Osteotomia de Akin asociada a otras técnicas para el tratamiento del Hallux Valgus

Porque percutánea?

Es necesario fijarla?

Dr. Del Vecchio, JavierDr. Aliaga, AndrésDr. Raimondi, NicolásDra. Pinto Piotti, Teresa

Hystory

Akin OF: The treatment of hallux valgus-a new operative procedure and its results. Med. Sentinel 33:678,1925.Makwana NK. Osteotomy of the hallux proximal phalanx. Foot Ankle Clin. 2001 Sep;6(3):455-71. Review.

The Akin Procedure

Buniectomy

Phalangeal Osteotomy

Lateral Release

Nowadays…

Contraindicated(Alone)

Severe metatarsus primus varus Incongruent 1st metatarsophalangeal joint Severe Athritis

Coughlin MJ. Hallux valgus. J Bone Joint Surg Am. 1996 Jun;78(6):932-66. Review. Frey C, Jahss M, Kummer FJ. The Akin procedure: an analysis of results. Foot Ankle. 1991 Aug;12(1):1-6.

Indicated Mild HV without metatarsus primus varus HV with large medial eminence HV interphalangeus Increased Distal Articular Set Angle (DASA)

The Akin Procedure

Goldberg I, Bahar A, Yosipovitch Z. Late results after correction of hallux valgus deformity by basilar phalangeal osteotomy. J Bone Joint Surg Am. 1987 Jan;69(1):64-7. 

The Akin Osteotomy

History

“…..does not have a sound biomechanical basis and should not be performed as an isolated surgical procedure”.

Only indication Combination with other procedures in cases of failure Large intermetatarsal angle combined with other osteotomies

Nowadays…

Hallux Rigidus: Akin-Moberg Technique Extensus: Plantarflexion Akin

The Akin Osteotomy

Turned to!

Where?

Proximal Distal

Distal Articular Set Angle(DASA)

Interphalangeous Angle (IPA)

Diapheseal not recomended!

Hypothesis

Is secure? Consolidation rate, complications

Is efective? Clinic results Rx measurements Cosmetic

Why percutaneous?

Is fixation necessary?

Malunion Rate

Methods

44 Akin osteotomies(42 Women:95,5%)

35 (74,3%): Modified Chevron

9 (25,7%): Bosch

Weightbearing X-Rays3th and 4th Week 3th month

January-October 2008

Methods

Distal Articular Set Angle(DASA)

Angular measurements

Interphalangeous Angle (IPA)

Normally 0-6˚ Normally < 10˚

Surgical Technique

Medial Portal Swann-Morton Blade MS67 Large Shannon Straight Wedge Burr if necessary…

Percutaneous Akin Osteotomy

Results

DASA: 4,9°

5,3° (1-10°) 0,4° (-5 a 4)

IFA: 6,4°Pre

10,6° (5-17°) 4,2°(-1 a 9°)

Post

Angular measurements

Normal Values

Results

Normal DASA84% 16% Hypercorrection(Average -2,7°)

Angular measurements

Results

100% Consolidation rate: Corticalisation

Consolidation

Clinical

X-Ray

3.4 Weeks

Dissapearence of pain – Osteotomy site( 2 authors)

Dissapearence >80% – Osteotomy line( 3 authors)

4.5 Weeks

Rehabilitation Protocol

Inmediatly weighbearing Rigid Insole Shoe

Passive articular movement Sylicon Device

First 3/4 weeks

Week 3/4-6

Complications

Fracture of lateral cortex: 1 case (0,44%) Delayed Union: 2 Cases (0,88%) Malunion: 1 case (0,44%) No nerve lesion: 1 Dysesthesia (Pregabalin)

3 Weeks

Discussion

“The size of the wedge can be calculated using trigonometric analysis to give the desired angular correction”.

Correction

Wedge Base Correction3 mm 8°5 mm 16°8 mm 24°

Frey C, Jahss M, Kummer FJ. The Akin procedure: an analysis of results. Foot Ankle. 1991 Aug;12(1):1-6.

DASA: 4,9°

IFA: 6,4°

Greater wedges not neccesary!

Sutures Absorvibles

Non absorvibles

Staples Biodegradable

Surgical Steel

Titanium Clips

Screws Surgical Steel

Titanium Wires

K-wire

Fixation methods

Discussion

Our series: not necessary

Non union

Discussion

Less than 1% Our series: 0%

Malunion

0-24%

Frey C, Jahss M, Kummer FJ. The Akin procedure: an analysis of results. Foot Ankle. 1991 Aug;12(1):1-6.Goldberg I, Bahar A, Yosipovitch Z. Late results after correction of hallux valgus deformity by basilar phalangeal osteotomy. J Bone Joint Surg Am. 1987 Jan;69(1):64-7.Seelenfreund M, Fried A, Tikva P. Correction of hallux valgus deformity by basal phalanx osteotomy of the big toe. J Bone Joint Surg Am. 1973 Oct;55(7):1411-5.

Our series: 0,44% (1 case)Hypercorrection:16%

Frey C, Jahss M, Kummer FJ. The Akin procedure: an analysis of results. Foot Ankle. 1991 Aug;12(1):1-6Green AH, Bosta SD. Akin osteotomy of the hallux proximal phalanx utilizing Richards mini staple fixation.J Foot Surg. 1986 Sep-Oct;25(5):386-9.

Conclusions

High Consolidation Rate in short period of time Low complication rate

Efective

Secure

Clinic Results X-Ray Measurements Cosmetic

No fixation needed 1 malunion: Complication

Weekness: Few cases