Restoring Sesamoid Position in Scarf Osteotomy: A Learning Curve

Seng, Chusheng; Ho, Derek; Chong, Keen Wai

doi:10.1053/j.jfas.2015.07.001

Cited by 17 publications

(20 citation statements)

References 23 publications

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“…It has been shown that there is a significant relationship between reduction of sesamoids and recurrent deformities. 11,55,65 In the present study, a significant improvement of TSP was achieved because the device permitted the derotation and relocation of the I-MTTH during lateral translation above the sesamoids without performing the LR of the sesamoid complex. During the MIIND technique, surgeons should be meticulous in the correction of IMA and HVA by proper bunionectomy, linear osteotomy, and adequate I-MTTH lateral translation to achieve the optimal balancing of the sesamoid complex.…”

Section: Discussionmentioning

confidence: 54%

Functional and Radiographic Outcomes of Minimally Invasive Intramedullary Nail Device (MIIND) for Moderate to Severe Hallux Valgus

et al. 2020

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Background: This study was aimed at assessing clinical and radiographic outcomes of the Minimally Invasive Intramedullary Nail Device (MIIND) to correct moderate to severe hallux valgus (HV) and the long-term persistence of its effects. Methods: This case series study involved 100 patients, 84 women and 16 men (mean age, 59 years), who underwent the MIIND procedure with a mean follow-up of 97 months. Assessment was performed preoperatively, postoperatively, at 6 and 12 months, and at last follow-up. Clinical outcomes were evaluated with American Orthopaedic Foot & Ankle Society (AOFAS) scores, visual analog scale (VAS), and patient satisfaction. Intermetatarsal angle (IMA), metatarsophalangeal hallux valgus angle (HVA), distal metatarsal articular angle (DMAA), and tibial sesamoid position were assessed. Statistical analysis was performed. Results: The mean AOFAS score improved from 57.9 to 90.5 points, VAS scale was 1.5 ± 2.0, and patients’ satisfaction was 8.7 ± 1.4. The mean correction of the HVA and IMA showed a significant correction; however, the effect of time was not statistically significant on DMAA. Sex ( P = .047), severity ( P = .050), associated procedures ( P = .000), and preoperative angle ( P = .000) showed significant association with HVA correction and its persistence over time. Age was not statistically significant. Complications were 9 cases of superficial wound infection and 6 recurrences. Conclusions: The MIIND technique proved a viable procedure to correct moderate to severe HV with a low rate of complications and recurrence, producing significant correction of most radiographic parameters assessed and their persistence, even at long term. Level of Evidence: Level IV, case series study.

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Section: Discussionmentioning

confidence: 54%

Functional and Radiographic Outcomes of Minimally Invasive Intramedullary Nail Device (MIIND) for Moderate to Severe Hallux Valgus

et al. 2020

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“…7,21,38 Factors linked to hallux valgus recurrence after scarf osteotomy include surgical experience, first ray instability, preoperative joint incongruence, preoperative HVA, preoperative IMA, preoperative distal metatarsal articular angle, incomplete metatarsal head reduction over the sesamoids, and postoperative noncompliance. 7,9,21,24,38,41 The definition of recurrence in the literature is variable, some report it as an HVA greater than 15 degrees and some an HVA greater than 20 degrees. 7,21 In addition, the postoperative time frame reported for a recurrence is also ill defined.…”

Section: Discussionmentioning

confidence: 99%

Pes Planus Deformity and Its Association With Hallux Valgus Recurrence Following Scarf Osteotomy

et al. 2020

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Background: Hallux valgus recurrence is an unsatisfactory complication, with many causes postulated. This study investigated the effect of pes planus on recurrence after scarf osteotomy. Methods: A total of 183 feet were retrospectively reviewed. All patients were treated with a scarf osteotomy and if required Akin osteotomy. We measured preoperative lateral talus first metatarsal angle (T1MA) to study pes planus; an angle of under −4 degrees was considered pes planus. We measured pre and postoperative hallux valgus angle (HVA), intermetatarsal angle (IMA), and sesamoid location. In total 164 feet were suitable for inclusion, with follow-up of at least 6 months (10 males and 154 females, mean age: 52 years). Results: Recurrence frequency (HVA greater than 15 degrees) was 27 feet (16%). Hallux valgus recurrence was not influenced by gender ( P value = .66) or preoperative IMA ( P value = .48). Preoperative HVA greater than 35 degrees was associated with increased frequency of recurrence ( P value = .004). Those with T1MA less than −10 degrees demonstrated progression in HVA and deterioration in sesamoid location up to 6 months postoperatively ( P value = .038). HVA did not progress beyond 6 months. The prevalence of recurrent hallux valgus with normal T1MA was 1%, in T1MA −4 to −10 degrees it was 29% and in T1MA less than −10 degrees it was 47% ( P value <.001). Breaks in T1MA less than −4 degrees were found at the naviculocuneiform joint in 68% of feet in this series. Conclusion: The prevalence of hallux valgus recurrence correlated with the severity of pes planus. Level of Evidence: Level III, retrospective cohort study.

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“…One study identified joint congruity as an outcome predicting factor at least for short-term results [10]. Another publication outlined soft tissue realignment as a predictive factor as well [11].…”

Section: Discussionmentioning

confidence: 99%

“…Most of them and their influence are discussed controversially [8, 9]. Joint congruity and soft tissue realignment have been proven as predictive factors of the outcome [10, 11].…”

Section: Introductionmentioning

confidence: 99%

Outcomes after scarf osteotomy with and without Akin osteotomy a retrospective comparative study

Kaufmann¹,

Hofmann

Ulmer

et al. 2019

J Orthop Surg Res

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Background The scarf osteotomy is a well-established surgical method for correcting a hallux valgus deformity. It is often combined with an Akin osteotomy. However, clear guidelines defining indication criteria are missing. The purpose of this study was to analyze the radiological outcome after scarf osteotomy in dependence of additional Akin osteotomy. Methods This study included 184 patients in whom a hallux valgus deformity was corrected with a scarf osteotomy (group S), and 63 patients in whom an additional Akin osteotomy was performed (group SA). Weight-bearing radiographs were evaluated preoperatively, postoperatively, after 6 weeks, after 3 months and at a follow-up with a mean of 45.4 months. Analysis was made for the following radiological parameters: the intermetatarsal angle (IMA), the hallux valgus angle (HVA), the distal metatarsal articular angle (DMAA), the proximal to distal phalangeal articular angle (PDPAA), and the position of the sesamoids as well as the joint congruity. Results Radiographic recurrence (HVA > 20°) was detected in 1 patient (1.6% of recurrence) in the SA group, and in 27 patients in the S group (14.7% of recurrence) at follow-up. Outcome between the two groups differed significantly showing reduced loss of HVA correction in the SA group ( p < 0.001). The subgroup with a preoperative PDPAA above eight degrees showed significant inferiority of outcome for the S group compared to the SA group. Conclusion Radiological outcome after scarf osteotomy is superior with concomitant Akin osteotomy. A preoperative PDPAA above eight degrees makes additional Akin osteotomy recommendable. Level of evidence Therapeutic, Level III, retrospective comparative series

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Restoring Sesamoid Position in Scarf Osteotomy: A Learning Curve

Cited by 17 publications

References 23 publications

Functional and Radiographic Outcomes of Minimally Invasive Intramedullary Nail Device (MIIND) for Moderate to Severe Hallux Valgus

Functional and Radiographic Outcomes of Minimally Invasive Intramedullary Nail Device (MIIND) for Moderate to Severe Hallux Valgus

Pes Planus Deformity and Its Association With Hallux Valgus Recurrence Following Scarf Osteotomy

Outcomes after scarf osteotomy with and without Akin osteotomy a retrospective comparative study

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