The document discusses the Akin osteotomy procedure used in the treatment of hallux valgus, highlighting its historical background, indications, and outcomes. It reports a high consolidation rate and low complication rate, with findings suggesting that fixation may not be necessary for successful results. The analysis includes clinical results, angular measurements, and postoperative rehabilitation protocols.

1. Osteotomia de Akin asociada a otras técnicas para el tratamiento del Hallux Valgus Porque percutánea? Es necesario fijarla? Dr. Del Vecchio, Javier Dr. Aliaga, Andrés Dr. Raimondi, Nicolás Dra. Pinto Piotti, Teresa

2. 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

3. 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

4. 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

5. Nowadays… Hallux Rigidus: Akin-Moberg Technique Extensus: Plantarflexion Akin The Akin Osteotomy Turned to!

6. Where? Proximal Distal Distal Articular Set Angle (DASA) Interphalangeous Angle (IPA) Diapheseal not recomended!

7. Hypothesis Is secure? Consolidation rate, complications Is efective? Clinic results Rx measurements Cosmetic Why percutaneous? Is fixation necessary? Malunion Rate

8. Methods 44 Akin osteotomies (42 Women:95,5%) 35 (74,3%): Modified Chevron 9 (25,7%): Bosch Weightbearing X-Rays 3th and 4th Week 3th month January-October 2008

9. Methods Distal Articular Set Angle (DASA) Angular measurements Interphalangeous Angle (IPA) Normally 0-6˚ Normally < 10˚

10. Surgical Technique Medial Portal Swann-Morton Blade MS67 Large Shannon Straight Wedge Burr if necessary… Percutaneous Akin Osteotomy

11. 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

12. Results Normal DASA 84% 16% Hypercorrection (Average -2,7°) Angular measurements

13. 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

14. Rehabilitation Protocol Inmediatly weighbearing Rigid Insole Shoe Passive articular movement Sylicon Device First 3/4 weeks Week 3/4-6

15. 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

16. Discussion “ The size of the wedge can be calculated using trigonometric analysis to give the desired angular correction”. Correction 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! Wedge Base Correction 3 mm 8° 5 mm 16° 8 mm 24°

17. Sutures Absorvibles Non absorvibles Staples Biodegradable Surgical Steel Titanium Clips Screws Surgical Steel Titanium Wires K-wire Fixation methods Discussion Our series: not necessary

18. 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):1-6 Green 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.

19. 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