Metatarsal osteotomy - Int2Med

Surgical Technique
1 - « Scarf » Metatarsal osteotomy :
SCARF osteotomies allows several corrections :
• Medial and lateral translation,
• DMAA,
• Lowering of the metatarsal head,
• Shortening of the first metatarsal.
1
60°
Dr Maestro
5 6 7
60°
4
30°
After the longitudinal cut and
30°
transverse cuts are performed, the
appropriate correction is made by
translation and/or by shortening
and/or by rotation.
50
50
40
0
40
40
30
40
30
30
20
30
20
20
20
The first screw is distal and unicortical.
60°
60°
60°
5 6 7
4
30°
10
20
30
20
30
10
10
20
30
40
50
10
20
30
40
50
40
50
40
50
4
30°
The distal end of the Pyxis screw
is designed to minimize soft tissue
60°
damage.
5 6 7
60°
4
5 6 7
4
7
20
10
20
10
70
60
50
30
40
70
60
50
30
40
40
10
30
20
70
60
50
60°
10
30
20
70
60
50
40
50
30
20
40
60°
2 3
50
30
20
40
20
10
70
60
50
30
40
20
30
40
20
30
50
50
40
10
30
20
70
60
50
40
20
10
70
60
50
60°
50
30
20
40
30
40
20
30
50
40
60°
10
30
20
70
60
50
40
A Scarf 30° clamp is used to
maintain the corrected
position.
60°
60°
1cm
60°
NB : The Pyxis screw is inserted
obliquely in the metatarsal head.
It is important to adequately
prepare the proximal part of the
drillhole to allow the head of the
screw to be fully countersunk.
Pyxis
30
20
10
40
50
20
30
10
10
20
30
40
50
40
50
30
10
20
40
50
°
30°
30°
50
1cm
5 6 7
30°
60°
4
30°
30°
The length of the screw is 30° measured
(usually 18 or 20 mm).
50
30
20
40
20
30
50
40
5 6 7
60°
30°
4
5
1cm
30
20
40
40
30
50
70
60
50
20
20
10
60
50
30
40
30
20
10
40
40
10
30
20
60
50
60°
40
70
60
50
30
20
10
50
30
20
40
40
20
30
50
30°
A 0.8 mm K-wire is introduced
1 cm from the distal transverse cut,
and a proximal 0.8 mm K-wire is
introduced obliquely.
The cannulated step 30° drill (2.0 mm
diameter proximally and 1.8 mm
distally) is inserted over the 0.8 mm
K-wire.
1cm
20
10
70
60
50
30
40
10
30
20
70
The cannulated step drill is
graduated from 15 mm in 5 mm
increments.
60
50
40
60°
50
30
20
40
40
20
30
50
30
20
10
40
50
20
30
10
10
20
30
40
50
40
50
30
10
20
40
50
30
20
10
40
50
20
30
10
10
20
30
40
50
40
50
30
10
20
40
50
30
20
10
40
50
20
30
10
10
20
30
40
50
40
50
6
30
10
20
40
50
4
5 6 7
60°
1cm
1cm