Iatrogenic second transfer metatarsalgia and the first metatarsal shortening and elevation after Scarf osteotomy

2021 ◽  
Author(s):  
Jae Wan Suh ◽  
Ho-Seong Jang ◽  
Park Hyun-Woo
Keyword(s):  
First Metatarsal ◽  
Scarf Osteotomy

Comparison of Postoperative Height Changes of the Second Metatarsal Among 3 Osteotomy Methods for Hallux Valgus Deformity Correction

2016 ◽  
Vol 38 (1) ◽  
pp. 20-26 ◽  
Author(s):  
Jun Young Choi ◽  
Yu Min Suh ◽  
Ji Woong Yeom ◽  
Jin Soo Suh
Keyword(s):  
Hallux Valgus ◽  
Deformity Correction ◽  
Metatarsal Head ◽  
Valgus Deformity ◽  
Metatarsal Osteotomy ◽  
Level Of Evidence ◽  
First Metatarsal ◽  
Scarf Osteotomy ◽  
Hallux Valgus Deformity ◽  
Second Metatarsal

Background: We aimed to compare the postoperative height of the second metatarsal head relative to the first metatarsal head using axial radiographs among 3 different commonly used osteotomy techniques: proximal chevron metatarsal osteotomy (PCMO), scarf osteotomy, and distal chevron metatarsal osteotomy (DCMO). Methods: We retrospectively reviewed the radiographs and clinical findings of the patients with painful callosities under the second metatarsal head, complicated by hallux valgus, who underwent isolated PCMO, scarf osteotomy, or DCMO from February 2005 to January 2015. Each osteotomy was performed with 20 degrees of plantar ward obliquity. Along with lateral translation and rotation of the distal fragment to correct the deformity, lowering of the first metatarsal head was made by virtue of the oblique metatarsal osteotomy. Results: Significant postoperative change in the second metatarsal height was observed on axial radiographs in all groups; this value was greatest in the PCMO group (vs scarf: P = .013; vs DCMO: P = .008) but did not significantly differ between the scarf and DCMO groups ( P = .785). The power for second metatarsal height correction was significantly greater in the PCMO group (vs scarf: P = .0005; vs DCMO: P = .0005) but did not significantly differ between the scarf and DCMO groups ( P = .832). Conclusions: Among the 3 osteotomy techniques commonly used to correct hallux valgus deformity, we observed that PCMO yielded the most effective height change of the second metatarsal head. Level of Evidence: Level III, retrospective comparative series.

Pes Planus Deformity and Its Association With Hallux Valgus Recurrence Following Scarf Osteotomy

2020 ◽  
Vol 41 (10) ◽  
pp. 1212-1218
Author(s):  
Gavin John Heyes ◽  
Amir R. Vosoughi ◽  
Lizzy Weigelt ◽  
Lyndon Mason ◽  
Andrew Molloy
Keyword(s):  
Hallux Valgus ◽  
P Value ◽  
Level Of Evidence ◽  
Pes Planus ◽  
First Metatarsal ◽  
Scarf Osteotomy ◽  
Metatarsal Angle ◽  
Valgus Angle ◽  
Akin Osteotomy

Background: Hallux valgus recurrence is an unsatisfactory complication, with many causes postulated. This study investigated the effect of pes planus on recurrence after scarf osteotomy. Methods: A total of 183 feet were retrospectively reviewed. All patients were treated with a scarf osteotomy and if required Akin osteotomy. We measured preoperative lateral talus first metatarsal angle (T1MA) to study pes planus; an angle of under −4 degrees was considered pes planus. We measured pre and postoperative hallux valgus angle (HVA), intermetatarsal angle (IMA), and sesamoid location. In total 164 feet were suitable for inclusion, with follow-up of at least 6 months (10 males and 154 females, mean age: 52 years). Results: Recurrence frequency (HVA greater than 15 degrees) was 27 feet (16%). Hallux valgus recurrence was not influenced by gender ( P value = .66) or preoperative IMA ( P value = .48). Preoperative HVA greater than 35 degrees was associated with increased frequency of recurrence ( P value = .004). Those with T1MA less than −10 degrees demonstrated progression in HVA and deterioration in sesamoid location up to 6 months postoperatively ( P value = .038). HVA did not progress beyond 6 months. The prevalence of recurrent hallux valgus with normal T1MA was 1%, in T1MA −4 to −10 degrees it was 29% and in T1MA less than −10 degrees it was 47% ( P value <.001). Breaks in T1MA less than −4 degrees were found at the naviculocuneiform joint in 68% of feet in this series. Conclusion: The prevalence of hallux valgus recurrence correlated with the severity of pes planus. Level of Evidence: Level III, retrospective cohort study.

Saw transection of retained compression screws with damaged heads instead of removal in revision first metatarsal osteotomy: a technique tip

2021 ◽  
Vol 14 (1) ◽  
pp. e234868
Author(s):  
Radwane Faroug ◽  
Ali Abbassian
Keyword(s):  
Hallux Valgus ◽  
Significant Loss ◽  
Host Bone ◽  
Metatarsal Osteotomy ◽  
First Metatarsal ◽  
Scarf Osteotomy ◽  
Primary Surgery ◽  
Additional Equipment ◽  
Saw Blade ◽  
The Uk

Distal first metatarsal osteotomy is performed to correct hallux valgus. The surgery is being performed throughout the UK in increasing numbers. The osteotomies used are commonly fixed with one or two variable pitch compression screws. Recurrence of the deformity or inadequate correction in the primary surgery may require revision osteotomy which necessitates removal of previous screws. Revision rates for scarf osteotomy have been reported at 5%. Removal of screws can be challenging as they are often buried in bone and/or the screw heads can get damaged even despite meticulous preparation. Various techniques for removal of damaged screws are described, which require additional equipment and may result in significant loss of the host bone. We describe another technique where a standard Stryker TPS sagittal saw and saw blade (Kalamazoo, USA) are used to cut through the shaft of the compression screws in line with the planned revision osteotomy. We have successfully performed this on two occasions with good results, and describe our experience of using this technique which eliminates the need for complex over drilling procedures often required for removing stripped and retained screws

Restoration and Preservation of First Metatarsal Length Using the Distraction Scarf Osteotomy

2008 ◽  
Vol 47 (2) ◽  
pp. 96-102 ◽  
Author(s):  
Nicholas J. Bevilacqua ◽  
Lee C. Rogers ◽  
James S. Wrobel ◽  
David Z. Shechter
Keyword(s):  
First Metatarsal ◽  
Scarf Osteotomy

scholarly journals Introduction the revolving scarf osteotomy for treating severe hallux valgus with an increased distal metatarsal articular angle: a retrospective cohort study

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Xinwen Wang ◽  
Qian Wen ◽  
Yi Li ◽  
Cheng Liu ◽  
Kai Zhao ◽  
...  
Keyword(s):  
Hallux Valgus ◽  
Avascular Necrosis ◽  
Metatarsal Head ◽  
Foot Deformities ◽  
Metatarsal Osteotomy ◽  
Aofas Score ◽  
First Metatarsal ◽  
Scarf Osteotomy ◽  
Vas Score ◽  
Akin Osteotomy

Abstract Background Hallux valgus(HV) with an increased distal metatarsal articular angle (DMAA) is one of the most common foot deformities among adults. Double metatarsal osteotomy (DMO) is effective in treating severe HV deformity with an increased DMAA. However, this technique presents the risk of avascular necrosis (AVN) of the metatarsal head and transfer metatarsalgia due to shortening of the first metatarsal. The aim of this study was to introduce a surgical procedure defined as revolving scarf osteotomy (RSO) and compare the clinical and radiological results of RSO and DMO performed for treating severe HV with an increased DMAA. Methods First metatarsal osteotomies and Akin osteotomy were performed in 56 patients (62 ft) with severe HV with an increased DMAA in Honghui Hospital from January 2015 to December 2017. RSO was performed in 32 ft and DMO was performed in 30 ft. The Akin osteotomy was performed in both groups. The American Orthopedic Foot and Ankle Society (AOFAS) score, visual analogue scale (VAS) score, the hallux valgus angle (HVA), intermetatarsal angle (IMA), DMAA, and first metatarsal length (FML) and the rates of complications were compared preoperatively and postoperatively in the two groups. Results The mean AOFAS score, VAS score, HVA, IMA, and DMAA showed significant improvements in both groups after surgery, but with no significant differences between the two groups. The postoperative FML was significantly larger in the RSO group than in the DMO group (p < 0.001). One of the 30 ft (3.3%) in the DMO group exhibited transfer metatarsalgia at 12 months postoperatively, while another foot (3.3%) in same group had avascular necrosis of the metatarsal head. One of the 30 ft (3.1%) in the RSO group had hallux varus. Conclusions No differences in the clinical and radiographic results were observed between the two groups with severe HV and an increased DMAA. However, RSO does not cause shortening of the metatarsal and AVN of the metatarsal head. A long-term, randomized, controlled prospective study with a larger sample would provide higher-level evidence for confirming the clinical efficacy and safety of RSO.

Perioperative Complications of the Scarf Osteotomy

2003 ◽  
Vol 24 (3) ◽  
pp. 222-227 ◽  
Author(s):  
Andrew M. Smith ◽  
Tarek Alwan ◽  
Mark S. Davies
Keyword(s):  
Perioperative Complications ◽  
Intraoperative Complications ◽  
Early Experience ◽  
Senior Author ◽  
Case Note ◽  
First Metatarsal ◽  
Scarf Osteotomy ◽  
Surgical Trainees ◽  
Postoperative Stress ◽  
Case Note Review

We reporting the perioperative complications during our early experience using the Scarf osteotomy to correct hallux valgus. A case note review was carried out for the first 100 Scarf osteotomy procedures completed by the senior author. There were six patients (6%) with perioperative complications. Four of these were intraoperative complications including a split first metatarsal in three cases, a shearing of the K-wire in one case and there were two cases of postoperative stress fracture. These complications should be considered by those beginning to master the Scarf osteotomy procedure and by surgeons teaching surgical trainees.

scholarly journals Surgical Reconstruction of Nonunion after Iatrogenic Scarf Osteotomy

2021 ◽  
Vol 18 (11) ◽  
pp. 5620
Author(s):  
Mercedes Ortiz-Romero ◽  
Luke D. Cicchinelli ◽  
Álvaro Fernández-Garzón ◽  
Luis M. Gordillo-Fernández
Keyword(s):  
Surgical Reconstruction ◽  
Fixation Method ◽  
First Metatarsal ◽  
Scarf Osteotomy ◽  
Osteosynthesis Material ◽  
Low Profile ◽  
Ankle Surgery ◽  
Bone Nonunion ◽  
Bone Fragments ◽  
Bone Autograft

We present the case of a young patient, 32 years old, with nonunion in the diaphysis of the first metatarsal after scarf osteotomy for correction of hallux valgus. After removal of the failed osteosynthesis material and preparation of the bone fragments, a calcaneal bone autograft, previously extracted from the patient, was placed in the nonunion area. The new physiological position of the first metatarsal in the three planes was checked intraoperatively, and autograft and fragment fixation was performed using a combination of a low-profile plate with six screws and two interfragmentary screws. The advantage of using an autogenous graft is that it provides corticocancellous bone and great osteogenic capacity with little antigenic capacity. This makes it an excellent option in many situations in foot and ankle surgery. Regarding the fixation method, we used the two most commonly used techniques for osteosynthesis of bone grafts in cases of bone nonunion, combining plates with locking screws and two interfragmentary screws. This provides greater stability of the bone fragments in the three planes and makes it possible to bring forward when the patient starts postsurgical loading.

scholarly journals Proximal fragment intermetatarsal angle (PFIA) increases after SCARF osteotomy

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0039
Author(s):  
Henrique Prudente ◽  
Daniel Baumfeld ◽  
Caio Nery
Keyword(s):  
Hallux Valgus ◽  
Proximal Fragment ◽  
Intermetatarsal Angle ◽  
First Metatarsal ◽  
Scarf Osteotomy ◽  
Varus Displacement ◽  
The Mean ◽  
Degree Of Instability ◽  
Varus Position

Category: Bunion Introduction/Purpose: Instability of the joint between the medial cuneiform and the first metatarsal is considered as one of the progression factors of Hallux valgus and its recurrence in some cases. We believe that we must increase the intermetatarsal angle of the proximal fragment during the correction by the SCARF osteotomy, seeking the greater degree of instability of this joint. Doing that, we can prevent further varus displacement, as we have reached the greater degree of instability. The purpose of this study was to evaluate if the SCARF osteotomy is able to increase the varus position of the base of the first metatarsal. Methods: This is a retrospective study with 32 patients with mild, moderate and severe hallux valgus, who were submitted to surgical treatment by the SCARF technique. All patients were operated by the same surgeon. Anteroposterior radiographs of the loaded foot were analyzed in the pre and postoperative (3 months) moments. We developed two measures to evaluate the position of the base of the first metatarsal: The Proximal Fragment Intermetatarsal Angle (PFIA), and the distance between the lateral cortex of the first metatarsal and the medial cortex of the second metatarsal (3 cm from the base of the first metatarsal). All measurements were made with a virtual ruler on magnified digital images and rounded to the nearest 0.1 mm. A 95% confidence interval was considered for statistical significant results (p<0,05). Results: The mean age of the sample was 44 years, with a predominance of females (62%). The mean pre-operative intermetatarsal angle was 14.9°, while in the postoperative period it was 5.2°, showing that there was correction of the metatarsal positioning. However, the PFIA increased to 17.8° at the post-operative period (p<0,05), showing a greater instability of the first metatarsal cuneiform joint, as the base of the first metatarsal was positioned in a more varus condition. In addition, we observed that there was an increase in the distance between the base of the first metatarsus and the second metatarsus after the surgical procedure, from 13.7 to 16 millimeters (p<0,05). Conclusion: We concluded that the SCARF osteotomy is able to increase the varus position of the base of the first metatarsal, leading to more instability at the first metatarsal cuneiform joint, and, in our opinion, less chance of recurrence in the long-term. A prospective and long-term is needed to prove this statement.

scholarly journals Shortened First Metatarsal Bone and Newly Developed Second Metatarsalgia after Parallel-shaped Modified Scarf Osteotomy for Hallux Valgus Deformity

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0003 ◽  
Author(s):  
Jae Wan Suh ◽  
Ho-Seong Jang ◽  
Hyun-Woo Park ◽  
Sung Bae Park
Keyword(s):  
Propensity Score ◽  
Hallux Valgus ◽  
Valgus Deformity ◽  
Metatarsal Bone ◽  
First Metatarsal ◽  
Scarf Osteotomy ◽  
Hallux Valgus Deformity ◽  
Second Metatarsal ◽  
The Mean

Category: Bunion Introduction/Purpose: The scarf osteotomy has gained in popularity for the treatment of a symptomatic hallux valgus deformity due to its inherent stability, versatility of correction and early mobilization. We have reported parallel-shaped modified scarf osteotomy(PSMSO) with good functional outcomes and no complication as stress fracture or troughing. However, we encountered second transfer metatarsalgia after the osteotomy. The scarf osteotomy can be shortened, but there was no specific amount of shortening that will produce transfer metatarsalgia in limitation of our literature review. In this study, we measured the shortening of first metatarsal length and investigated the relation of first metatarsal length and second transfer metatarsalgia after PSMSO for hallux valgus deformity. Methods: We retrospectively reviewed 168 consecutive PSMSOs performed in 124 patients with hallux valgus deformity between March 2009 and August 2015. Concomitant other pathologies of foot or previous second metatarsalgia were excluded. After excluding 45 cases, 123 cases in 88 patients were included. For clinical assessment, VAS, the AOFAS Hallux Metatarsophalangeal-Interphalangeal (AOFAS Hallux MTP-IP) Scale were obtained. The hallux valgus angle (HVA), the intermetatarsal angle (IMA), the distal metatarsal articular angle (DMAA), the first metatarsal length measured by a modified Davies and Saxby’s method and the protrusion of second metatarsal relative to first metatarsal using the Maestro’s method were assessed on standard weight bearing radiographs of the foot. For evaluation of the development of second transfer metatarsalgia, callosity or tenderness beneath the second metatarsal head was investigated. After identifying the lesion, we divided two groups with and without second transfer metatarsalgia and compared the variables after propensity score matching. Results: Mean follow-up period was 20.6±7.8 (12-66) months. The mean VAS and AOFAS Hallux MTP-IP score improved significantly (p<0.001). Significant corrections in the HVA, IMA and DMAA were obtained and the mean shortening of the first metatarsal length and the mean relative lengthening of second metatarsal protrusion were -3.1±2.5 mm and +2.5±2.8 mm at last follow-up (p<0.001, p<0.001). Eleven (8.9%, 11/123) cases developed second transfer metatarsalgia after PSMSO. After propensity score matching considered baseline characteristics, 9 cases with second transfer metatarsalgia were compared to 31 cases without it. The group with transfer metatarsalgia showed significant shortening in first metatarsal length and lengthening of second metatarsal protrusion relative to first metatarsal compared to those without the transfer lesion (-4.8±3.8 vs -2.0±2.1, p=0.013, +4.2±1.6 vs +1.9±2.1, p=0.005). Conclusion: Transfer metatarsalgia is one of numerous possible complications after scarf osteotomy. To avoid complications, we suggest that shortening of first metatarsal bone length should be minimized within -2 mm and second metatarsal protrusion relative to first metatarsal kept within +1.9 mm with considering the metatarsal parabola. If the shortening of first metatarsal was done over -4.8 mm, the additional procedure for second metatarsal may be considered.

Sign in / Sign up

Export Citation Format

Share Document