or TSO.

METHODS

Of 175 patients (247 feet) with MSHV, 100 patients (138 feet) treated with MRSO and 75 patients (109 feet) treated with TSO were evaluated according to relevant indicators in twenty-four months follow-up. Pre-surgical and post-surgical HVA, IMA, DMAA, MTP-1 ROM, sesamoid grade and AOFAS (American Orthopaedic Foot and Ankle Society) scores and postsurgical complications were evaluated.

RESULTS

Both groups manifested similar baseline characters. The mean follow-up was of 25.9 (range, 22-37) months. Significantly lower IMA, lower Sesamoid grade and higher DMAA at six months, twelve months and twenty-four months post-surgically had been showed in MRSO group compared to TSO group. There was no significant difference in HVA, MTP-1 ROM and AOFAS data at each follow-up time point post-surgically between the two groups. No major complications occurred in either group.

CONCLUSION

MRSO showed comparable results to TSO, and improved IMA and sesamoid grade to a greater extent, with a lower probability of throughing effect. Although DMAA could be increased by MRSO, MRSO could still be a reproducible, non-dangerous and efficacious alternative procedure for treating HV patients which do not have severe DMAA.

A Technique to Correct Troughing in a Z-Osteotomy for Hallux Valgus Correction

A Z-osteotomy is a commonly performed procedure to correct mild-moderate hallux valgus. It is an effective procedure with high patient satisfaction rates. However, it is not without its challenges. One of the most frequently encountered issues during a Z-osteotomy is troughing of the first metatarsal. We present a simple surgical technique to correct troughing if it is encountered without the need for additional soft tissue or bony procedures.

Complications after Metatarsal Osteotomies for Hallux Valgus: Malunion, Nonunion, Avascular Necrosis, and Metatarsophalangeal Osteoarthritis

Avascular necrosis (AVN), nonunion, malunion, and metatarsophalangeal (MTP) osteoarthritis following hallux valgus osteotomies, as well as pathophysiology, diagnosis, prevention strategies, and treatment are discussed in this article. AVN and nonunion are very infrequent, and they can be effectively prevented taking into consideration local anatomy preservation, biomechanics, and patient comorbidities. Shortening, elevation, plantarflexion, varus/valgus, and rotational of the first metatarsal are the most common types of malunion. They can lead to pain, stiffness, deformity recurrence, and transfer metatarsalgia. MTP osteoarthritis can develop after metatarsal malunion or AVN. Treatment options include cheilectomy, osteotomies to correct malunions, and MTP arthrodesis.

Hallux Valgus Correction With Rotational Scarf Combined With Adductor Hallucis Tendon Transposition

Hallux valgus affects 23% of people older than 40 years, and there are hundreds of methods dealing with this pathology, which have their advantages and disadvantages. The aim of the present prospective cohort study was to report our experience in treating the patients with hallux valgus and to perform a comparative analysis of the outcomes of the innovative and standard methods of surgical correction. Data on 78 patients (113 feet) with hallux valgus operated on between March 2010 and December 2015 using either an innovative method, which included rotational scarf osteotomy with bone fragment impaction and adductor hallucis tendon reinsertion, or the classical scarf osteotomy were analyzed. X-ray examination was performed preoperatively and 3 and 36 months after the procedure. A comparative analysis of the outcomes between the groups was carried out. No significant difference in mean radiographic data (p > .05) was found between these 2 groups preoperatively and 3 months after surgery. Nevertheless, the mean intermetatarsal angle 36 months after surgery in standard and innovative groups was 9.7 ± 0.7° and 9.0 ± 0.8° (p < .01) and the mean metatarsophalangeal angle 13.6 ± 0.9° and 13.2 ± 1.1° (p = .01), respectively. The innovative method of surgical correction of hallux valgus was seen to produce improved radiographic results.