Midshaft Osteotomies

Background Information

100

Midshaft osteotomies are categorized into these two types of osteotomies

Translational and Rotational

200

Midshaft osteotomies have these three radiographic indications

1. IMA between 12 and 20 degrees

2. Hallux abductus angle >30 degrees

3. Short first metatarsal; unable to perform inherently shortening osteotomy

300

These are the three contraindications for midshaft osteotomies

1. Arthrosis of the 1st MTPJ

2. Relatively normal PASA; osteotomies may worsen PASA

3. Poor bone quality

400

During fixation of the midshaft osteotomies, screws are usually placed in this general direction, and for this anatomy-based reason

Slightly medial; this is done to capture the opposing cortex and accommodates for plantar surface anatomy by preventing screws from potentially splitting the plantar bone

Surgeries Info

100

Difference in osteotomy technique between the Mau and Ludloff

Direction; 

Mau = dorsal-distal to plantar-proximal osteotomy

Ludloff = dorsal-proximal to plantar-distal osteotomy

200

This procedure can be adjunctive to the Mau and Ludloff, and is usually done to correct this issue

Reverdin-Laird; performed if articular deviation is present or additional IM correction is warranted

300

This is the order in which the cuts for a Scarf osteotomy should be made

1. Dorsal cut at a 60-70 degree angle on the distal end of the metatarsal

2. Transverse cut with respect to the "1/3, 2/3 rule"

3. Plantar cut at a 60-70 degree angle on the proximal end of the metatarsal

400

This is a rare complication associated with the Scarf osteotomy

Troughing; medial portion of the dorsal shelf falls into the softer medullary canal of the plantar bone