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Modified Rotational Scarf Osteotomy for Hallux Valgus

 
CPT Technique
Indications Complications
Contraindications Follow-up Care / Rehab Protocol
Alternatives Outcomes
Pre-op Planning / Case Card Review References

synonyms:Modified Rotational Scarf Osteotomy for Hallux Valgus, hallux valgus surgery

 Modified Rotational Scarf Osteotomy for Hallux Valgus CPT 

Modified Rotational Scarf Osteotomy for Hallux Valgus Indications

  • Moderate to severe Hallux Valgus

 Modified Rotational Scarf Osteotomy for Hallux Valgus Contraindications

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Modified Rotational Scarf Osteotomy for Hallux Valgus Alternatives

  • Conservative care
  • 1st MTP arthrodesis

Modified Rotational Scarf Osteotomy for Hallux Valgus Pre-op Planning

  • Ensure headless compression screws are available

Modified Rotational Scarf Osteotomy for Hallux Valgus Technique

  • Sign operative site.
  • Pre-operative antibiotics, +/- regional block (link is external).
  • General endotracheal anesthesia
  • Supine position. All bony prominences well padded.
  • Prep and drape in standard sterile fashion.Medial incision over 1st MTP joint and 1st metatarsal. 
  • Capsule elevated to expose medial and lateral aspects of MTP joint. 
  • Latersl sesmoid exposed.  Abductor tendon release and lateral capsule released. 
  • Medial emmince resected. 
  • Scarf osteotomy cuts
  • Planter half rotated medially to  reduce IM angle until metatarsal head was parallel to second ray.
  • Nutrient artery plantarly was preserved.
  • Fluoroscopy
  • 3.0mm compression screws
  • Bony prominences removed for a smooth medial border
  • Consider Akin osteotomy.
  • Irrigate
  • Plicate medial capsule with the toe in a neutral position. Small portion of dorsal capsule may need to be removed if it is redundant after removal of medial emminence.
  • Irrigate.
  • Close in Layers

Modified Rotational Scarf Osteotomy for Hallux Valgus Complications

Modified Rotational Scarf Osteotomy for Hallux Valgus Follow-up care

  • Post-op: Keep elevated.  NWB in hard soled shoe.
  • 7-10 Days: wound check.  Soft toe spacer used for 1 month.  WBAT in hard soled shoe.
  • 6 Weeks: repeat xray.  May discontinue hard soled shoe when callus/healing visible radiographically.
  • 3 Months: Gradually return to full activities including sports.
  • 6 Months: follow up xrays, consider functional outcome measures
  • 1Yr: follow up xrays, consider functional outcome measures

Modified Rotational Scarf Osteotomy for Hallux Valgus Outcomes

  • AOFAS score improved from 52 points to 92 points; SF-36 V2 score improved from 69 points preop to 94 pts post-op.  IM angle preop 18° to 8° postop. 9% complications rate.

Modified Rotational Scarf Osteotomy for Hallux Valgus Review References

 

 

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