A randomized comparison of the proximal crescentic osteotomy and rotational scarf osteotomy in the treatment of hallux valgus

Abstract

ObjectivesThe aim of this study was to compare clinical and radiological results of proximal crescentic osteotomy (PCO) and rotational scarf osteotomy performed in the treatment of hallux valgus.MethodsA total of 57 consecutive patients (60 feet) with symptomatic hallux valgus deformity were randomly assigned to one of two groups. The PCO group consisted of 22 women and 5 men (30 feet) and the mean age was 43(±14.5) years. The scarf group consisted of 23 women and 7 men (30 feet) and the mean age was 40.9(±12.6) years. Outcomes were assessed by using of preoperative and postoperative American Orthopaedic Foot and Ankle Society (AOFAS) scores and visual analogue scale (VAS). Weight bearing X-rays were used for radiological evaluation.ResultsThe mean AOFAS scores improved from 42(±16.2) to 66.7(±13.4) points in PCO group and from 36.2(±16.1) to 73.2(±13.5) points in scarf group. The mean pain score improved from 6.3(±1.3) to 2.4(±2) in PCO group and from 6.5(±1.9) to 2.5(±1.3) in scarf group. The mean hallux valgus angle (HVA) decreased from 38.1°(±7.1) preoperatively to 23.8°(±8.5) at postoperative first year in PCO group, and from 36.1°(±7.5) preoperatively to 22.2°(±7.5) at postoperative first year in scarf group. The mean intermetatarsal angle (IMA) decreased from 17.3°(±3.8) preoperatively to 11.8°(±3.3) at postoperative first year in PCO group, and from 16.2°(±2.6) preoperatively to 9.3°(±2.4) at postoperative first year in scarf group.When all the patients were assessed together, the relations between preoperative DMAA values and postoperative first year HVA (r = 0,327) and IMA (r = 0,399) values were positive but had low significance. The HVA and IMA values were increased in both groups at the end of the first year when compared to the postoperative sixth week values (p < 0.01 for both groups for both values).ConclusionThe PCO and the rotational scarf osteotomy in the treatment of hallux valgus deformity provides a satisfactory correction. The clinical and radiological results of both methods are similar. Especially in patients with high preoperative DMAA, an increase in the HVA and the IMA values may occur in the first postoperative year when compared to the postoperative sixth week values.Level of evidenceLevel II, therapeutic study.

Compare the Initial Result of One Screw or Two Screws Fixation for Proximal Crescentic Metatarsal Osteotomy with Distal Soft Tissue Reconstruction in Severe Hallux Valgus Treatment

“…Bene ts of the proximal crescentic osteotomy combined with a distal soft-tissue procedure have been described for the correction of severe hallux valgus in many literatures [12,20]. This technique was popular for correction of hallux valgus associated with metatarsus primus varus in a report [20].…”

“…The open-wedge osteotomy resulted in a slight lengthening of the rst metatarsal (1-2 mm) [27].But only very few prospective randomized researches have been reported to compare two different kinds of techniques of correction for hallux valgus. Sahin et al [12] made a report about the comparison of rotational scarf osteotomy and proximal crescentic osteotomy in correction of the hallux valgus. The proximal crescentic osteotomy and scarf osteotomy combined with the distal soft tissue procedures provided similar satisfactory correction, clinical and radiological results.…”

“…The recurrence rate of complications in Group2 was obviously lower than that of Group1. Adequate internal xation implant was necessary for the rst metatarsal proximal crescentic osteotomy because dorsal angulation has been reported to occur in the range of 28 -82% undergoing this procedure [12,21] . The rate of rst metatarsal dorsal angulation was occurred in 4 feet (13%) in Group1, and no feet was occurred in Group 2.…”

“…After distal soft tissue reconstruction, a proximal crescentic osteotomy about 1cm away from the rst TMT joint. The distal part of the osteotomy was translated and rotated laterally under uoroscopic to reduce the HVA and IMA angle, and the proximal part was translated medially until the desired alignment was achieved{Şahin, 2018 #209} [12]. Provisional xation was carried out with two guide pins.…”

Introduction the revolving scarf osteotomy for treating severe hallux valgus with an increased distal metatarsal articular angle: a retrospective cohort study

“…Our osteotomy method improved the three main radiographic parameters of HV: HVA, IMA, and DMAA. The IMA and HVA are objective parameters for assessing corrections performed in each type of osteotomy [24, 25], while the DMAA is commonly used to quantify articular deformity [34, 35]. The DMAA is one of the most important radiographic angles in HV, and it has been shown that non-correction of DMAA alterations is associated with early recurrence of the deformity, reduced range of motion of the metatarsophalangeal joint, and pain [36–38], and so correcting the increased DMAA is key to a satisfactory surgical outcome.…”