J Korean Orthop Assoc.  2018 Oct;53(5):415-420. 10.4055/jkoa.2018.53.5.415.

Rotational Long Scarf Osteotomy on Hallux Valgus in Elderly Patients with Osteoporosis

• Nam IH
• Kim DG
• Lee YH
• Lee DH
• Choi YD
• Lee HH

• KMID: 2424100
• DOI: http://doi.org/10.4055/jkoa.2018.53.5.415

Abstract

PURPOSE
This paper reports an experience of rotational long scarf osteotomy for elderly patients with a hallux valgus deformity.
MATERIALS AND METHODS
From January 2005 to July 2014, 37 cases in 24 patients over 70 years of age, who received rotational long scarf osteotomy for hallux valgus and were followed-up for at least 3 years, were evaluated. The bone mineral density (BMD) was checked in all cases preoperatively. The mean age at surgery was 73.9 years old. The mean follow-up period was 5.1 years. The plantar head fragment was rotated medially to correct the distal metatarsal articular angle (DMAA) and to cross the two cortices to form an "X" shape to prevent troughing. In the operating room, the DMAA was measured before and after rotation of the plantar head fragment. The hallux valgus angle, 1st intermetatarsal angle, range of motion of the first metatarsophalangeal (MTP) joint and American Orthopedic Foot and Ankle Society (AOFAS) score were measured both preoperatively and in the final follow-up. In addition, stress fractures were checked in the routine follow-ups.
RESULTS
The average T-score of the preoperative BMD was −3.54. The mean DMAA measured in the operation room was corrected from 24.8° to 6.7°. The 1st intermetatarsal angle was corrected from 17.6° to 6.2° and hallux valgus angle was corrected 36.7° to 6.5°. The average range of motion of the first MTP joint was improved from 37.4° preoperatively to 64.3° in the final follow-up, and the average AOFAS scores were improved from 56.4 preoperatively to 89.2 at the final follow-up. No troughing was observed in any of the patients. In 3 cases, screw fixation failure made an additional screw necessary to obtain stability between the two fragments. No stress fractures were observed at the follow-up.
CONCLUSION
The rotational long scarf osteotomy produced the effect of a DMAA correction. The rotational long scarf osteotomy might correct the DMAA and improve the clinical score in elderly hallux valgus patients.

Keyword

hallux valgus; osteoporosis; rotational long scarf osteotomy

MeSH Terms

Aged*
Ankle
Bone Density
Congenital Abnormalities
Follow-Up Studies
Foot
Fractures, Stress
Hallux Valgus*
Hallux*
Head
Humans
Joints
Metatarsal Bones
Operating Rooms
Orthopedics
Osteoporosis*
Osteotomy*
Range of Motion, Articular

Figure

• 

  Figure 1 Consecutive methods of lateral translation and medial (internal) rotation of plantar head fragment. (A) After scarf osteotomy. (B) Lateral translation of the plantar head fragment. (C) Medial (internal) rotation of the plantar head fragment with an X shaped cross of the two cortices.

• 

  Figure 2 Measured distal metatarsal articular angle. (A) Before the scarf osteotomy. (B) After medial rotation of the plantar head fragment using a scarf osteotomy.

• 

  Figure 3 (A) Preoperative radiography showed hallux valgus feet with severe osteoporosis. (B) Additional screw fixation was needed at the distal part of the metatarsal bone due to a loss of fixation stability.

Reference

1. Park HW, Kim SJ. Treatment results of hallux valgus deformity by parallel-shaped modified scarf osteotomy. J Korean Foot Ankle Soc. 2012; 16:123–127.

2. Jones S, Al Hussainy HA, Ali F, Betts RP, Flowers MJ. Scarf osteotomy for hallux valgus. A prospective clinical and pedobarographic study. J Bone Joint Surg Br. 2004; 86:830–836.

3. Jeong BO, Lee SH. Treatment for hallux valgus with chevron metatarsal osteotomy in patients over 60 years old. J Korean Foot Ankle Soc. 2012; 16:223–228.

4. Smith AM, Alwan T, Davies MS. Perioperative complications of the Scarf osteotomy. Foot Ankle Int. 2003; 24:222–227.

5. Coetzee JC. Scarf osteotomy for hallux valgus repair: the dark side. Foot Ankle Int. 2003; 24:29–33.

6. Coughlin MJ. Hallux valgus. J Bone Joint Surg Am. 1996; 78:932–966.

7. Burutaran JM. Hallux valgus y cortedad anatomica del primer metatarsano (correction quinrusica). Actual Med Chir Pied XIII. 1976; 261–266.

8. Zygmunt KH, Gudas CJ, Laros GS. Z-bunionectomy with internal screw fixation. J Am Podiatr Med Assoc. 1989; 79:322–329.

9. Weil LS. Scarf osteotomy for correction of hallux valgus. Historical perspective, surgical technique, and results. Foot Ankle Clin. 2000; 5:559–580.

10. Barouk LS. Forefoot reconstruction. 2nd ed. Paris: Springer;2005. p. 44–48.

11. Barouk P, Vioreanu M, Barouk LS. The short scarf 1st metatarsal osteotomy. In : Bentley G, editor. European surgical orthopaedics and traumatology. Berlin: Springer;2014. p. 3433–3450.

12. Zünd T, Rippstein P. The scarf osteotomy for the correction of hallux valgus. Orthop Traumatol. 2001; 9:101–112.

13. Nam IH, Ahn GY, Moon GH, et al. Complications of scarf osteotomy for hallux valgus. J Korean Foot Ankle Soc. 2014; 18:178–182.

14. O'Kane C, Kilmartin TE. The rotation Scarf and Akin osteotomy for the correction of severe hallux valgus. The Foot. 2002; 12:203–212.

15. Kilmartin TE, O'Kane C. Combined rotation scarf and Akin osteotomies for hallux valgus: a patient focussed 9 year follow up of 50 patients. J Foot Ankle Res. 2010; 3:2.

16. Duke HF. Rotational scarf (Z) osteotomy bunionectomy for correction of high intermetatarsal angles. J Am Podiatr Med Assoc. 1992; 82:352–360.

17. Murawski CD, Egan CJ, Kennedy JG. A rotational scarf osteotomy decreases troughing when treating hallux valgus. Clin Orthop Relat Res. 2011; 469:847–853.

18. Larholt J, Kilmartin TE. Rotational scarf and akin osteotomy for correction of hallux valgus associated with metatarsus adductus. Foot Ankle Int. 2010; 31:220–228.