Scarf osteotomy in tailor’s bunion: A review

Tailor’s Bunion (TB) is a prominence of the Vth metatarsal bone at the base of the little toe. Scarf Osteotomy (SO) is a very useful technique to treat TB and in some cases it represents the first-rate surgical treatment for this deformity. The aim of this paper is to describe this little known pathology, analyze all surgical techniques of the past and review controlled trials or reviews that compare SO in TB published in the literature. All studies published in the literature have shown good results about the stability of the deformity correction over time, recovery of function of the little toe and pain. Correspondence to: Marco Caforio, MD, Department of Orthopaedics and Traumatology, “Guglielmo da Saliceto” Hospital, Via Taverna, 49, 20121 Piacenza, Italy, Tel: +39 349 4507950; Fax: +39 0523 303120; E-mail: [email protected]/[email protected] Received: February 25, 2015; Accepted: April 07, 2015; Published: April 10, 2015 Introduction Tailor’s Bunion (TB), or Bunionette, or Digitus Quintus Varus, is a prominence of the Vth metatarsal bone at the base of the little toe, as described by Davies in 1949 [1]. This prominence was firstly observed in tailors sitting when crossing their legs because of putting pressure on the outer borders of their feet. Usually, it is clinically characterized by pain and formation of the callus, and radiographically by a wide angle between the IVth and Vth metatarsal bones, a wide metatarsophalageal angle and a deformity in varus of the metatarsophalangeal joint [2]. The conservative treatment consists in the use of comfortable shoes, but when this treatment is not possible to apply, the surgery is recommended. The literature has shown many surgical treatments about TB [3-6], but some authors have highlighted the power of osteotomical techniques in comparing to simple exostectomies without internal fixation [7] for the increased incidence of recurrence. In a few cases of TB, procedures can be arthroplasty or silastic sphere implants [8]. Vth metatarsal osteotomies are divided into distal, proximal or shaft, such as the surgical management of hallux valgus. Since ’50 years, the Vth metatarsal osteotomies with medial transposition of its distal part are very frequent: the transversal neck osteotomy [9], Mitchell’s osteotomy [10], the oblique neck osteotomy [11] with the compact of osteotomized fragment on the medial cortical bone [12], the “V” sliding osteotomy in traversal plane (like Chevron) [13,14], the wedge osteotomy (like Reverdin) [15], the semicircle osteotomy with a medial convexity [16], the derotation and the transposition neck osteotomy [17], the wedge oblique osteotomy medially closed [18], the distal horizontal osteotomy [3], the S.E.R.I. (simple, effective, rapid, inexpensive) osteotomy [6], the osteotomy of the base [19] or other simple proximal, distal or diaphyseal osteotomies [20] associated with a lateral metatarso-phalangeal capsulotomy [21]. Choosing the most useful surgical technique is not easy because of several explanations, as follows: the simple lateral condilectomy with bursectomy is useful in large metatarsal heads (like Du Vrier’s purpose [22]), the distal subcapital osteotomy in valgus deformities and the obliqual shaft osteotomy in “sabre-blade” proximal shaft deformities [2]. Considering the large number of procedures, a single surgical technique is preferred to solve all issues of the diversity of anatomopathological forms. The main evolution of all correction techniques is represented by a shaft osteotomy: the Scarf Osteotomy [23]. It uses three cutting lines: a longitudinal (along the diaphysis), and two trasversal (anterior and posterior perpendicural at the first longitudinal cut). Thus nine osteotomized fragment displacements are possible: four on the dorsal-plantar plane (medial or lateral translation, with a medial or lateral rotation) and five on the sagittal plane (shortening, lengthening, lowering, axial rotation and elevation). It allows a triplar metatarsal correction, which is not allowed for the other techniques, and it also permits an easier fixation without involving the vascular supply. Although Scarf Osteotomy technique was created for the first metatarsal deformities, Barouk used this technique in cases of Digitus Quintus Varus [24]. Its transverse bony cuts are performed with an angle of 30° on the longitudinal cut of the big toe, and with the resultant displacement of the Vth head fragment towards the big toe: its osteotomy and its correction are in the reverse direction to the traditional Scarf Osteotomy (used for the big toe). This surgical procedure is a viable option, especially in cases of “sabre-blade” Vth metatarsal deformities. According to this introduction and our experience, Scarf Osteotomy is the most adequate technique, and it is the first-rate treatment in cases of TB in our Orthopaedic Department, already used for the first metatarsal deformity. Thus the purpose of this study is the review of the published literature about Scarf Osteotomy in TB cases. Materials and methods The literature review is systematically conducted by using some Caforio M (2015) Scarf osteotomy in tailor’s bunion: A review Volume 1(1): 8-10 Clin Res Trials, 2015 doi: 10.15761/CRT.1000103 database (i.e. PubMed, EMBASE, CINAHL) and considering articles until November 2014. Clinical cases that report controlled trials and review comparing Scarf Osteotomy in TB are included. The quality of studies is assessed. The titles and abstracts of all articles are reviewed following study-selection criteria. Each full-text manuscript is systematically evaluated according to: the study typology, its characteristics (i.e. the deformity degree, the evaluation foot scoring system, the age of patients), the aspects of the surgery (i.e. surgeon’s ability about Scarf Osteotomy Technique, the type of fixation, followups), the targeted outcomes, and the major findings.