Introduction: The Scarf osteotomy for the treatment of hallux valgus is achieving popularity, but no comparative study has proven the efficacy of this procedure over other first metatarsal osteotomies.

We present a retrospective comparative review of the radiological outcomes of Chevron and Scarf with Akin osteotomy in the treatment of hallux valgus.

Materials and Methods: The radiological outcomes of 40 first metatarsal osteotomies, 20 Chevron and 20 Scarf with Akin are presented. The radiological parameters studied included hallux valgus angle, hallux inter-phallangeus, intermetatarsal angle, sesamoid station and foot width.

Results: The mean post-operative hallux valgus angles (HVA’s) were: Chevron mean HVA 17.90, standard deviation 7.360, standard error 1.65. Scarf with Akin osteotomy mean HVA 9.550, standard deviation 6.60, standard error 1.4. The difference in postoperative HVA between the two operations was statistically significant (p< 0.001).

The mean post-operative intermetatarsal angles (IMA) were: Chevron mean 8.050, standard deviation 2.560, standard error 0.57. Scarf with Akin mean 7.220, standard deviation 2.56, standard error 0.57. The difference in postoperative IMA between the two groups did not achieve statistical significance.

The mean change in IMA for each was: Chevron mean increment 4.90 Standard deviation 2.290, standard error 0.51. Scarf with Akin mean increment 6.680, standard deviation 4.130, and standard error 0.88. The difference in alteration of IMA between the two groups did not achieve statistical significance.

Discussion and Conclusion: We conclude that as there was no difference in the distribution of post-op IMA for Scarf and Chevron osteotomies that the added affect of an Akin osteotomy may contribute to the Scarf to produce the better correction in hallux valgus angle.

Aim: To validate the accuracy of the MobilityTotal Ankle Replacement alignment jig.

Method: The early radiological alignment outcomes (angles ‘A, B, C’) of 35 Mobility ankle replacements were determined from weight bearing X rays.

These radiological outcomes were compared with alignment outcomes for ‘Star’ total ankle replacement, as published by PLR Wood. (Total Ankle Replacement JBJS April 2003 85B, pg 334)

Results: Indication: osteoarthritis 25, posttraumatic osteoarthritis 6, rheumatoid arthritis 4.

32/35 Angle A were within the published accepted range (850–950).

No statistical difference between the distribution of angle A, B and C and the means for A, B and C for the published results.

Discussion: Results for angle B are skewed toward the upper limit of the current accepted range (800–900). The author (MSS) attempts to reproduce this, to place the anterior margin of the tibial component on subchondral bone.

A lower angle B positions the implant on metaphyseal bone with a risk of subsidence. Comparing Angle B with a modified acceptable range (850–950) 31/35 fell in the new range.

Conclusion: Early radiological alignment for Mobility is reproducible and compares favourably with published data.