Scarf versus proximal closing wedge osteotomy in hallux valgus treatment

Aim  The aim of this study was to evaluate the distal metatarsal articular angle as a key factor in choosing between the proximal closing wedge osteotomy and scarf osteotomy. Method  The investigation involved 40 feet: 32 females aged 13–68 in whom 24 unilateral and 8 bilateral operations had been performed from 24 to 63 months previously. Results  There were statistically significant differences between groups in the postoperative hallux valgus angle and in first metatarsal shortening. We found an inverse correlation between the preoperative distal metatarsal articular angle and intermetatarsal angle improvement after proximal closing wedge osteotomy and a positive correlation after scarf osteotomy. Conclusion  This study confirmed the value of distal metatarsal articular angle assessment.     

Bunionette deformity corrected with “shortening” scarf osteotomy of the fifth metatarsal: mid-term results of a 34-cases

BackgroundThe aim of this study was to evaluate the clinical and radiological outcomes (in mid-term) after “shortening” scarf osteotomy of the fifth metatarsal for the treatment of bunionette deformity.MethodsWe retrospectively reviewed the functional score — American Orthopaedic Foot and Ankle Society (AOFAS) Lesser Toe Metatarsophalangeal-Interphalangeal Scale, radiographic results — 4th/5th intermetatarsal angle, varus angle of the 5th metatarsophalangeal joint and complications in a consecutive series of 34 feet (27 patients) with bunionette. Nine males and 18 females (mean age: 45 years) were included in the study. Three males and four females were operated bilaterally The patients were operated on between 2004 and 2015, and evaluated during 2017.ResultsThe average AOFAS score improved from 59.4 to 93 at a mean follow-up of 7.2 years. The 4th/5th intermetatarsal angle and varus angle of the 5th metatarsophalangeal joint decreased from 13.9°/19.5° preoperatively to 6°/5.9° at final follow-up. No neurovascular damage was recorded. Complications arose in five feet (14.7%): delayed union (n = 1), early infection (n = 1), distal screw migration (n = 1), asymptomatic non-union (n = 1), transverse metatarsalgia (n = 1). The osteotomy healed within less than three months except twoo (delayed union, non-union). Three feet needed additional surgery: screw removal (n = 2), Weil osteotomy of 2nd–4th metatarsals (n = 1).Conclusions“Shortening” scarf osteotomy is an acceptable, but not complication-free, treatment option for the bunionette deformity and offers promising results in the mid-term.     

不同入路外侧软组织松解在外翻Scarf截骨术中应用效果的研究

目的 探讨Scarf截骨术联合两种不同入路外侧软组织松解术治疗中、重度外翻的临床效果。方法 选取2018年1月至2019年6月中、重度外翻患者30例,随机分为2组,每组15例。A组接受Scarf截骨术,并于同一切口行外侧软组织松解术;B组接受Scarf截骨术,并于第一、二跖趾关节间另行切口行外侧软组织松解手术。比较两组术前,术后6个月的外翻角（HVA）,第一、二跖骨间角（IMA）,AOFAS前足评分及并发症。结果 A、B两组间比较,术前HVA、IMA、AOFAS前足评分差异无统计学意义（P>0.05）。与术前相比,两组患者手术后6个月HVA、IMA、AOFAS前足评分均得到显著改善（P<0.05）,两种手术方法均能有效矫正外翻。两组间比较HVA,IMA,AOFAS前足评分手术前后的变化值差异无统计学意义（P>0.05）。A组发生1例畸形复发,2例足趾轻度麻木的并发症;B组没有出现畸形复发,但出现3例足趾轻度麻木,3例对疤痕不满意的并发症。两组均未出现感染,跖骨头缺血坏死（AVN）的并发症。结论 Scarf截骨术联合两种不同入路外侧软组织松解术均可以有效地治疗中、重度外翻。单一切口手术的患者对手术瘢痕的满意度更高。     

The results of Scarf osteotomy combined with distal soft tissue procedure are mostly satisfactory in surgical management of moderate to severe hallux valgus

Background

Intrinsically stable diaphyseal osteotomy gained popularity in recent years for symptomatic hallux valgus deformities. In this study, Scarf osteotomy results, in surgical management of moderate to severe hallux valgus, are presented.

Outcome of the scarf osteotomy in adolescent hallux valgus

Purpose  We have reported the radiological and clinical outcome of scarf osteotomy in the treatment of moderate to severe hallux valgus among adolescent children. Method  Data were collected retrospectively between April 2001 and June 2006. The pre- and post-operative intermetatarsal angle (IMA), hallux valgus angle (HVA) and distal metatarsal articular angle (DMAA) were determined. Patients were followed up for a mean of 37.6 months. Results  Thirteen patients with 19 operated feet were available at the time of the latest follow-up. There was significant improvement in the mean post-operative IMA, which was maintained to the last follow-up. There was statistically significant improvement in the 6-week post-operative HVA and DMAA. However, this was lost at the final follow-up. The mean American Orthopaedic Foot and Ankle Society score for the whole group was 80 (54–100). Conclusion  This study indicates that scarf osteotomy should be used with caution in symptomatic adolescent hallux valgus, as there is a high recurrence rate.     

Scarf联合Akin手术治疗拇外翻的疗效

目的 探究Scarf联合Akin手术治疗对拇外翻的疗效、骨代谢水平及术后并发症的影响。方法 选取2018年4月~2020年2月四川大学华西医院就诊的拇外翻患者104例（150足）,采用随机数字表法将其分为观察组（52例,73足）和对照组（52例,77足）。对照组给予Chevron联合Akin截骨术治疗,观察组给予Scarf联合Akin截骨术治疗,并对两组患者追踪随访。比较两组患者术前及术后12个月的疼痛情况（视觉模拟评分VAS）,血清骨代谢水平［Ⅰ型前胶原氨基端前肽（PINP）、Ⅰ型胶原羧基端肽β特殊序列（β-CTX）、骨钙素（OC）］,行走状况［功能性步行量表（FAC）、Berg平衡量表（BBS）］,影像学指标［拇外翻角（HVA）、第1、2跖骨间夹角（IMA）、远端关节面固有角（DMAA）］变化,治疗效果［美国足踝外科学会足功能评分系统（AOFAS）］。记录两组患者术后并发症发生情况。结果 两组患者术前的VAS评分、BBS评分、AOFAS评分、血清骨代谢指标（PINP、β-CTX、OC）水平、影像学指标（HVA、IMA、DMAA）、疼痛程度、FAC行走能力分级及足功能评价比较,差异无统计学意义（均P>0.05）;术后12个月时,两组患者的VAS评分、血清PINP水平、DMAA值显著低于术前（均P<0.05）,血清β-CTX水平及AOFAS评分显著高于术前（均P<0.05）,疼痛程度评价、FAC行走能力分级、足功能评价较术前显著改善,差异有统计学意义（均P<0.05）,但组间比较差异无统计学意义（均P＞0.05）。两组患者术后12个月时的BBS评分较术前显著提高（P<0.05）,HVA、IMA值较术前显著降低（均P<0.05）,且两组间比较差异有统计学意义（均P<0.05）。两组患者术后拇内翻、跖趾关节活动受限、矫正不足及复发等并发症的发生率比较差异无统计学意义（P>0.05）。结论 Scarf联合Akin截骨术、Chevron联合Akin截骨术对拇外翻患者均有良好的治疗效果,前者在改善HVA、IMA夹角及患者术后平衡能力的效果更佳。     

Footwear modification following hallux valgus surgery: The all-or-none phenomenon

AIM: To define footwear outcomes following hallux valgus surgery, focusing on patient return to comfortable and heeled footwear and patterns of post-operative footwear selection. METHODS: Surgical intervention is indicated for symptomatic cases of hallux valgus unresponsive to conservative methods, with favourable reported outcomes. The return to various types of footwear post-operatively is reflective of the degree of correction achieved, and corresponds to patient satisfaction. Patients are expected to return to comfortable footwear post-operatively without significant residual symptoms. Many female patients will additionally attempt to return to high-heeled, narrow toe box shoes. However, minimal evidence exists to guide their expectations. Sixty-five female hallux valgus patients that had undergone primary surgery between 2011 and 2013 were retrospectively identified using our hospital surgical database. Patients were reviewed using a footwear-specific outcome questionnaire at a mean 18.5 mo follow-up. RESULTS: Eighty-six percent of patients were able to return to comfortable footwear post-operatively with minimal discomfort. Of those intending to resume wearing heeled footwear, 62% were able to do so, with 77% of these patients wearing these as or more frequently than pre-operatively. No significant difference was observed between pre- and post-operative heel size. Mean time to return to heeled footwear was 21.4 wk post-operation. Cosmetic outcomes were very high and did not adversely impact footwear selection. CONCLUSION: We report high rates of return to both comfortable and heeled shoes in female patients following primary hallux valgus surgery. We observed an “all-or-none phenomenon” where patients rejected a return to heeled footwear unless able to tolerate them at the same frequency and heel size as pre-operatively. A minority of patients were unable to return to comfortable footwear post-operatively, which had adverse ramifications on their quality-of-life. We recommend that the importance of managing patient expectations through appropriate pre-operative counselling be emphasized in forefoot surgery.     

Effect of different Scarf osteotomy angles on orthopedic surgery for flat foot北大核心

BACKGROUND: Scarf osteotomy is an effective procedure for correcting the valgus of the flat foot, which is a three-dimensional orthopedic procedure. Whether the angle of the osteotomy will affect the orthopedic strength needs to be studied. OBJECTIVE: To simulate Scarf osteotomy at different angles in 3-matic software, and to analyze the effect of Scarf osteotomy angle on flat foot orthopedics. METHODS: Three-dimensional models of the flat foot on weight-bearing state were imported into 3-matic software to obtain the sketches of the frontal lateral and coronal rear foot. The relevant indexes of flat feet were measured as the flat feet indexes before operation. In the same model, the traditional Evans combined with medial displacement calcaneal osteotomy, as well as different angles of Scarf osteotomy, such as 45°, 60°, 75°, 90°, 105°, 120° were performed. After the osteotomy was completed, the flat foot-related indicators were measured again, and compared with those before the operation. RESULTS AND CONCLUSION: Simple bone surgery had little effect on the talus pitch angle and the talo-first metatarsal angle on lateral side. Evans operation had greater correction of fore foot abduction, while Scarf osteotomy had no significant effect on it. For the effect on the hind foot valgus, Scarf osteotomy showed greater effects than the traditional Evans combined with medial displacement calcaneal osteotomy. The contact area of the osteotomy was larger than that of the traditional one, and decreased gradually with the increase of the angle of Scarf osteotomy. In addition, this study found that perpendicular to the lateral wall of the opposite bone after osteotomy, along the perpendicular to the lateral wall of the external bone can play a part in the role of deepening the arch. © 2023, Publishing House of Chinese Journal of Tissue Engineering Research. All rights reserved.     

Scarf 截骨联合 Akin 截骨可吸收螺钉或金属螺钉固定治疗中重度鰒外翻畸形疗效比较

目的通过临床及影像学评估 Scarf 截骨联合 Akin 截骨治疗中重度ﾙ外翻可吸收螺钉或金属螺钉固定截骨的疗效差异。方法2014 年 3 月—2016 年 5 月，采用 Scarf 截骨联合 Akin 截骨治疗中重度ﾙ外翻患者 62 例（83 足），其中 25 例（35 足）采用可吸收螺钉固定（A 组），37 例（48 足）采用金属螺钉固定（B 组）。两组患者性别、年龄、发病侧别、发病原因、ﾙ外翻严重程度、病程、术前负重正位 X 线片测量的ﾙ外翻角（hallux valgus angle，HVA）和第 1、2 跖骨间角（first-second intermetatarsal angle，1-2IMA）、术前美国矫形足踝协会（AOFAS）评分、疼痛视觉模拟评分（VAS）等一般资料比较，差异均无统计学意义（P>0.05），具有可比性。记录并比较两组患者并发症发生情况和截骨愈合时间；末次随访时采用 AOFAS 评分、VAS 评分以及足负重正位 X 线片测量的 HVA 和 1-2IMA 评价疗效。 结果术后两组患者切口均Ⅰ期愈合，无切口相关并发症发生。两组患者均获随访，A 组随访时间 12～36 个月，平均 24.4 个月；B 组为 14～38 个月，平均 25.7 个月。A 组术后 1 足并发ﾙ内翻，2 足出现轻度ﾙ僵硬，1 足出现转移性跖痛；B 组分别为 2、3、2 足；两组术后均无ﾙ外翻复发；两组患足首次术后并发症发生率比较差异无统计学意义（χ²=0.275，P=0.843）。B 组 89.2%（33 例）患足二次手术取出内固定物，其中 3 例取出时出现螺钉滑丝，1 例发生螺钉断裂；10.8%（4 例）因年龄较大拒绝二次手术取出内固定物。术后 X 线片示两组截骨处均愈合良好，两组愈合时间比较差异无统计学意义（t=1.633，P=0.285）。末次随访时两组患者 AOFAS 评分、VAS 评分及 HVA 和 1-2IMA 均较术前显著改善（P<0.05）；两组间上述指标比较差异均无统计学意义（P>0.05）。 结论Scarf 联合 Akin 截骨治疗中重度ﾙ外翻效果显著，并发症较少；可吸收螺钉固定截骨疗效与金属螺钉固定相当，但避免了二次手术取出内固定物的相关风险。