Progressive Akin Osteotomy

Giménez, E. Martínez; Roman, Carmen Verdu; Sanz-Reig, J.; Santias, Manuel Morales; Puga, David Bustamante Suarez de; Martínez, Jesús Más

doi:10.1177/1179544119852099

Cited by 5 publications

(8 citation statements)

References 3 publications

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“…Angular changes of up to 24 degrees in the transverse plane have been described with good results. 14 Although Akin and Moberg osteotomies are performed to correct pathology, the final angulation measurements that were accepted in this series are consistent with the changes noted in these commonly performed procedures. In our series, a final sagittal plane angulation of 12 to 15 degrees was accepted with good results and a final transverse plane angulation of 4 degrees was accepted.…”

Section: Discussionsupporting

confidence: 72%

“…Akin osteotomies are commonly used to treat or augment the surgical management of hallux valgus. Angular changes of up to 24 degrees in the transverse plane have been described with good results 14. Although Akin and Moberg osteotomies are performed to correct pathology, the final angulation measurements that were accepted in this series are consistent with the changes noted in these commonly performed procedures.…”

Section: Discussionsupporting

confidence: 70%

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Fractures of the Great Toe Proximal Phalanx: A Case Series and Review of the Literature

Dworkin

Harris

Ryan

2021

Techniques in Foot &Amp; Ankle Surgery

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Phalangeal fractures are the most common fractures seen in the foot, especially in the great toe. Acceptable angulations for fractures of the proximal phalanx are not known. To determine practice trends, a retrospective review of consecutive patients treated at a single institution from January 2011 to August 2014 was performed. All patients were skeletally mature with fractures to the diaphysis of the proximal phalanx with or without intra-articular extension. Outcomes from the medical record review included the type of treatment, radiographic alignment, and visual analog pain scores. Of the 12 patients reviewed, 4 sustained crush injuries and 8 sustained axial load injuries. Statistical analysis was done using Student’s t test for a normally distributed population. Nine of the 12 fractures were treated with manipulation, 7 were closed reduction and percutaneous pinning (CRPP), and 2 were isolated closed reduction without internal fixation. Two of the 9 patients with CRPP required additional surgery. The comparison between the sagittal plane angulation in the closed reduction cohort was 25 degrees compared with 42 degrees in the CRPP cohort (P=0.02). The final sagittal plane angulation comparison was not significant 12 versus 15 degrees (P=0.55). In the transverse plane, no statistical difference was seen between the 2 cohorts with an initial angulation of 8 degrees in the closed reduction cohort versus 13 degrees in the CRPP cohort (P=0.45). The final transverse angulation was symmetric with a mean of 4 degrees in each cohort (P=0.91). The patients in this review were more likely to be treated with operative intervention when initial angulation had a mean of 42 degrees in the sagittal plane. Patients with initial mean angulation of 25 degrees were more likely to be treated with a closed reduction. Final sagittal plane angulations of 12 to 15 degrees were associated with good outcomes. This series may help surgeons and patients in their shared decision making when faced with shaft fractures of the proximal phalanx. Level of Evidence: Level IV—retrospective cohort study.

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Section: Discussionsupporting

confidence: 72%

Section: Discussionsupporting

confidence: 70%

Fractures of the Great Toe Proximal Phalanx: A Case Series and Review of the Literature

Dworkin

Harris

Ryan

2021

Techniques in Foot &Amp; Ankle Surgery

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“…In the same group the mean HVA improved from 27.2 (16-42) degrees preoperatively to 10.7 degrees (4-12) postoperatively. The mean IPA in the unfractured group improved from 13.9 (11)(12)(13)(14)(15)(16)(17) degrees to 3.9 (3-8) degrees postoperatively. In the group with lateral cortex fracture, the mean first-to-second IMA angle preoperatively was 13.3 (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22) degrees and improved postoperatively to 3.8 (1-6) degrees.…”

Section: Primary Outcomesmentioning

confidence: 87%

“…The mean IPA in the unfractured group improved from 13.9 (11)(12)(13)(14)(15)(16)(17) degrees to 3.9 (3-8) degrees postoperatively. In the group with lateral cortex fracture, the mean first-to-second IMA angle preoperatively was 13.3 (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22) degrees and improved postoperatively to 3.8 (1-6) degrees. The preoperative HVA was 29.3 degrees and improved to 7.1 (4-12) degrees postoperatively.…”

Section: Primary Outcomesmentioning

confidence: 87%

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Fracturing the Lateral Hinge Improves Radiographic Alignment and Does Not Affect Clinical Outcomes of the Minimally Invasive Akin Osteotomy

Marciano,

Ashinsky,

Mysore

et al. 2023

Foot Ankle Int.

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Background: Intraoperative fracture of the lateral cortex is common during Akin osteotomy. In a recent study, lateral cortex fracture did not impede healing or result in loss of correction in a combined cohort of open and percutaneous osteotomies stabilized by K-wire fixation. We hypothesize that undesired lateral cortex fracture will not affect radiographic correction and patient-reported outcomes in a percutaneous cohort stabilized by permanent, rigid screw fixation. Methods: Consecutive patients with hallux valgus who underwent first metatarsal osteotomy and percutaneous Akin osteotomy stabilized by permanent, rigid screw fixation between May 2020 and January 2022 were retrospectively reviewed. Patients were stratified based on fractured lateral cortex (FC) or its absence (nonfractured cortex [NFC]). Visual analog scale (VAS) and Foot Function Index (FFI) were used to assess pain and patient-reported outcomes at 1-year follow-up. Patients were polled for satisfaction at 1-year follow-up by yes/no survey. Results: Ninety-eight patients (89% female) were reviewed (98 feet; 43 NFC, 55 FC). Mean age was 48.3 years (range, 18-83 years). Mean preoperative VAS score was 7.5 and 7.7 in NFC and FC groups, which significantly decreased to 0.6 ( P < .01) and 0.6 ( P < .01), respectively. Mean total FFI was 53.9 and 54.2 and decreased to 17.9 ( P < .01) and 17.2 ( P < .01) in the NFC group and FC group, respectively. Overall, 97.8% of the NFC group and 96.4% of the FC group reported satisfaction. Mean HVA improved from 27.2 (16-42) degrees to 10.7 degrees (4-12) postoperatively in the NFC group. And in the FC group, HVA improved from 29.3 (19-39) degrees to 7.1 (4-12) degrees postoperatively. Postoperative HVA was significantly lower in the FC group ( P < .05). Conclusion: In an exclusively percutaneous surgical cohort with correction maintained by rigid screw fixation, fracture of the lateral cortex is associated with improved postoperative radiologic alignment without detriment to patient-reported outcomes. Level of Evidence: Level III, retrospective cohort study.

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Hallux Valgus Interphalangeus Measurement: Comparison of the 2 Radiographic Methods

Nebhani

Trivedy

Heyes

et al. 2022

Foot & Ankle Specialist

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Background To determine the reliability of Delta PP (difference in medial and lateral proximal phalanx wall length) compared with HIA (hallux interphalangeal angle) in the assessment of HVI (hallux valgus interphalangeus) in both preoperative and postoperative radiographs. Methods This was a retrospective observational study of 186 feet with hallux valgus. The number of cases required to adequately power the study was 128. Preoperative and postoperative hallux alignment were evaluated by 2 different radiological parameters, Delta PP and HIA. Interobserver variability was assessed independently by 2 authors and compared using a intraclass correlation coefficient. Results The intraclass correlation coefficient was more than 0.8 for all parameters, thus both HIA and Delta PP measurement provide reliable and reproducible data. Mean HIA significantly increased following surgical correction of hallux valgus. In comparison, the mean Delta PP decreased after correction. This postoperative increase in HIA indicates that preoperative HIA underestimates the magnitude of HVI and therefore is an inaccurate tool for measuring HVI’s contribution to the TVDH (total valgus deformity of the hallux) and to preoperative planning. However, the Delta PP was a greater determinant of the phalanx deformity’s contribution to the TVDH. Conclusion The outcome of our study shows that both HIA and Delta PP are reproducible when assessing the HVI deformity; however, Delta PP quantifies the amount of correction obtained more precisely. The additional benefit of measuring the Delta PP is that it allows for accurate planning in determining the dimensions of the medial-based wedge of the Akin osteotomy that needs to be resected. Levels of Evidence: Level 4

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Progressive Akin Osteotomy

Cited by 5 publications

References 3 publications

Fractures of the Great Toe Proximal Phalanx: A Case Series and Review of the Literature

Fractures of the Great Toe Proximal Phalanx: A Case Series and Review of the Literature

Fracturing the Lateral Hinge Improves Radiographic Alignment and Does Not Affect Clinical Outcomes of the Minimally Invasive Akin Osteotomy

Hallux Valgus Interphalangeus Measurement: Comparison of the 2 Radiographic Methods

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