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Presentado en II International Congress of Mini-Invasive Foot and Ankle Surgery - MISFA 2009. 23 de abril; Murcia, España.
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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