Abstract
Introduction: This study compares two diaphyseal osteotomies (scarf and Ludloff), which correct moderate to severe metatarsus primus varus. This is a single surgeon, prospective cohort study with clinical and radiological follow up at six and twelve months.
Material and methods: Clinical assessment included visual analogue scale questionnaires for subjective assessment and functional activities and the American Orthopaedic Foot and Ankle Society (AOFAS) score. Standardised weight bearing radiographs were analysed.
Results: There were 57 patients in each group. Both groups were similar in terms of age, gender and preoperative deformity. There was no statistically significant difference in the two groups at 6 and 12 months in subjective satisfaction, AOFAS forefoot score, improvement in functional activities and range of movements. The improvement in pain (at best) and plantar callosities at 12 months was significantly better in the scarf group (p< 0.001). The radiological results at 6 and 12 months including intermetatarsal angle (p< 0.001), hallux valgus angle and shortening of the first ray (p< 0.01), distal metatarsal articular angle and sesamoid position (p< 0.05) were significantly better in the scarf osteotomy group. There were six complications in the Ludloff group with three delayed unions, two dorsiflexion malunions and one complex regional pain syndrome. There were two wound complications in the scarf group.
Conclusion: Overall the patients who had a scarf osteotomy had a superior outcome at 6 and 12 months.
Correspondence should be addressed to A.H.N. Robinson, BOX 37, Department of Orthopaedics, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Trust, Hills Road, Cambridge. CB2 0QQ, England.
