Effectiveness comparison between Scarf osteotomy combined with Akin osteotomy fixed by absorbable screws and fixed by metal screws for the treatment of moderate to severe hallux valgus_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

CAI Jie ¹ , QU Fufeng ¹ , LIU Peilong ¹ , ZHAO Hongmou ² , WANG Junhu ² , LI Yi ² , ZENG Qiu ² , JI Weina ² ,  LIANG Xiaojun ²

1. Xi’an Medical University, Xi’an Shaanxi, 710068, P.R.China;
2. Department of Foot and Ankle Surgery, Honghui Hospital Affiliated to Medical College of Xi’an Jiaotong University, Xi’an Shaanxi, 710054, P.R.China;

Corresponding author：

LIANG Xiaojun, Email: hhliangxiaojun@163.com

Keywords：

Hallux valgus; Scarf osteotomy; Akin osteotomy; absorbable screw; metal screw; internal fixation

DOI：

10.7507/1002-1892.201805116

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Objective To evaluate the effectiveness of Scarf osteotomy combined with Akin osteotomy in the treatment of moderate to severe hallux valgus with absorbable screws or metal screws fixation by clinical and radiological data. Methods Between March 2014 and May 2016, the Scarf osteotomy combined with Akin osteotomy was used to treat 62 patients (83 feet) with moderate to severe hallux valgus. Twenty-five patients (35 feet) were fixed by absorbable screws (group A) and 37 patients (48 feet) were fixed by metal screws (group B). The difference in gender, age, affected side, etiology, severity, disease duration, preoperative hallux valgus angle (HVA) and first-second intermetatarsal angle (1-2IMA) measured in weight-bearing anteroposterior X-ray film, preoperative American Orthopaedic Foot and Ankle Society (AOFAS) scores and visual analogue scale (VAS) scores between 2 groups (P>0.05). The complications and healing time of 2 groups were recorded and compared. At last follow-up, the AOFAS and VAS scores, and HVA, 1-2IMA measured by weight-bearing anteroposterior X-ray film were used to evaluate the effectiveness. Results All incisions healed by first intention and no incision-related complication occurred in the two groups after operation. Both groups were followed up, the follow-up time in group A was 12-36 months (mean, 24.4 months) and in group B was 14-38 months (mean, 25.7 months). In group A, 1 foot was complicated with hallux varus, 2 feet had mild stiffness, 1 foot appeared metastatic metatarsal pain, and in group B was 2, 3, 2 feet, respectively. There was no recurrence of hallux valgus in both groups. The difference in the incidence of complications between the two groups after the first operation was not significant (χ²=0.275, P=0.843). The removal rate of internal fixator in group B was 89.2% (33 cases) during the second operation, among which 3 cases had screw slip and 1 case had screw fracture. And 10.8% (4 cases) refused the second removal operation due to their age. Postoperative X-ray films showed that both groups had good healing at the osteotomy site, and there was no significant difference in healing time between the two groups (t=1.633, P=0.285). At last follow-up, the AOFAS score, VAS score, HVA, and 1-2IMA were significantly improved in the two groups when compared with preoperative ones (P<0.05); but no significant difference was found between the two groups (P>0.05). Conclusion The effectiveness of Scarf osteotomy combined with Akin osteotomy in the treatment of moderate to severe hallux valgus is significant, with few complications. Compared with being fixed by metal screws, being fixed by absorbable screws has the same effectiveness, but can avoid the risk of second operation to remove the internal fixator.

Citation： CAI Jie, QU Fufeng, LIU Peilong, ZHAO Hongmou, WANG Junhu, LI Yi, ZENG Qiu, JI Weina, LIANG Xiaojun. Effectiveness comparison between Scarf osteotomy combined with Akin osteotomy fixed by absorbable screws and fixed by metal screws for the treatment of moderate to severe hallux valgus. Chinese Journal of Reparative and Reconstructive Surgery, 2018, 32(11): 1386-1391. doi: 10.7507/1002-1892.201805116 Copy

1.	Hardy RH, Clapham JC. Observations on hallux valgus; based on a controlled series. J Bone Joint Surg (Br), 1951, 33-B(3): 376-391.
2.	Okuda R, Kinoshita M, Morikawa J, et al. Distal soft tissue procedure and proximal metatarsal osteotomy in hallux valgus. Clin Orthop Relat Res, 2000, (379): 209-217.
3.	Inman VT. Hallux valgus: a review of etiologic factors. Orthop Clin North Am, 1974, 5(1): 59-66.
4.	Piqué-Vidal C, Solé MT, Antich J. Hallux valgus inheritance: pedigree research in 350 patients with bunion deformity. J Foot Ankle Surg, 2007, 46(3): 149-154.
5.	Torkki M, Malmivaara A, Seitsalo S, et al. Surgery vs orthosis vs watchful waiting for hallux valgus: a randomized controlled trial. JAMA, 2001, 285(19): 2474-2480.
6.	Agrawal Y, Bajaj SK, Flowers MJ. Scarf-Akin osteotomy for hallux valgus in juvenile and adolescent patients. J Pediatr Orthop B, 2015, 24(6): 535-540.
7.	Kerr HL, Jackson R, Kothari P. Scarf-Akin osteotomy correction for hallux valgus: short-term results from a district general hospital. J Foot Ankle Surg, 2010, 49(1): 16-19.
8.	Garrido IM, Rubio ER, Bosch MN, et al. Scarf and Akin osteotomies for moderate and severe hallux valgus: clinical and radiographic results. Foot Ankle Surg, 2008, 14(4): 194-203.
9.	王正义. 足踝外科学. 2 版. 北京: 人民卫生出版社, 2014: 95.
10.	Adam SP, Choung SC, Gu Y, et al. Outcomes after scarf osteotomy for treatment of adult hallux valgus deformity. Clin Orthop Relat Res, 2011, 469(3): 854-859.
11.	Choi JH, Zide JR, Coleman SC, et al. Prospective study of the treatment of adult primary hallux valgus with scarf osteotomy and soft tissue realignment. Foot Ankle Int, 2013, 34(5): 684-690.
12.	Farrar NG, Duncan N, Ahmed N, et al. Scarf osteotomy in the management of symptomatic adolescent hallux valgus. J Child Orthop, 2012, 6(2): 153-157.
13.	Gupta S, Fazal MA, Williams L. Minifragment screw fixation of the Scarf osteotomy. Foot Ankle Int, 2008, 29(4): 385-389.
14.	Barouk LS, Barouk P, Baudet B, et al. The great toe proximal phalanx osteotomy: the final step of the bunionectomy. Foot Ankle Clin, 2005, 10(1): 141-155.
15.	Kristen KH, Berger C, Stelzig S, et al. The SCARF osteotomy for the correction of hallux valgus deformities. Foot Ankle Int, 2002, 23(3): 221-229.
16.	Marudanayagam A, Appan SV. Scarf osteotomy with or without proximal phalangeal osteotomy for severe hallux valgus deformity. J Orthop Surg (Hong Kong), 2014, 22(1): 39-41.
17.	Okuda R, Kinoshita M, Yasuda T, et al. Postoperative incomplete reduction of the sesamoids as a risk factor for recurrence of hallux valgus. J Bone Joint Surg (Am), 2009, 91(7): 1637-1645.
18.	Owens S, Thordarson DB. The adductor hallucis revisited. Foot Ankle Int, 2001, 22(3): 186-191.
19.	Weiler A, Windhagen HJ, Raschke MJ, et al. Biodegradable interference screw fixation exhibits pull-out force and stiffness similar to titanium screws. Am J Sports Med, 1998, 26(1): 119-126.
20.	Werner A, Wild A, Ilg A, et al. Secondary intra-articular dislocation of a broken bioabsorbable interference screw after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc, 2002, 10(1): 30-32.
21.	Plaass C, von Falck C, Ettinger S, et al. Bioabsorbable magnesium versus standard titanium compression screws for fixation of distal metatarsal osteotomies-3 year results of a randomized clinical trial. J Orthop Sci, 2018, 23(2): 321-327.
22.	Kim JS, Cho HK, Young KW, et al. Effectiveness of headless bioabsorbable screws for fixation of the scarf osteotomy. Foot Ankle Int, 2016, 37(11): 1189-1196.
23.	Windhagen H, Radtke K, Weizbauer A, et al. Biodegradable magnesium-based screw clinically equivalent to titanium screw in hallux valgus surgery: short term results of the first prospective, randomized, controlled clinical pilot study. Biomed Eng Online, 2013, 12: 62.
24.	Kilmartin TE, O'Kane C. Combined rotation scarf and Akin osteotomies for hallux valgus: a patient focussed 9 year follow up of 50 patients. J Foot Ankle Res, 2010, 3: 2.
25.	Baravarian B, Ben-Ad R. Revision hallux valgus: causes and correction options. Clin Podiatr Med Surg, 2014, 31(2): 291-298.

1. Hardy RH, Clapham JC. Observations on hallux valgus; based on a controlled series. J Bone Joint Surg (Br), 1951, 33-B(3): 376-391.
2. Okuda R, Kinoshita M, Morikawa J, et al. Distal soft tissue procedure and proximal metatarsal osteotomy in hallux valgus. Clin Orthop Relat Res, 2000, (379): 209-217.
3. Inman VT. Hallux valgus: a review of etiologic factors. Orthop Clin North Am, 1974, 5(1): 59-66.
4. Piqué-Vidal C, Solé MT, Antich J. Hallux valgus inheritance: pedigree research in 350 patients with bunion deformity. J Foot Ankle Surg, 2007, 46(3): 149-154.
5. Torkki M, Malmivaara A, Seitsalo S, et al. Surgery vs orthosis vs watchful waiting for hallux valgus: a randomized controlled trial. JAMA, 2001, 285(19): 2474-2480.
6. Agrawal Y, Bajaj SK, Flowers MJ. Scarf-Akin osteotomy for hallux valgus in juvenile and adolescent patients. J Pediatr Orthop B, 2015, 24(6): 535-540.
7. Kerr HL, Jackson R, Kothari P. Scarf-Akin osteotomy correction for hallux valgus: short-term results from a district general hospital. J Foot Ankle Surg, 2010, 49(1): 16-19.
8. Garrido IM, Rubio ER, Bosch MN, et al. Scarf and Akin osteotomies for moderate and severe hallux valgus: clinical and radiographic results. Foot Ankle Surg, 2008, 14(4): 194-203.
9. 王正义. 足踝外科学. 2 版. 北京: 人民卫生出版社, 2014: 95.
10. Adam SP, Choung SC, Gu Y, et al. Outcomes after scarf osteotomy for treatment of adult hallux valgus deformity. Clin Orthop Relat Res, 2011, 469(3): 854-859.
11. Choi JH, Zide JR, Coleman SC, et al. Prospective study of the treatment of adult primary hallux valgus with scarf osteotomy and soft tissue realignment. Foot Ankle Int, 2013, 34(5): 684-690.
12. Farrar NG, Duncan N, Ahmed N, et al. Scarf osteotomy in the management of symptomatic adolescent hallux valgus. J Child Orthop, 2012, 6(2): 153-157.
13. Gupta S, Fazal MA, Williams L. Minifragment screw fixation of the Scarf osteotomy. Foot Ankle Int, 2008, 29(4): 385-389.
14. Barouk LS, Barouk P, Baudet B, et al. The great toe proximal phalanx osteotomy: the final step of the bunionectomy. Foot Ankle Clin, 2005, 10(1): 141-155.
15. Kristen KH, Berger C, Stelzig S, et al. The SCARF osteotomy for the correction of hallux valgus deformities. Foot Ankle Int, 2002, 23(3): 221-229.
16. Marudanayagam A, Appan SV. Scarf osteotomy with or without proximal phalangeal osteotomy for severe hallux valgus deformity. J Orthop Surg (Hong Kong), 2014, 22(1): 39-41.
17. Okuda R, Kinoshita M, Yasuda T, et al. Postoperative incomplete reduction of the sesamoids as a risk factor for recurrence of hallux valgus. J Bone Joint Surg (Am), 2009, 91(7): 1637-1645.
18. Owens S, Thordarson DB. The adductor hallucis revisited. Foot Ankle Int, 2001, 22(3): 186-191.
19. Weiler A, Windhagen HJ, Raschke MJ, et al. Biodegradable interference screw fixation exhibits pull-out force and stiffness similar to titanium screws. Am J Sports Med, 1998, 26(1): 119-126.
20. Werner A, Wild A, Ilg A, et al. Secondary intra-articular dislocation of a broken bioabsorbable interference screw after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc, 2002, 10(1): 30-32.
21. Plaass C, von Falck C, Ettinger S, et al. Bioabsorbable magnesium versus standard titanium compression screws for fixation of distal metatarsal osteotomies-3 year results of a randomized clinical trial. J Orthop Sci, 2018, 23(2): 321-327.
22. Kim JS, Cho HK, Young KW, et al. Effectiveness of headless bioabsorbable screws for fixation of the scarf osteotomy. Foot Ankle Int, 2016, 37(11): 1189-1196.
23. Windhagen H, Radtke K, Weizbauer A, et al. Biodegradable magnesium-based screw clinically equivalent to titanium screw in hallux valgus surgery: short term results of the first prospective, randomized, controlled clinical pilot study. Biomed Eng Online, 2013, 12: 62.
24. Kilmartin TE, O'Kane C. Combined rotation scarf and Akin osteotomies for hallux valgus: a patient focussed 9 year follow up of 50 patients. J Foot Ankle Res, 2010, 3: 2.
25. Baravarian B, Ben-Ad R. Revision hallux valgus: causes and correction options. Clin Podiatr Med Surg, 2014, 31(2): 291-298.

Chinese Journal of Reparative and Reconstructive Surgery

Effectiveness comparison between Scarf osteotomy combined with Akin osteotomy fixed by absorbable screws and fixed by metal screws for the treatment of moderate to severe hallux valgus

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