Short scarf osteotomy for hallux valgus medium term results

Transcription

1 E Poster presentation Short scarf osteotomy for hallux valgus medium term results 1. Rajesh Rachha - MBBS, DIP(ORTHO), MRCS, FEBOT, FRCS (Tr&Orth) 2. Saqib Javed - BSc, MBBS, MRCS 3. Cezary Kocialkowski - BSc, MBBS, MRCS 4. Rakesh Dalal, MS, FRCS (Tr & Orth) Dept. of Trauma & Orthopaedics

2 Disclosure and conflict of interest Title: Short scarf osteotomy for hallux valgus medium term results Rajesh Rachha My disclosure is in the final AOFAS Program Book. I have no potential conflicts with this presentation.

3 Introduction The scarf osteotomy as described by Barouk is a universal procedure for moderate and severe hallux valgus. The technique requires extensive exposure, fixation and increased operative time. We present a short scarf osteotomy (SSO), which retains all the cuts but requires a reduced exposure, less metalwork, less operating time and is more economical. Early to medium term results indicate excellent clinical and radiological outcomes with minimal complications. Standard Scarf Red line represents the SSO

4 Methods 53 patients and 60 feet were included in the study. There were 5 males and 48 females. Age range was with an average age of 59. Minimum follow-up was 12 months. Standardised pre-operative and post-operative radiographs were taken. Intra-operative parameters used were length of surgical incision, length of bone exposure, fixation used and operating time.

5 Methods Radiological assessment of films measuring sesamoid coverage intraoperatively and at final follow up was made Patient satisfaction was performed by questionnaire and review of post-operative clinical notes.

6 Surgical technique 50mm incision Z shaped cut fashioned after cheilectomy SSO displaced laterally and temporary k-wire SSO fixed with headless compression screw

7 Results 53 patients, 60 feet 5 males:48 females Age range: with average age of 59 Mean length of osteotomy was 26 mm (20-36) Mean length of incision was 47 mm (42-56) 2 SSO s fixed with k wires (because of poor fixation achieved with screw in porotic bone)

8 Results Mean operating time was 24 minutes (20-34 mins) Outcome rated as good to excellent by 48 patients All cases demonstrated radiographical union by 3 months Significantly improved sesamoid coverage was achieved in all but 1 case 3 mild overcorrections overzealous lateral release Further surgery not required 2 superficial infections Rx with antibiotics only 1 prominent metalwork removed at 6 months 2 persistent pain, due to pre existing OA No AVN of the distal fragment, no perioperative fractures No recurrence of deformity

9 Discussion and Conclusions We strongly recommend this osteotomy and believe that it offers: Good to excellent results in most cases of hallux valgus surgery Cost effective due to shorter operating time and lesser metalwork; improved theatre efficiency Reduced morbidity decreased swelling and post-operative pain with better cosmesis Biologically the decreased exposure should improve healing and reduce the risk of stiffness Over 95% of cases suitable for a standard Scarf are possible with this technique Inherent stability is good Relatively easy learning curve Contraindications are severe osteoporosis, previous failed surgery with scarring and severe deformity

10 References 1. Louis Samuel Barouk. Forefoot reconstruction, 2 nd edition, Springer-Verlag France, Paris, Simon E. Smith et al. Scarf versus Chevron Osteotomy for the Correction of 1 2 Intermetatarsal Angle in Hallux Valgus: A Systematic Review and Meta-analysis ;Journal of Foot and Ankle Surgery. vol 51,issue 4, Pg , July De Vil JJ et al. Scarf osteotomy for hallux valgus deformity: a prospective study with 8 years of clinical and radiologic follow-up J Am Podiatr Med Assoc Jan-Feb;100(1): Borrelli AH, Weil LS. Modified Scarf Bunionectomy : Our Experience in More Than 1,000 Cases. J. Foot Surg. (1991);30, Dereymaeker G. Scarf Osteotomy for Correction of Hallux Valgus. Surgical Technique and Results as Compared to Distal Chevron Osteotomy. Foot Ankle Cli. 5, 3 : (2000). Review. 1. Crevoisier X, Mouhsine E, Ortolano V, Udin B, Dutoit M. The Scarf Osteotomy for the Treatment of Hallux Valgus Deformity : A review of 84 Cases. Foot Ankle Int. 22 : (2001).