Scarf bunionectomy (Surgery Unit)

Question 1

Z-scarf or inverted Z is a A osteotomy

Answer 1

A: Mid-shaft osteotomy

Question 2

What are the indications for Scarf osteotomy?

1. IMA A
2. B metatarsal
3. +/- deviated C
4. D bone
5. May be utilized in E

Answer 2

1. A: 12 to 18 degrees
2. B: average to wide metatarsal
3. C: PASA
4. D: Solid non-osteopenic
5. E: May be utilized in a long or short 1st metatarsal

Question 3

What are the contraindications for scarf osteotomy?

1. ? disease
2. Heavy ?
3. Patient ?
4. ?
5. ? bone
6. IMA exceeding ? degrees

Answer 3

1. Metabolic bone disease
2. Heavy smoker
3. Patient non-smoker
4. Obesity
5. Narrow, thin bone
6. 18 degrees

Question 4

What are the variations to osteotomy cuts?

1. ? cut
2. ? of metatarsal neck
3. start osteotomy in ?

Answer 4

1. Distal/proximal vertical cut
2. dorsal/plantar 2/3rds of metatarsal neck
3. distal metaphyseal bone

Question 5

Scarf modifications - inverted Z

Provides 1?

Answer 5

1. greater resistance to disruption from weight bearing forces

Question 6

What’s another advantage of having the inverted Z-osteotomy, i.e. proximal cut existing dorsally?

Answer 6

Proximal cut exits dorsally-leaving proximal plantar surface intact to resist weightbearing

Question 7

What’s the purpose of axis guide?

Answer 7

Axis Guide-Utilized to perform osteotomy with greater precision

Question 8

What’s the displacement involved in osteotomy displacement?

Release of 2? allows for easy translocation

Answer 8

Metatarsal head displaced medially

2. lateral sesamoid

Question 9

What’s the main complication of osteosynthesis 1?

How to prevent it 2?

Answer 9

1. Troughing of bone with lateral displacement-results
2. should be performed in proximal 1/3rd of bone (cancellous bone)

Question 10

What are the anti-troughing techniques?

1?

2?

3?

Answer 10

1. Distal bone graft
2. Distal screw into metatarsal head
3. Maintain non weight bearing-4-6 weeks

Question 11

What is the post-op care?

Answer 11

Stable fixation-flat surgical shoe -3 weeks

Unstable fixation-CAM walker/crutches, scooter/

cast-6-8 weeks

Question 12

What are the complications associated with Z-osteotomy?

1?

2?

3?

4?

5?

6?

7?

Answer 12

1. Distal/proximal fractures
2. Troughing - dorsiflexion 1st met head
3. Too short Z - dorsiflexion 1st met head
4. Central metatarsalgia
5. Non-union
6. AVN
7. Hallux varus

Question 13

What is the complication for inverted Z osteotomy?

Answer 13

Similar to Z-osteotomy