Scarf osteotomy without screw fixation

Abstract

The scarf osteotomy is now well recognised as reliable and effective to contribute to the correction of the majority of hallux valgus. The challenge remains for the correction of severe deformities with metatarsus varus angle >18° and Distal Metatarsal Articular Angle (DMAA) >15°. In order to significantly improve in 3D the metatarsal head displacements, our scarf design became more oblique, shorter and if necessary a medial wedge removal from the plantar fragment was done to supinate the head. And gradually, with the amount of the horizontal translation, there was no space left for any screw. A bone cerclage with an absorbable suture in order to obtain distally a constrained fixation, and proximally an impacted autologus bone grafting (distal wedge of the dorsal M1 fragment) have been done. The immediate weight-bearing ambulation allowed with always a sole of total contact cast for two weeks (only this method is able to decrease the weight on the foot <20 Mpa), followed by post-operative shoe wearing for a month, have not been changed. The M1P1 angle, the M1M2 angle and the DMAA angle had been measured after bone fusion on a weight-bearing dorsoplantar X-ray, on the different series of moderate and severe hallux valgus. Results: For the two screws series (1993–1995) 49 cases: M1P1 = 12.67° +−7.22°, M1M2 = 7.93° +− 2.61°, DMAA = 13.5° =− 4.5°. For the one screw series (1996–1998) 37 cases: M1P1 =13.11°+− 6.67°, M1M2 = 7.44°=−2.51°, DMAA= 6.89°+−4.27°. For the “no screw series” (since 1999) 33 cases: M1P1 = 7.07° +− 4.84°, M1M2 = 6.51° +− 2.36°, DMAA = 7° +− 3.8°. It appears that the correction is better without screw fixation, especially for M1P1 and M1M2 angles.