Effectiveness of Headless Bioabsorbable Screws for Fixation of the Scarf Osteotomy.
BACKGROUND
Scarf osteotomy has been used in hallux valgus surgery due to its large fixation surface for screws and low postoperative complications. However, screws may cause skin irritation from their head, which may require an additional surgical procedure to remove.


METHODS
This study included 115 patients (106 females and 9 males, 115 feet) who underwent hallux valgus correction with a scarf osteotomy using bioabsorbable screws between September 2010 and September 2012. Preoperative and postoperative 1-month and 1-year radiographic measurements, including intermetatarsal angle (IMA), hallux valgus angle (HVA), distal metatarsal articular angle (DMAA), proximal phalangeal articular angle (PPAA), and lateral translational distance (LTD), were obtained. American Orthopaedic Foot & Ankle Society (AOFAS) hallux/forefoot scores were used for patient satisfaction.


RESULTS
Preoperative mean values of HVA, IMA, and PPA of 32.8 degrees, 14.6 degrees, and 7.52 degrees, respectively, improved to 10.7 degrees, 6.0 degrees, and 4.6 degrees, respectively at 1-year follow up (P < .05). The difference in LTD between the 1-month and 1-year follow-up was not statistically significant. AOFAS hallux/forefoot score improved from 69.1 to 96.1 at the 1-year follow up (P < .001). Complete screw absorption was not seen radiographically. Sixteen feet had complications reported. One patient complained of skin irritation over a small protrusion of the screw, and another patient had a foreign body reaction. There were 3 patients with neurologic injury from a popliteal block and 3 patients with dorsal cutaneous nerve symptoms. Four feet had metatarsal fracture during surgery.


CONCLUSIONS
We found the scarf osteotomy using bioabsorbable screws to have satisfactory clinical and radiographic results with a low complication rate.


METHODS
Level IV, case series.
Surgery of Foot and Ankle, CM chungmu general hospital, Yeongdeuon-po, Seoul, Republic of Korea.
Jin Su
JS
Kim
Surgery of Foot and Ankle, Eulji Medical Center, College of Medicine, Eulji University, Seoul, Republic of Korea part4uos@naver.com.
Hun Ki
HK
Cho
Surgery of Foot and Ankle, Eulji Medical Center, College of Medicine, Eulji University, Seoul, Republic of Korea.
Ki Won
KW
Young
Surgery of Foot and Ankle, Eulji Medical Center, College of Medicine, Eulji University, Seoul, Republic of Korea.
Sang Young
SY
Lee
Surgery of Foot and Ankle, Eulji Medical Center, College of Medicine, Eulji University, Seoul, Republic of Korea.
Ji Soo
JS
Kim
KT Lee's Orthopedic Hospital, Seoul, Republic of Korea.
Kyoungtae
K
Lee
D020341:Absorbable Implants; D006215:Hallux Valgus / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008682:Metatarsal Bones / Q000503:physiopathology / Q000601:surgery*; D008683:Metatarsophalangeal Joint / Q000601:surgery*; D010027:Osteotomy / Q000379:methods*; D011859:Radiography; D016059:Range of Motion, Articular; D016896:Treatment Outcome
fixation device; hallux valgus; scarf osteotomy