Restoration and Preservation of First Metatarsal Length Using the Distraction Scarf Osteotomy

The authors reviewed the records of 8 patients who underwent a distraction scarf osteotomy of the first metatarsal, and report the radiographic outcomes achieved with this procedure. The osteotomy was used to reestablish or maintain the length of the first metatarsal, without the use of a structural bone graft. The osteotomy was used as part of a revisional procedure for a failed bunionectomy in 4 patients. In the remaining patients, the procedure was used to preserve the length of the first metatarsal in conjunction with a Lapidus arthrodesis. The first and second metatarsals were measured radiographically, and the length of the first metatarsal was expressed as a percentage of the length of the second metatarsal. The average proportional increase in first metatarsal length obtained in the patients undergoing correction of the shortened first metatarsal was 7.08%, and the difference between the pre- and postoperative length of the first metatarsal was statistically significant (P = .0013) in these patients. Relative shortening of the first metatarsal was avoided in those patients undergoing distraction scarf osteotomy in conjunction with Lapidus arthrodesis. ACFAS Level of Clinical Evidence: 4.