Introduction: There are more than 150 different methods of surgical correction of hallux valgus deformity. In our institution there is a long tradition of SCARF osteotomy. We hereby present the longterm results of the SCARF.

Material & Methods: During the years 1995 and 1996 111 patients with 128 feet were operated on for a hallux valgus deformity by the SCARF osteotomy. Of those, 81 patients with 95 feet could be seen for follow up. The mean age at time of surgery was 50.9 (21–78) years. A clinical and radiographic examination was done.

Results: After an average time of 121.9 (107–141) months 92% of the patients were very satisfied with the result of their surgery. The VAS for pain improved from an average of 6.5 to 0.34. The AOFAS score for the forefoot improved from a preoperative average of 54.4 to a postoperative average of 91.6. The radiographic evaluation gave the following results: the preoperative HVA of 31.7° improved to an average of 16.8°; the preoperative IMA of 14.8° improved to an average of 7.6°. The preoperative average dorsal extension of the MTPI did not change very much from 48.6° to 50.6°, the preoperative plantar flexion decreased from an average of 50.6° to 15°. Two patients had to be reoperated because of a recurrent hallux valgus deformity. Five other patients had a recurrent deformity, but did not need any further surgery. We could observe 3 patients with an overcorrection where one needed another surgery. No head necrosis was seen.

Conclusion: Overall the SCARF osteotomy gave good and predictable results with a good correction of the deformity and a low potential for recurrence if applied for the right patient group.

Introduction: Thumb duplication is one of the most common congenital malformations of the hand.

The goals of surgery are to ablate the hypoplastic component and to create a stable and well-aligned thumb with a good pinch-function besides a maximum of mobility. Yet this aim is seldom achieved by simple ablative surgery alone which often results in a residual deformity and loss of function.

The objective of this review is a critical analysis of the used surgical techniques in 113 cases of thumb duplication.

Patients and Methods: Within the 11 year period from 1992 to 2003 113 patients (67 male, 46 female) with 120 duplicated thumbs (7 bilateral) underwent surgery at our institution. Details of primary reconstruction, X-ray findings, follow-up details, analysis of secondary deformities and details of secondary surgery were documented and evaluated. The follow-up time ranged from 6 months to 10 years. The patients were evaluated for functional and cosmetic outcomes.

Results: The right thumb was involved in 63 patients, the left in 57 and both sides were affected in 7 cases.11 Patients had associated anomalies.

Using the classification proposed by Wassel to grade the thumb duplication the most frequent types were IV with 53 cases (48%), II with 27 cases (24%). Patient age at the time of initial surgery varied from 5 months to 26 years with a mean age of 20 months.

11 patients underwent previous surgery in another institution and had a second surgery at our hospital.

8 Patients underwent only simple ablation, in 88 cases there was an excision combined with reconstruction of collateral ligaments, in 51 cases combined with a tendon transfer or release and reinsertion. Osteotomy of the metacarpal bone or proximal phalanx was performed in 47 cases. 5 patients received a Bilhaut-Cloquet procedure.

The most common complications were joint deviation (n = 12), joint stiffness (n = 2), joint instability (n = 11), nail deformity (n = 5) and scarring (n = 7). The 10 patients who under-went primary surgery at another institution and had to be reoperated are included in this listing.

The type of secondary reconstruction was in 7 cases scar release, in 6 cases a ligament reconstruction, 4 patients received an arthrodesis and 6 patients needed a corrective osteotomy.

Conclusions: Thumb function is critical to hand function. Despite its seeming simplicity surgery of thumb duplication is a complex procedure. Nowadays it is recognized that simple ablation leeds mostly to poor functional and cosmetic results. Treatment requires a thoroughful preoperative assessment, as well as an appreciation and understanding of the bony, capsuloligamentous and tendinous components involved. Taking this into account in mostly all cases a satisfactory cosmetic and functional result can be achieved.