PDF
ePub
Citation
Print
Changhoon Jeong, Il-Kyu Park, Jin-Wha Chung
Abstract
Purpose
This study compared the radiographic and clinical outcomes of simultaneous bilateral short scarf osteotomy with those of unilateral short scarf osteotomy in hallux valgus patients.
Materials and Methods
The authors undertook a retrospective chart and radiographic review between January 2015 and June 2017 to identify 15 patients (30 cases, group A) who underwent a simultaneous bilateral short scarf osteotomy. The patients were matched with 30 patients (30 cases, group B) with a unilateral short scarf osteotomy. No significant preoperative differences were observed between the two groups in terms of age, gender, American Orthopaedic Foot and Ankle Society (AOFAS) hallux score, and radiographic parameters. The clinical and radiographic follow-up was carried out at three months and one year.
Results
Hallux valgus angles in groups A and B were reduced from the mean preoperative values of 32.5° and 34.7° to 12.5° and 12.2° at 12 months, respectively. The first-second intermetatarsal angles in groups A and B were also reduced from the mean preoperative values of 14.2° and 16.5° to 7.4° and 7.3° at 12 months, respectively. No significant inter-group differences in radiographic outcomes were observed. After three months, the patients in group A reported significantly worse mean pain and functional scores than group B. The mean AOFAS hallux score was higher in group B at the three-month follow-up, but this difference disappeared at the one-year follow-up.
Figures and Tables
Figure 1
Photographs of short scarf osteotomy shows the longitudinal skin incision was extended approximately 25 mm from the base of the proximal phalanx to the metatarsal shaft and the scarf osteotomy that has short longitudinal cut was marked in line (A), and the distal fragment was translated laterally from 7 mm to 11 mm after completion of the osteotomy (B).
Figure 2
Preoperative (A), postoperative 4-month (B) and postoperative 12-month (C) follow-up weight bearing anteroposterior foot radiographs of 57-year-old female who underwent bilateral synchronous scarf surgery showed decrease of the hallux valgus and the first-second intermetatarsal angles after the surgery.
Table 1
Radiographic Angle Measurements before and after Operation according to Group
Values are presented as mean±standard deviation.
Group A: bilateral, Group B: unilateral, HVA: hallux valgus angle, IMA, intermetatarsal angle.
*The p-values pertain to the comparison between preoperative and follow-up examinations (unpaired, two-tailed Student's t-test). The level of significance was set at p<0.05.
References
1. Coughlin MJ, Jones CP. Hallux valgus: demographics, etiology, and radiographic assessment. Foot Ankle Int. 2007; 28:759–777. DOI: 10.3113/FAI.2007.0759.
2. Young KW, Park YU, Kim JS, Jegal H, Lee KT. Unilateral hallux valgus: is it true unilaterality, or does it progress to bilateral deformity? Foot Ankle Int. 2013; 34:498–503. DOI: 10.1177/1071100712469333.
3. Fridman R, Cain JD, Weil L Jr, Weil LS Sr, Ray TB. Unilateral versus bilateral first ray surgery: a prospective study of 186 consecutive cases-patient satisfaction, cost to society, and complications. Foot Ankle Spec. 2009; 2:123–129. DOI: 10.1177/1938640009335972.
4. Lee KB, Hur CI, Chung JY, Jung ST. Outcome of unilateral versus simultaneous correction for hallux valgus. Foot Ankle Int. 2009; 30:120–123. DOI: 10.3113/FAI.2009.0120.
5. Carvalho P, Viana G, Flora M, Emanuel P, Diniz P. Percutaneous hallux valgus treatment: unilaterally or bilaterally. Foot Ankle Surg. 2016; 22:248–253. DOI: 10.1016/j.fas.2015.11.002.
6. Kristen KH, Berger C, Stelzig S, Thalhammer E, Posch M, Engel A. The SCARF osteotomy for the correction of hallux valgus deformities. Foot Ankle Int. 2002; 23:221–229. DOI: 10.1177/107110070202300306.
7. Aminian A, Kelikian A, Moen T. Scarf osteotomy for hallux valgus deformity: an intermediate followup of clinical and radiographic outcomes. Foot Ankle Int. 2006; 27:883–886. DOI: 10.1177/107110070602701103.
8. Kwon SY, Gil HJ, Chung JW. Short scarf osteotomy for moderate hallux valgus. J Korean Foot Ankle Soc. 2012; 16:235–240.
9. Rajeev A, Tumia N. Three-year follow-up results of combined short scarf osteotomy with Akin procedure for hallux valgus. J Foot Ankle Surg. 2019; 58:837–841. DOI: 10.1053/j.jfas.2018.12.016.
10. Hardy RH, Clapham JC. Observations on hallux valgus; based on a controlled series. J Bone Joint Surg Br. 1951; 33-B:376–391. DOI: 10.1302/0301-620X.33B3.376.
11. Murray O, Holt G, McGrory R, Kay M, Crombie A, Kumar CS. Efficacy of outpatient bilateral simultaneous hallux valgus surgery. Orthopedics. 2010; 33:394. DOI: 10.3928/01477447-20100429-09.
12. Kitaoka HB, Alexander IJ, Adelaar RS, A Nunley J, Myerson MS, Sanders M, et al. Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int. 1997; 18:187–188. DOI: 10.1177/107110079701800315.
13. Bullock DP, Sporer SM, Shirreffs TG Jr. Comparison of simultaneous bilateral with unilateral total knee arthroplasty in terms of perioperative complications. J Bone Joint Surg Am. 2003; 85:1981–1986. DOI: 10.2106/00004623-200310000-00018.
14. Meehan JP, Danielsen B, Tancredi DJ, Kim S, Jamali AA, White RH. A population-based comparison of the incidence of adverse outcomes after simultaneous-bilateral and staged-bilateral total knee arthroplasty. J Bone Joint Surg Am. 2011; 93:2203–2213. DOI: 10.2106/JBJS.J.01350.
15. Odum SM, Springer BD. In-hospital complication rates and associated factors after simultaneous bilateral versus unilateral total knee arthroplasty. J Bone Joint Surg Am. 2014; 96:1058–1065. DOI: 10.2106/JBJS.M.00065.
16. Osei DA, Calfee RP, Stepan JG, Boyer MI, Goldfarb CA, Gelberman RH. Simultaneous bilateral or unilateral carpal tunnel release? A prospective cohort study of early outcomes and limitations. J Bone Joint Surg Am. 2014; 96:889–896. DOI: 10.2106/JBJS.M.00822.
17. Barg A, Knupp M, Hintermann B. Simultaneous bilateral versus unilateral total ankle replacement: a patient-based comparison of pain relief, quality of life and functional outcome. J Bone Joint Surg Br. 2010; 92:1659–1663. DOI: 10.1302/0301-620X.92B12.25204.
XML Download