[Scarf osteotomy for the treatment of hallux valgus deformity. Achievements and complications]

Abstract

Purpose of the study: To present the authors' own experience with Scarf osteotomy in a group of patients treated by this technique in their institution since 2004, together with emphasis on the aspects leading to successful outcome as well as to potential complications.

Material: Between May 2004 and January 2008, 70 operations were performed in 60 patients, 50 women and 10 men, with an average age of 56 years.The use of an appropriate surgical technique was decided on the basis of the IMA angle, as seen on an anteroposterior load radiograph of the forefoot. Scarf osteotomy was indicated when the angle was 12 to 20 degrees. There were 21 Scarf osteotomy procedures, 14 Scarf/Akin osteotomies and 35 operations combined with procedures on other rays.

Methods: Pre-operative evaluation included HVA and IMA angles and the AOFAS score. Tourniquet-induced ischaemia was used and surgery was completed with lateral release of the soft tissues of the first metatarsophalangeal (MTP) joint. Osteotomy was always carried out extra-articularly, carefully avoiding damage to the vascular supply of the metatarsal head. It was fixed with original Barouk screws. At regular follow-ups, the radiographic findings, AOFAS score and patient's satisfaction with surgical outcome were assessed.

Results: The average follow-up was 26 months. The pre-operative values decreased from 37 to 15 degrees for the average HVA and from 18 to 8 degrees for the average IMA at 2 years after surgery. The average pre-operative AOFAS score of 48 increased to 91 points at 2 years post-operatively. At 6 months after surgery, the outcome was subjectively evaluated as excellent or good by 66 patients (94 %). One rapid progression of first MTP arthritis and one second metatarsal stress fracture were recorded. Two operative wounds showed prolonged healing. A first metatarsal stress fracture in the proximal part of osteotomy occurred in two cases, one of which required further surgery. DISCUSSION Our results are in full agreement with the published data, including the frequency and types of complications.These are, as indicated by both literature reports and our experience, most often due to an incorrect operative technique. This is true, in the first place, for fractures at the site of osteotomy as a result of an insufficiently tilted or a too short longitudinal cut of osteotomy, or wrongly applied fixation.

Conclusions: Scarf osteotomy is a reliable and effective method for hallux valgus treatment. It provides excellent primary stability and permits good IMA correction up to 20 degrees. However, perfect management of the operative technique is a prerequisite for minimising the risk of serious post-operative complications.