SERI osteotomy yields more complications than Scarf and Akin for bunion deformity

Patients treated with either technique improved in AOFAS scores, had better X-ray results at 1 year.

Issue: Issue 5 2007

TORONTO – The SERI osteotomy technique for treating hallux valgus yielded slightly worse clinical and radiological results – and significantly more complications – than the Scarf and Akin technique in a short-term study presented here.

At a minimum 1-year follow-up, Pablo Fernández de Retana, MD, and his colleagues evaluated 40 patients who underwent the simple, effective, rapid and inexpensive (SERI) technique and 40 patients who underwent the Scarf and Akin technique for mild to moderate hallux valgus.

Hallux valgus treated using the Scarf and Akin technique
Fernández de Retana and his colleagues treated 40 patients with mild to moderate hallux valgus using the Scarf and Akin technique, as demonstrated in this intraoperative image.

Images: Fernández de Retana P

“Postoperative [outcomes] scores improved in both groups, but were slightly better with the Scarf and Akin group. X-ray results were significantly better after 12 months in both groups. In our hands, there were more complications in the SERI group,” Fernández de Retana said at the American Orthopaedic Foot and Ankle Society (AOFAS) 23rd Annual Summer Meeting.

Inclusion criteria

Investigators included in the study patients who had a hallux valgus angle less than 40°, an intermetatarsal angle between 11° and 16°, a distal metatarsal articular angle (DMAA) less than 20°, and a range of motion of the first metatarsophalangeal joint of greater than 34°.

The two groups were similar in age and gender, with women outnumbering men, Fernández de Retana said.

AOFAS scores, satisfaction

Preoperatively, investigators found that the SERI group patients had a mean AOFAS Score hallux valgus scale of 53, and the Scarf and Akin patients had a mean scale of 55. At postop, the SERI group improved to a score of 78 and the Scarf and Akin group demonstrated a score of 85.

“The differences didn’t have a statistical significance, but were better for the Scarf and Akin group,” Fernández de Retana said. “In terms of satisfaction at 1 year, more than 87% of both groups were excellent or good, but there were more complications in the SERI group.”

Both groups had a preoperative hallux valgus angle of roughly 30°, which improved postoperatively to 14° for the Scarf and Akin group and to 17° for the SERI group.

“There were no differences in the preop and postop intermetatarsal angle in both groups,” Fernández de Retana said. “The preop DMAA was the same in both groups, but the postop DMAA was better in the SERI group: 5° for the SERI group and 8° for Scarf and Akin.”

Intraoperative image of (SERI) technique for hallux valgus
Surgeons treated another 40 patients in this study with the simple, effective, rapid and inexpensive (SERI) technique for hallux valgus, as seen in this intraoperative image.

Postoperative X-ray of the Scarf and Akin technique
Shown here: a postoperative X-ray image of a patient treated with the Scarf and Akin technique. Investigators found that patients treated with the Scarf and Akin technique improved slightly better in AOFAS score hallux valgus scales, but the difference was not statistically significant.

Complications

Investigators found significantly more complications in the SERI group, including two superficial infections, two deep infections, six cases of hardware intolerance, three delayed unions, three cases of complete metatarsal head displacement, 12 cases of first metatarsal dorsal displacement and 23 undercorrections, Fernández de Retana said.

In the Scarf and Akin group, complications included one superficial infection, five cases of first metatarsal elevation, two metatarsal fractures and 12 undercorrections.

Fernández de Retana explained that the surgeons’ experience in performing the SERI technique was not as extensive as that of the Scarf and Akin, which is a weakness of the study.

Postoperative X-ray of the SERI technique
Here is a postoperative X-ray of a patient treated with the SERI technique.

A postoperative clinical image of a patient treated with the SERI technique. Fernández de Retana and his colleagues found significantly more complications with this technique.

For more information:
Pablo Fernández de Retana, MD, can be reached at the University of Barcelona, Centre Ciutat, Facultat de Medicina, Casanova, 143, 08036 Barcelona, Spain; +34-934-039-380; pfernan@clinic.ub.es. He has no financial conflicts to disclose.
Reference:
Fernández de Retana P, Ortega JP, Poggio D, Botello J. Scarf and Akin osteotomy in comparison with SERI technique in the treatment of hallux valgus. Presented at the American Orthopaedic Foot and Ankle Society 23rd Annual Summer Meeting. July 13-15, 2007. Toronto.