The SERI distal metatarsal osteotomy and Scarf osteotomy provide similar correction of hallux valgus

Abstract

Background: Ideal surgical treatment for hallux valgus is still controversial. A traditional distal metatarsal osteotomy with rigid fixation (Scarf procedure) and a more minimally invasive approach to a distal metatarsal osteotomy, termed SERI (Simple, Effective, Rapid, Inexpensive), have proven successful with short-term followup. However, no data are available directly comparing the two procedures.

Questions/purposes: We performed a prospective randomized trial to determine which technique (SERI or Scarf) was associated with (1) better functional outcomes, (2) better radiographic correction, and (3) fewer complications at 2 and 7 years followup.

Methods: Twenty patients, 53 ± 11 years of age, with bilateral hallux valgus, clinically and radiographically similar, underwent bilateral surgery with Scarf on one side and SERI on the other, at random. Clinical (AOFAS score) and radiographic assessments were considered before surgery, and at 7 years followup.

Results: SERI and Scarf techniques provided correction of the hallux valgus angle, intermetatarsal angle, and distal metatarsal angle in the range of normal. Both led to similar clinically important improvements in the AOFAS. No differences were observed between the groups. All osteotomies healed, and two patients who underwent the Scarf procedure required hardware removal. Reduction of ROM with respect to preoperative was observed in three patients for SERI and three patients for Scarf procedures.

Conclusions: Scarf and SERI techniques resulted in effective correction of hallux valgus with similar outcomes, however the SERI technique required a shorter skin incision, less surgical time, less expensive fixation device, and was without residual pain attributable to hardware.

Level of evidence: Level II, prospective comparative study. See Guidelines for Authors for a complete description of levels of evidence.

Figures

Fig. 1

The photograph shows the feet of a 35-year-old woman with bilateral hallux valgus deformities.

Fig. 2A–B

Preoperative dorsoplantar weightbearing radiographs of the patient’s (A) left and (B) right feet show the deformities.

Fig. 3A–B

Immediate postoperative radiographs of the patient’s feet show the correction obtained with the (A) SERI technique and (B) the Scarf technique.

Fig. 4A–B

The drawings show the SERI osteotomy technique. (A) In the dorsoplantar view, the inclination of the osteotomy in the mediolateral direction is perpendicular to the foot axis (the long axis of the second metatarsal bone) if the length of first metatarsal bone must be maintained. The osteotomy is inclined in a distal to proximal direction as much as 25° if shortening of the metatarsal bone or decompression of the metatarsophalangeal joint is necessary. If lengthening is necessary, the osteotomy is inclined 15° in a proximal to distal direction. (B) In the lateral view, the adjustment of the plantar or dorsal dislocation of the metatarsal head is possible fixing the osteotomy with the K wire in the upper, or more rarely in the lower, site with regard to the long axis of the metatarsal head.

Fig. 5A–C

The drawings show the Scarf osteotomy technique. (A) The dorsoplantar view shows how to maintain or modify the length of first metatarsal bone. (B) The lateral view shows how to perform a correct osteotomy, and (C) the AP view shows how to correct a first ray insufficiency. The osteotomy must be performed with a 20°-angle and the distal portion is displaced plantarward.

Fig. 6

A photograph of the patient’s feet was taken at the 7-year followup.

Fig. 7A–B

Dorsoplantar weightbearing radiographs of the (A) left and (B) right feet obtained at the 7-year followup shows maintenance of correction.

Fig. 8A–B

Photographs of the patient’s feet taken 7 years after surgery show the scar from the (A) Scarf osteotomy and the scar from the (B) SERI osteotomy, which had a smaller scar compared with the Scarf procedure.