Z-scarf or inverted Z is a A osteotomy
A: Mid-shaft osteotomy
What are the indications for Scarf osteotomy?
- IMA A
- B metatarsal
- +/- deviated C
- D bone
- May be utilized in E
- A: 12 to 18 degrees
- B: average to wide metatarsal
- C: PASA
- D: Solid non-osteopenic
- E: May be utilized in a long or short 1st metatarsal
What are the contraindications for scarf osteotomy?
- ? disease
- Heavy ?
- Patient ?
- ? bone
- IMA exceeding ? degrees
- Metabolic bone disease
- Heavy smoker
- Patient non-smoker
- Narrow, thin bone
- 18 degrees
What are the variations to osteotomy cuts?
1. ? cut
2. ? of metatarsal neck
3. start osteotomy in ?
1. Distal/proximal vertical cut
2. dorsal/plantar 2/3rds of metatarsal neck
3. distal metaphyseal bone
Scarf modifications - inverted Z
1. greater resistance to disruption from weight bearing forces
What's another advantage of having the inverted Z-osteotomy, i.e. proximal cut existing dorsally?
Proximal cut exits dorsally-leaving proximal plantar surface intact to resist weightbearing
What's the purpose of axis guide?
Axis Guide-Utilized to perform osteotomy with greater precision
What's the displacement involved in osteotomy displacement?
Release of 2? allows for easy translocation
Metatarsal head displaced medially
2. lateral sesamoid
What's the main complication of osteosynthesis 1?
How to prevent it 2?
1. Troughing of bone with lateral displacement-results
2. should be performed in proximal 1/3rd of bone (cancellous bone)
What are the anti-troughing techniques?
1. Distal bone graft
2. Distal screw into metatarsal head
3. Maintain non weight bearing-4-6 weeks
What is the post-op care?
Stable fixation-flat surgical shoe -3 weeks
Unstable fixation-CAM walker/crutches, scooter/
What are the complications associated with Z-osteotomy?
1. Distal/proximal fractures
2. Troughing - dorsiflexion 1st met head
3. Too short Z - dorsiflexion 1st met head
4. Central metatarsalgia
7. Hallux varus
What is the complication for inverted Z osteotomy?
Similar to Z-osteotomy