Surgical Reconstruction of Nonunion after Iatrogenic Scarf Osteotomy.

We present the case of a young patient, 32 years old, with nonunion in the diaphysis of the first metatarsal after scarf osteotomy for correction of hallux valgus. After removal of the failed osteosynthesis material and preparation of the bone fragments, a calcaneal bone autograft, previously extracted from the patient, was placed in the nonunion area. The new physiological position of the first metatarsal in the three planes was checked intraoperatively, and autograft and fragment fixation was performed using a combination of a low-profile plate with six screws and two interfragmentary screws. The advantage of using an autogenous graft is that it provides corticocancellous bone and great osteogenic capacity with little antigenic capacity. This makes it an excellent option in many situations in foot and ankle surgery. Regarding the fixation method, we used the two most commonly used techniques for osteosynthesis of bone grafts in cases of bone nonunion, combining plates with locking screws and two interfragmentary screws. This provides greater stability of the bone fragments in the three planes and makes it possible to bring forward when the patient starts postsurgical loading.

Surgical Reconstruction of the Forefoot with Hallux Valgus Associated with Metatarsus Adductus.

Metatarsus adductus is a structural deformity that may be associated with hallux valgus and that may lead to metatarsal pain and functional abnormality of the foot. Correcting hallux valgus is complicated in these cases because of the deviation in adduction of the lesser metatarsals, especially the second metatarsal that occupies the first intermetatarsal space. We report the case of a 49-year-old man who underwent a scarf osteotomy in the first metatarsal, shortening and abductor oblique distal osteotomies of the lesser metatarsals, and arthrodesis of the central toes with Z-lengthening of the capsule and long extensor tendons of the toes.