THE CLINICAL EFFECTIVENESS OF THE MODIFIED SINGLE-SCREW SCARF OSTEOTOMY IN COMPARISON TO THE TRADITIONAL TWO-SCREW SCARF OSTEOTOMY: AN OBSERVATIONAL STUDY

This observational study investigated the clinical effectiveness of two-screw versus single-screw scarf osteotomies in hallux valgus deformities. Forty-eight hallux valgus deformities were reviewed between 2019 and 2024. Patient demographics, operative details, radiological outcomes, and patient-reported outcome measures (PROMs) were reported. Manchester Oxford Foot Questionnaire (MOxFQ) and visual analogue scale (VAS) documented the PROMs. A cost analysis was conducted. Fourteen (29.2%) cases underwent traditional two-screw osteotomies. In this group, hallux valgus angle (HVA) decreased from 37.4° to 19.6°. (p<0.001) and the intermetatarsal angle (IMA) reduced from 16.5° to 8.9° (p=0.004). The raw MOxFQ reduced from 37.8 to 27.4 (p=0.139) and the VAS score decreased from 7.4 to 3.3 (p=0.012). Complications were rare, with only 2 (14.3%) superficial infections. The remaining 34 (70.8%) cases underwent single-screw osteotomies. The single-screw group saw a HVA reduction from 34.7° to 12.6° (p<0.001) and an IMA decrease from 15.5° to 7.8°. (p<0.001). The raw MOxFQ score reduced from 39.4 to 10.4 (p<0.001) and the VAS scores decreased from 6.6 to 2.5 (p=0.002). Complications included 3 (8.8%) superficial infections, 2 (5.9%) intraoperative fractures and 2 (5.9%) cases with complex region pain syndrome. The cost of a two-screw scarf osteotomy was £395.14 compared to a single-screw osteotomy costing £197.57. The single-screw scarf osteotomy is non-inferior to the two-screw scarf osteotomy. Although these findings have not been widely proven, two-screw scarf osteotomies cost roughly double that of single-screw scarf osteotomies. This highlights a potential approach to reducing healthcare expenditures while maintaining patient care through financial and sustainable solutions.