무지 외반증에서 시행한 Scarf 절골술의 합병증 = Complications of Scarf Osteotomy for Hallux Valgus

다국어 초록 (Multilingual Abstract)

Purpose: The purpose of this study was to evaluate the frequency of troughing and stress fracture, which are the major complications of scarf osteotomy, and to suggest methods to prevent these complications. Materials and Methods: We reviewed 243 cases of 137 patients treated with the scarf osteotomy for hallux valgus from January 2005 to December 2012. The mean follow-up period was 2.8 years. During the scarf osteotomy, a long oblique longitudinal osteotomy was performed in order to decrease the possibility of troughing and stress fracture. Radiographs of lateral view of the foot were obtained and the thicknesses of the first metatarsal base at the sagittal plane were measured and compared. Results: There was no troughing during fragment translation and screw fixation intraoperatively. Radiographs of lateral view of the foot taken preoperatively and at the last follow-up showed that the mean thickness of the first metatarsal was 22.4 mm preoperatively and 21.6 mm at the last follow-up, with a mean difference of 0.8 mm. And no stress fracture was observed. Conclusion: To prevent troughing and stress fracture, a long oblique longitudinal cut, parallel to the first metatarsal plantar surface, was performed, making both ends of the proximal segment truncated cone-shape, and securing the strong bony strut of the proximal segment. No troughing or stress fracture was experienced with scarf osteotomy.

참고문헌 (Reference)

1 정진화, "소족지 중족골통을 동반한 무지 외반증에서의 변형 스카프 절골술" 대한족부족관절학회 12 (12): 134-139, 2008

2 박현우, "무지 외반증 환자에서 평행 변형 스카프 절골술을 이용한 치료 결과" 대한족부족관절학회 16 (16): 123-127, 2012

3 Zygmunt KH, "Z-bunionectomy with internal screw fixation" 79 : 322-329, 1989

4 Schoen NS, "Z-bunionectomy : retrospective long-term study" 35 : 312-317, 1996

5 Crevoisier X, "The scarf osteotomy for the treatment of hallux valgus deformity : a review of 84 cases" 22 : 970-976, 2001

6 Kramer J, "The modified Scarf bunionectomy" 31 : 360-367, 1992

7 Miller JM, "The inverted Z bunionectomy : quantitative analysis of the scarf and inverted scarf bunionectomy osteotomies in fresh cadaveric matched pair specimens" 33 : 455-462, 1994

8 Kristen KH, "The SCARF osteotomy for the correction of hallux valgus deformities" 23 : 221-229, 2002

9 Berg RP, "Scarf osteotomy in hallux valgus : a review of 72 cases" 73 : 219-223, 2007

10 Coetzee JC, "Scarf osteotomy for hallux valgus repair : the dark side" 24 : 29-33, 2003

11 Barouk LS, "Scarf osteotomy for hallux valgus correction. Local anatomy, surgical technique, and combination with other forefoot procedures" 5 : 525-558, 2000

12 Weil LS, "Scarf osteotomy for correction of hallux valgus. Historical perspective, surgical technique, and results" 5 : 559-580, 2000

13 Jones S, "Scarf oste- otomy for hallux valgus. A prospective clinical and pedobarographic study" 86 : 830-836, 2004

14 Duke HF, "Rotational scarf(Z)osteotomy bunionectomy for cor rection of high intermetatarsal angles" 82 : 352-360, 1992

15 Schneider W, "Reproducibility of the radiographic metatarsophalangeal angle in hallux surgery" 85 : 494-499, 2003

16 Smith AM, "Perioperative complications of the Scarf osteotomy" 24 : 222-227, 2003

17 Steck JK, "Long Z-osteotomy : a review and new modification to correct troughing" 40 : 305-310, 2001

18 Barouk LS, "Forefoot reconstruction" Springer 94-105, 2005