Results of Postoperative Hallux Valgus Correction After Middle Shaft (Scarf & Meyer) and the Proximal (Juvara) Osteotomies of I Metatarsal Bone

BACKGROUND: In this paper we show the use of Mann algorithm in correction of hallux valgus deformity (HVD). Follow up of complications were defined as: hallux varus, transfer metatar-salgia, stress fractures and recurrence of the deformity with proximal metatarsal osteotomies (Juvara and middle shaft Scarf & Meyer) in HVD rate (HVA 28 - 40 0, IMA 14 - 20 0). MATERIALS AND METHODS: A retrospective review was performed on 9 patients (14 surgical procedures) who underwent a Juvara (7) and Scarf & Meyer (7) bunionectomy between January 2000 to January 2008 in Clinical center University of Sarajevo. Data recorded on the pre-and postoperative AP radiographs included: intermetatarsal angle 1-2 (IMA), hallux valgus angle (HVA) and tibial sesamoid position. We also used Kitaoka score scale. Follow-up was performed in all patients at average of 9.5 months. Statistical differences were considered to be significant of p<0.05. RESULTS: Average age was 41.51 years. There were 7 females and 2 males. The operative side included 8 right and 6 left feet. Secondary procedures included: Juvara (DSTP 3, Akin + DSTP 2) and Scarf & Meyer (DSTP 4, Akin + DSTP 1). Pre-operative and postoperative radiographic findings were statistically significant different between the pre- and postoperative correction of the severe HAD; IMA - Juvara (preoperative 18,93±1.43 0, postoperative 4.81 0±1.72 0), p=0,001, Scarf & Meyer (preoperative 19,01±1,50 0, postoperative 4.99 0±1.68 0), p=0,001, HVA - Juvara (preoperative 35.28±9.06 0, postoperative 8.96±6.81 0), p=0,001, Scarf & Meyer (preoperative 36,01 ± 7,60 0, postoperative 9.21 ± 6.55 0) p=0.001, Tibial sesamoid position - Juvara (preoperative 4.95±0.92, postoperative 2.04±0.852), p=0,001, Scarf & Meyer (preoperative 5.01±1.41, postoperative 1.91±0.93), p=0.001. Complications included: under corrections, hallux varus, stress fractures, avascular necrosis, dorsal malunion not accepted. There were 2 cases of postoperative transfer metatarsalgia (M1 and M1/M2). Whole postoperative weight bearing, without crutch, was allowed after 6 weeks and shoes worn after 5 weeks (3 bilateral and 1 unilateral bunionectomy). Other cases were allowed to bear weigh, without crutch, after longer period. Kitaoka score scale assessment average was very good for all cases. CONCLUSIONS: Our study evaluated that the Juvara and Scarf & Meyer osteotomies predictably and accurately correct severe HAV deformities (HVA < 40 0 and IMA>15 0) isolated or in the secondary procedures. Primary stability is successful. We did not consider malposition and failure of bone healing or static foot as complications