Quantitative Analysis of the Long- and Short-arm Crescentic Shelf Bunionectomy Osteotomies in Fresh Cadaveric Matched Pair Specimens

Two variations of crescentic shelf osteotomies have been described for the treatment of moderate to severe hallux abductovalgus: a short arm and a long arm. This study tested the hypothesis that the short-arm osteotomy will have a greater moment to failure and angular stiffness than the long arm. Eighteen first metatarsal specimens were dissected from 9 matched pairs of fresh frozen cadaveric specimens. One metatarsal from each pair received a short-arm osteotomy, whereas the other received a long-arm osteotomy. Each osteotomy was fixed with 2 screws. The short arm was fixed with 1 oblique screw and 1 dorsal-to-plantar screw. The long arm was fixed with 2 dorsal-to-plantar screws: 1 at the proximal aspect and 1 at the distal aspect of the shelf. Each specimen was loaded in a materials testing machine to measure moment to failure and angular stiffness. The base of the first metatarsal was potted and load applied to the plantar aspect of the metatarsal head at a constant rate until failure of the osteotomy. The mean maximum moment to failure of the short arm was significantly greater than the long arm (2.04 ± 0.96 Newton meter [Nm] vs. 1.48 ± 0.67 Nm, P = .03). The mean angular stiffness was significantly greater for short arm versus long arm (23.8 ± 19.11 Nm/radian vs. 0.98 ± 9.08 Nm/radian, P = .01). We report statistically significant data supporting the short-arm crescentic shelf osteotomy to have a greater moment to failure and angular stiffness compared with the long-arm crescentic shelf osteotomy.