Abstract
Objective: Hypermobility of the first ray can explain the correlation between the instability of this joint and the progression and recurrence of hallux valgus. The modified Scarf osteotomy allows rotation of the distal fragment, in addition to medial traction of the proximal fragment. We believe that if the deformity is corrected by maximizing the instability of the metatarsal-cuneiform joint so that medial inclination of the first metatarsal is no longer possible, then the risk of recurrence in the long term may be lower. Methods: The pre- and postoperative radiographs of 32 modified Scarf osteotomy cases were analysed. We compared already established angles for the radiographic analysis of the deformity, in addition to the creation of two new parameters for the evaluation of the varisation capacity of the osteotomy proximal stump. Results: There was correction of hallux valgus and the intermetatarsal angle, in addition to correction of the first metatarsal head in relation to the sesamoids. We found an increase of the medial inclination of the osteotomy proximal fragment, measured using the parameters proposed by the authors. Conclusion: The modified Scarf osteotomy corrects the conventional hallux valgus parameters, is able to increase the varisation of the proximal fragment of the first metatarsal, and may lead to greater instability in the first metatarsal-cuneiform joint, which, in our opinion, would lead to less chance of recurrence in the medium and long term. Level of Evidence IV; Diagnostic Studies.
Highlights
Aumento do ângulo intermetatársico do fragmento proximal após osteotomia de SCARF modificada: um estudo radiográfico
Objective: Hypermobility of the first ray can explain the correlation between the instability of this joint and the progression and recurrence of hallux valgus
We found an increase of the medial inclination of the osteotomy proximal fragment, measured using the parameters proposed by the authors
Summary
Aumento do ângulo intermetatársico do fragmento proximal após osteotomia de SCARF modificada: um estudo radiográfico. 2. Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil. A osteotomia modificada de SCARF permite uma rotação do fragmento distal, além de uma tração medial do fragmento proximal. Acreditamos que, caso seja feita a correção da deformidade, aumentando ao máximo a instabilidade da articulação metatarso-cuneiforme, de modo que não seja mais possível a inclinação medial do primeiro metatarso, o risco de recidiva no longo prazo poderá ser menor. Conclusão: A osteotomia de SCARF modificada corrige os parâmetros convencionais de valgismo do hálux e é capaz de aumentar o varismo do fragmento proximal do primeiro metatarso, podendo gerar uma maior instabilidade na 1a articulação metatarso-cuneiforme, o que, na nossa opinião, levaria a uma menor chance de recorrência a médio e longo prazo. Descritores: Hálux Valgo; Osteotomia; Ossos do metatarso; Instabilidade articular; Ossos sesamoides
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