The effect of screw type on the biomechanical properties of SCARF and crescentic osteotomies of the first metatarsal

The basilar crescentic osteotomy is a popular method for correcting moderate to severe hallux valgus. However, inadvertent dorsiflexion of the osteotomy can result from intraoperative malposition or from malunion after fixation failure. The mechanical properties of osteotomies are dependent on the nature of the osteotomy and the type of fixation. This study examines the mechanical properties of the SCARF and crescentic osteotomies of the first metatarsal by using a cannulated asymmetric pitched screw or AO cancellous screws. Sixteen human cadaveric first metatarsal specimens were tested in plantar to dorsiflexion cantilever bending by using a mechanical testing machine. The data was compared with our recent work on the mechanical properties of the SCARF and crescentic osteotomies. Ultimate load and stiffness of the SCARF osteotomy were superior to the crescentic osteotomy but were not dependent on screw type. Screw type was a prominent factor in the stiffness but not in the strength of the crescentic osteotomy. The ultimate load and the stiffness of SCARF osteotomy fixed with the cannulated asymmetric pitched screws were not significantly different compared with AO screws (ultimate load, 124.6 N [SD = 56.8] v 105.3 N [SD = 57.0]; stiffness, 52.0 N/mm [SD = 48.0] v 31.8 N/mm [SD = 19.0]). Modes of failure were fracture of the cortical bone bridge between the screw hole and the osteotomy in all crescentic osteotomies and fracture of the proximal dorsal bridge in all SCARF osteotomies. The superior mechanical properties of the SCARF osteotomy, fixed with cannulated asymmetric pitched screws, make this a more secure construct, with less risk of malunion than the crescentic osteotomy. Stiffness is an important mechanical factor that helps distinguish the mechanical performance of different osteotomy techniques. (The Journal of Foot & Ankle Surgery 42(3):161-164, 2003)