Curative Effect Of Double Osteotomy And Modified SCARF Osteotomy In Treatment Of Hallux Valgus With Increased DMAA

Objective: We compared the postoperative clinical outcomes and imaging parameters of double osteotomy and modified Scarf osteotomy treating the halux valgus deformit y accompanying increased distal metatarsal articular angle(DMAA),to which provided a theoretical basis in treatment of hal ux valgus with increased DMAA.Methods: A total of 68 patients met the inclusion criteria from October,2016 to January,2018 in our department.Double osteotomy group: a total of 33 patients(39 feet),including 3 male patients(6 feet)and 30 female patients(33 feet),with an average age of(34.57±11.20).The modified Scarf osteotomy group: a total of 35 patients(42 feet),including 2 male patients(2 feet)and 33 female patients(40 feet),with an average age of(35.06±10.87).Two groups patients’ American Orthopedic Foot and Ankle Society(AOFAS)score for first metatarsal,phalangeal,metatarsophalangeal joints and interphalangeal joints,Visual Analogue Score(VAS)of activity and imaging parameters were collected at pre-operation.At postoperative follow-up,in addition to collecting the above data again,the patients’ satisfaction was also investigated.Preoperative and postoperative data were analyzed to evaluate the efficacy of the two surgical ways.Results: 68 patients(81 feet)were not wound infection and necrosis and hal ux valgus deformity recurrence.Double osteotomy group: one patient(one foot)developed osteoarthritis of the first metatarsophalangeal joint,and the pain disappeared after joint fusion.Two patients(two feet)presented metatarsalgia under the second metatarsophalangeal joint.One patient(one foot)was treated with orthopedic insole for pain relief,and the other one patient(one foot)was treated with Weil osteotomy of the second metatarsal for pain relief.Modified Scarf osteotomy group: one patient(one foot)presented hal ux varus deformity,which was corrected with reoperation.Two patients(two feet)occurred numbness of halux and were treated well by neurotrophic drug.Intra-group comparison: imaging parameters and mean VAS scores of patients were significantly lower than those before surgery in the two groups at postoperative follow-up,and mean AOFAS scores were obviously better than those before surgery,and the differences were statistically significant(P<0.05).Comparison among groups: there were not obviously difference in the mean bone healing time,AOFAS score,VAS score of activity and modified Roles and Maudsley score in two groups of patients at postoperative follow-up(P>0.05).Mean operative time and postoperative imaging parameters at follow-up of the two groups were significantly different(P<0.05).Conclusion: The short-term clinical effect of double osteotomy and modified Scarf osteotomy in the treatment of hal ux valgus with increased DMAA were similarly,but double osteotomy was more powerful in correcting the deformity in imaging parameters.