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. 2024 Sep 23;13(18):5628.
doi: 10.3390/jcm13185628.

Allograft Screws as Fixation of the Scarf Osteotomy

Kevin Döring  1 , Sebastian Apprich  1 , Markus Hanna  1 , Reinhard Windhager  1 , Stephan Puchner  1
Affiliations

Allograft Screws as Fixation of the Scarf Osteotomy

Kevin Döring et al. J Clin Med. .

Abstract

Background: In comparison to titanium screws, novel cortical bone allograft screws may come with advantages in osseointegration and with avoidance of potential material removal surgery after scarf osteotomy. Methods: A scarf osteotomy with allograft bone screws as fixation was performed in 21 patients (30 feet). Clinical and radiological parameters were prospectively collected until one year after surgery. A retrospective control group, consisting of 75 patients (82 feet) after scarf osteotomy using headless compression screws, was used to compare clinical outcomes. Results: After fixation with allograft bone screws, the mean preoperative AOFAS score increased from 51.5 points preoperatively to 93.5 points one year after surgery. In radiological assessments, a continuous osseointegration with the remodeling of the bone screw was observed in all patients that finished follow-up. However, four metatarsal fractures occurred early postoperatively after fixation using allograft bone screws. There were only three material removal surgeries in patients treated with headless compression screws. Conclusions: Allograft bone screws display a safe fixation and are a biological alternative for scarf osteotomy. Enough distance between the screw and the proximal osteotomy should be ensured to avoid fractures.

Keywords: allograft bone screw; headless compression screw; scarf osteotomy.

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Conflict of interest statement

One of the authors (RW) receives consulting fees from Johnson&Johnson Medical Limited (New Brunswick, NJ, USA) and consulting fees from Stryker European Operations Limited (Amsterdam, NL, EU). K.D., S.A., M.H. and S.P. confirm that there are no conflicts of interest associated with this publication, and there has been no financial support for this work that could have influenced its outcome.

Figures

Figure 1
Figure 1
Patient inclusion chart for the retrospective control group. Eighty-two scarf surgeries for hallux valgus between 2017 and 2022 were included for retrospective assessment.
Figure 2
Figure 2
Surgical standard procedure (A) soft-tissue and capsule release (B) metatarsal-bone osteotomy (C) reposition with a clamp and K-wires (D) allograft screw implantation (E) screw-head removal on bone level (F) surgical result (G) wound closure.
Figure 3
Figure 3
Radiologic pre- and postoperative dorsoplantar imaging with partial remodeling six months after surgery and full remodeling one year after surgery.
Figure 4
Figure 4
Fracture analysis of patients treated with allograft bone screws in scarf surgery. (A) Preoperative dorsoplantar X-ray showing the minimal diaphyseal width (B) postoperative dorsoplantar X-ray showing distance from the proximal screw to the proximal osteotomy (C) preoperative lateral X-ray showing the minimal diaphyseal metatarsal depth (D) postoperative lateral X-ray showing the distance between the proximal plantar osteotomy and the dorsal diaphyseal metatarsal cortical bone.
Figure 5
Figure 5
Radiologic pre- and postoperative imaging displaying a continuous screw integration with a full remodeling and residual sclerosis one year after surgery.
Figure 6
Figure 6
Radiologic imaging of a patient showing a fracture at the level of the proximal osteotomy after a fall two weeks after surgery (arrows). The patient received a white plaster cast for six weeks following the fracture. At six months after index surgery, the fracture was healed, while the allograft-screw-thread blur without osteolysis was a sign of osseointegration and partial remodeling.
Figure 7
Figure 7
Comparison of IMTA angles (y-axis, degrees) between both screw types over time (x-axis; 6W = 6 weeks, 6M = 6 months, 1a = 1 year).
Figure 8
Figure 8
Comparison of HV angles (y-axis, degrees) between both screw types over time (x-axis; 6W = 6 weeks, 6M = 6 months, 1a = 1 year).
See this image and copyright information in PMC

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