title: The SERI distal metatarsal osteotomy and Scarf osteotomy provide similar correction of hallux valgus.
abstract: BACKGROUND
  Ideal surgical treatment for hallux valgus is still controversial. A traditional distal metatarsal osteotomy with rigid fixation (Scarf procedure) and a more minimally invasive approach to a distal metatarsal osteotomy, termed SERI (Simple, Effective, Rapid, Inexpensive), have proven successful with short-term followup. However, no data are available directly comparing the two procedures.
  
  
  OBJECTIVE
  We performed a prospective randomized trial to determine which technique (SERI or Scarf) was associated with (1) better functional outcomes, (2) better radiographic correction, and (3) fewer complications at 2 and 7 years followup.
  
  
  METHODS
  Twenty patients, 53 ± 11 years of age, with bilateral hallux valgus, clinically and radiographically similar, underwent bilateral surgery with Scarf on one side and SERI on the other, at random. Clinical (AOFAS score) and radiographic assessments were considered before surgery, and at 7 years followup.
  
  
  RESULTS
  SERI and Scarf techniques provided correction of the hallux valgus angle, intermetatarsal angle, and distal metatarsal angle in the range of normal. Both led to similar clinically important improvements in the AOFAS. No differences were observed between the groups. All osteotomies healed, and two patients who underwent the Scarf procedure required hardware removal. Reduction of ROM with respect to preoperative was observed in three patients for SERI and three patients for Scarf procedures.
  
  
  CONCLUSIONS
  Scarf and SERI techniques resulted in effective correction of hallux valgus with similar outcomes, however the SERI technique required a shorter skin incision, less surgical time, less expensive fixation device, and was without residual pain attributable to hardware.
  
  
  METHODS
  Level II, prospective comparative study. See Guidelines for Authors for a complete description of levels of evidence.
authors.affiliation: I Clinic of Orthopaedic and Traumatology, Rizzoli Orthopaedic Institute, University of Bologna, Bologna, Italy.
authors.forename: Sandro
authors.initials: S
authors.lastname: Giannini
authors.forename: Marco
authors.initials: M
authors.lastname: Cavallo
authors.forename: Cesare
authors.initials: C
authors.lastname: Faldini
authors.forename: Deianira
authors.initials: D
authors.lastname: Luciani
authors.forename: Francesca
authors.initials: F
authors.lastname: Vannini
mesh_terms: D000328:Adult; D001696:Biomechanical Phenomena; D001863:Bone Screws; D005260:Female; D006215:Hallux Valgus / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007558:Italy; D008682:Metatarsal Bones / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D008683:Metatarsophalangeal Joint / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D008875:Middle Aged; D010027:Osteotomy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D010149:Postoperative Pain / Q000209:etiology; D011446:Prospective Studies; D011859:Radiography; D016059:Range of Motion, Articular; D020127:Recovery of Function; D013997:Time Factors; D016896:Treatment Outcome