Rossi Valentina, Hemmati Mohammed, Magliulo Paolo, Giordano Agostino, Izzo Antonio, Mariconda Massimo, Bernasconi Alessio
Trauma and Orthopaedics Unit, Department of Public Health, University of Naples Federico II, Naples, Italy.
Arch Orthop Trauma Surg. 2025 May 9;145(1):284. doi: 10.1007/s00402-025-05883-z.
Scarf-Akin osteotomy (with or without lateral soft-tissue release (LSTR)) is commonly performed to treat hallux valgus (HV). An insufficient correction of sesamoids can be a risk factor for early recurrence of the condition. We set out to determine 1) the radiographic correction achieved after Scarf-Akin osteotomy performed without LSTR and 2) the degree of correction of sesamoids obtained during the learning curve of the technique.
In this prospective single-centre study, the first 25 feet (25 patients, mean age 55.2 years, 14 left) undergone Scarf-Akin osteotomy without LSTR by a single foot and ankle orthopaedic consultant in his first year of activity were enrolled and followed-up at 1-year. On weightbearing standard pre-operative and 1-year follow-up radiographs two independent observers (senior residents) assessed and compared the hallux valgus angle (HVA), 1st and 2nd intermetatarsal Angle (IMA), distal metatarsal articular angle (DMAA) and tibial sesamoid position (SP, according to the Hardy and Clapham system). The inter and intraobserver reliability of measurements along with the correlation between the improvement achieved in different parameters and the number of cases performed were tested. Intra and post-operative complications were compared between the early (first 12) and late learning periods.
The inter and intraobserver agreement for the radiographic parameters investigated was excellent in all cases (ICC always > 0.92). A statistically significant improvement in mean HVA (from 36 ± 9.8 to 16.3 ± 2.8 degrees), mean IMA (from 14.5 ± 2.3 to 9.9 ± 1.5 degrees), mean DMAA (from 19.4 ± 4.4 to 11.4 ± 1.9 degrees) and median SP (from 4 (IQR, 3-6) to 2 (IQR, 1-2) points) was demonstrated in the cohort (p < 0.001 in all cases). There was a strong positive significant correlation between the progression of cases over time and the improvement achieved in terms of SP (R = 0.60, p = 0.003). Conversely, no significant correlation was demonstrated when comparing the improvement obtained in HVA, IMA and DMAA with the number of cases performed (p > 0.05 in all cases). One complication occurred during the first 12 cases (1 transfer metatarsalgia) and 1 during the last 13 (1 intra-operative fracture).
In this series, a satisfactory correction of HV after Scarf-Akin osteotomy was obtained without releasing lateral soft-tissues. Beginner surgeons should be aware that restoring sesamoid position may be more challenging as compared to correcting other angles during the first cases.
Level IV, prospective case series.
Scarf-Akin截骨术（伴或不伴外侧软组织松解术（LSTR））常用于治疗拇外翻（HV）。籽骨矫正不足可能是该疾病早期复发的一个危险因素。我们旨在确定：1）在不进行LSTR的情况下进行Scarf-Akin截骨术后的影像学矫正效果；2）在该技术的学习曲线期间所获得的籽骨矫正程度。
在这项前瞻性单中心研究中，纳入了由一位足踝骨科顾问在其执业第一年中对25只足（25例患者，平均年龄55.2岁，14例为左侧）进行的不伴LSTR的Scarf-Akin截骨术，并进行为期1年的随访。在负重状态下的标准术前和1年随访X线片上，两名独立观察者（高年资住院医师）评估并比较了拇外翻角（HVA）、第1和第2跖骨间角（IMA）、远节跖骨关节角（DMAA）以及胫骨籽骨位置（SP，根据Hardy和Clapham系统）。测试了测量结果的观察者间和观察者内可靠性，以及不同参数改善情况与手术病例数之间的相关性。比较了早期（前12例）和后期学习阶段的术中和术后并发症。
在所有病例中，所研究的影像学参数的观察者间和观察者内一致性均极佳（组内相关系数（ICC）均>0.92）。该队列中，平均HVA（从36±9.8度改善至16.3±2.8度）、平均IMA（从14.5±2.3度改善至9.9±1.5度）、平均DMAA（从19.4±4.4度改善至11.4±1.9度）以及中位SP（从4（四分位间距，3 - 6）改善至2（四分位间距，1 - 2）分）均有统计学意义上的显著改善（所有病例p<0.001）。随着时间推移病例数的增加与SP改善程度之间存在强正相关（R = 0.60，p = 0.003）。相反，将HVA、IMA和DMAA的改善情况与手术病例数进行比较时，未发现显著相关性（所有病例p>0.05）。在前12例中有1例发生并发症（1例转移性跖痛症），后13例中有1例（1例术中骨折）。
在本系列研究中，未进行外侧软组织松解的情况下，Scarf-Akin截骨术后对HV获得了满意的矫正效果。初级外科医生应意识到，与在最初病例中矫正其他角度相比，恢复籽骨位置可能更具挑战性。
IV级，前瞻性病例系列。
