J Korean Foot Ankle Soc.  2014 Dec;18(4):178-182. 10.14193/jkfas.2014.18.4.178.

Complications of Scarf Osteotomy for Hallux Valgus

• Nam IH
• Ahn GY
• Moon GH
• Lee YH
• Choi SP
• Lee TH
• Lee YH

• KMID: 2181638
• DOI: http://doi.org/10.14193/jkfas.2014.18.4.178

Abstract

PURPOSE
The purpose of this study was to evaluate the frequency of troughing and stress fracture, which are the major complications of scarf osteotomy, and to suggest methods to prevent these complications.
MATERIALS AND METHODS
We reviewed 243 cases of 137 patients treated with the scarf osteotomy for hallux valgus from January 2005 to December 2012. The mean follow-up period was 2.8 years. During the scarf osteotomy, a long oblique longitudinal osteotomy was performed in order to decrease the possibility of troughing and stress fracture. Radiographs of lateral view of the foot were obtained and the thicknesses of the first metatarsal base at the sagittal plane were measured and compared.
RESULTS
There was no troughing during fragment translation and screw fixation intraoperatively. Radiographs of lateral view of the foot taken preoperatively and at the last follow-up showed that the mean thickness of the first metatarsal was 22.4 mm preoperatively and 21.6 mm at the last follow-up, with a mean difference of 0.8 mm. And no stress fracture was observed.
CONCLUSION
To prevent troughing and stress fracture, a long oblique longitudinal cut, parallel to the first metatarsal plantar surface, was performed, making both ends of the proximal segment truncated cone-shape, and securing the strong bony strut of the proximal segment. No troughing or stress fracture was experienced with scarf osteotomy.

Keyword

Hallux valgus; Scarf osteotomy; Troughing; Stress fractures

MeSH Terms

Follow-Up Studies
Foot
Fractures, Stress
Hallux Valgus*
Humans
Metatarsal Bones
Osteotomy*

Figure

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  Figure 1. This picture shows longitudinal and transverse cut line in scarf osteotomy. Longitudinal cut is made from proximal plantar to distal dorsal area of the first metatarsal.

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  Figure 2. This is an axial plane image of computed tomography of a left foot taken 1∼2 cm distal to the metatarsal base. Note the angle between the plantar surface of first metatarsal and the plantar surface of foot sole.

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  Figure 3. These pictures show two different longitudinal cut crossing the 1st metatarsal transversally and after translation at 1∼2 cm distal to the metatarsal base. (A) Cut line is parallel to the plantar surface of first metatarsal bone. This direction of cut line makes lateral strut of dorsal fragment wide and strong (double headed arrow, lateral surface). (B) Cut line is not parallel to the plantar surface of 1st metatarsal bone. This cut results in narrow lateral strut and semi-circular dorsal fragment in coronal plane (double headed arrow, lateral surface). (C) During translation of each fragment, there is little chance of troughing, because of its structural character. (D) Also, during translation, the chance of troughing could be increased because of its relatively narrow and semi-circular lateral surface of first metatarsal bone.

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  Figure 4. (A) This is a preoperative lateral radiograph of a right foot before scarf osteotomy. (B) At the last follow-up after scarf osteotomy, there were no remarkable changes in the thickness of first metatarsal.

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