Mitchel vs Scarf osteotomy

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Mitchel vs Scarf osteotomy

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6th December 2006, 12:46 PM

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Mitchel vs Scarf osteotomy

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The mitchell and scarf osteotomies for hallux valgus correction: a retrospective, comparative analysis using plantar pressures.
J Foot Ankle Surg. 2006 Nov-Dec;45(6):400-9
Dhukaram V, Hullin MG, Senthil Kumar C

Quote:

A retrospective analysis was performed to describe the effects of Mitchell and Scarf osteotomies on plantar pressure distribution and their relevance to the clinical outcome. This study evaluated 28 patients who underwent operations for moderate to severe hallux valgus deformities over a period of 3 years at 2 different centers. Twenty-two Mitchell and 22 Scarf osteotomies were performed on 28 patients with a mean follow-up of 23 months (13-62 months). The average postoperative American Orthopaedic Foot and Ankle Society scores after Mitchell and Scarf osteotomies were 74 and 84, respectively. A control group of 15 individuals with 20 healthy feet were included for comparison. The plantar pressures were documented with the Musgrave footplate. The pressure distributions under the first metatarsal head were within normal limits in both study groups compared with the control group (P = .77). After Mitchell osteotomies, deficient load bearing was noted under the hallux (P = .007), coupled with overloading of the second and third metatarsal heads (P = .01). But after the Scarf procedures, increased weight bearing was noted at the heel (P = .04) and midfoot (P = .09), with better load distribution under the hallux. However, it was not comparable with the control group. Correlation of American Orthopaedic Foot and Ankle Society scores and pressure variables demonstrated a significant positive correlation with hallux loading (P = .001). This study demonstrates that adequate hallux loading is imperative for a better outcome of the procedure. Mitchell and Scarf osteotomies do not restore the load-bearing function of the foot to normal, whereas hallux loading plays an important role for a better outcome of the procedure.

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6th December 2006, 02:29 PM

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Last edited by Admin2 : 6th December 2006 at 02:41 PM.

29th October 2008, 01:12 PM

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Re: Mitchel vs Scarf osteotomy

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We hypothesised that the use of bioabsorbable pins in Mitchell's osteotomy would improve the outcome of patients treated for hallux valgus deformity. A total of 68 patients underwent Mitchell's osteotomy to correct hallux valgus deformity: 33 patients (group A) underwent Mitchell's osteotomy augmented with bioabsorbable pins and 35 patients were treated with the classic operative procedure (group B). Hallux valgus angle (HVA), intermetatarsal angle (IMA), the American Orthopaedic Foot and Ankle Society (AOFAS) hallux metatarsophalangeal-interphalangeal scale and the visual analogue score (VAS) for pain were measured preoperatively and postoperatively. There was no statistically significant difference between the two groups as far as the improvement of the IMA, HVA and AOFAS scale were concerned. Patients of group A had significantly less postoperative pain and returned to their previous activities earlier than patients of group

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30th October 2008, 11:55 PM

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Re: Mitchel vs Scarf osteotomy

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Fixation of Mitchell's osteotomy with bioabsorbable pins for treatment of hallux valgus deformity. Nikolaou VS, Korres D, Xypnitos F, Lazarettos J, Lallos S, Sapkas G, Efstathopoulos N.

Patients of group A had significantly less postoperative pain and returned to their previous activities earlier than patients of group B. The use of the pins did not improve the final outcome of the osteotomy. However, it allowed for faster rehabilitation due to less postoperative pain.

Some seemingly good things about this study:

There were no significant differences in subject age and gender between groups.

The same surgeon performed all procedures

Post-op protocols were the same for both groups

Estimates of random variability were provided (SD’s) in addition to actual P values

The surgical procedures are well described

Some seemingly not so good things:

Subjects were not randomized to groups. Subjects in group A (pins) were selected according to radiographic signs of osteoporosis. This difference between groups could be a confounding variation, eg post-op pain levels may have been lower in Group A because the bones were softer ?

Subjects were not blinded to their group allocation. Subjects in group A (pins) may have had greater expectations regarding the treatment than subjects in Group B (classic procedure). The placebo effect was not controlled for, and raises a question about the findings for subjective pain reduction, where subjects in Group A (pins) reported significantly lower pain levels at 4 wks post-op.

It would have been a good idea if the researcher who asked the questions about pain levels at follow-up was blinded to the group allocation, otherwise there could be inadvertent suggestion about how well the recovery was going.

The conclusion quoted above implies a statistically significant difference in convalescence (time to return of previous activities) between groups, which was not the case (0.059). Close though, and would be more meaningful if the effect size (d) had been calculated.

I take my hat off to those who conduct clinical research in surgery ...

Regards,

Andrew

Attached Files

nikoloaou.pdf (246.9 KB, 3 views)

Last edited by a.mcmillan : 31st October 2008 at 12:12 AM. Reason: attachment

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