J Korean Foot Ankle Soc.  2015 Dec;19(4):197-200. 10.14193/jkfas.2015.19.4.197.

Medial Horizontal Suture Fixation of the Akin Osteotomy: A Technical Report

• Yune YP
• Kim S

• KMID: 2132465
• DOI: http://doi.org/10.14193/jkfas.2015.19.4.197

Abstract

The Akin osteotomy is a complimentary procedure in hallux valgus surgery. Surgical techniques may vary depending on the operators or fixation devices. Suture fixation, for which a removal procedure is not necessary, can often be recommended. However, there is a risk of failure due to the thin cortex of the phalanx. We describe a new technique using Ethibond suture fixation in Akin osteotomy, which can lower the risk of phalangeal cortical failure and articular cartilage irritation. First, the Akin osteotomy was performed on the proximal phalanx 5 to 6 mm distal to the first metatarsophalangeal joint. Then bone holes were drilled from dorsum to plantar parallel to osteotomy with the Kirschner wire. The final procedure involved passing the Ethibond sutures connected to a straight needle through the holes and tying it. This fixation method offers an effective and easy technique for performance of Akin osteotomy.

Keyword

Hallux valgus; Akin osteotomy; Suture fixation

MeSH Terms

Cartilage, Articular
Hallux Valgus
Metatarsophalangeal Joint
Needles
Osteotomy*
Sutures*

Figure

• 

  Figure 1. (A, B) Osteotomy is performed on the proximal phalanx 5 to 6 mm distal to the first metatarsophalangeal joint. The size of medial closing wedge osteotomy was determined by remaining valgus angle.

• 

  Figure 2. (A, B) Two holes are placed horizontally on either side of osteotomy using 1.6 mm Kirschner wire.

• 

  Figure 3. (A, B) No. 2 Ethibond sutures (Ethibond Inc.) on straight needle are passed into both side holes.

• 

  Figure 4. (A, B) Osteotomy site was closed and tied with Ethibond suture (Ethibond Inc.).

• 

  Figure 5. Preoperative weightbearing anteroposterior radiograph of a 65-year-old woman shows hallux valgus in the left foot.

• 

  Figure 6. Radiograph at postoperative 1 week shows drill holes fixed with Ethibond (Ethibond Inc.) at the proximal phalanx of the great toe.

• 

  Figure 7. Radiograph at postoperative 12 months shows improved alignment of the hallux and union of Akin osteotomy.

Reference

References

1. Murphy JS, Mozena JD, Walker RE. J-wire technique for fixation of the Akin osteotomy. J Am Podiatr Med Assoc. 1989; 79:291–3.

2. Neumann JA, Reay KD, Bradley KE, Parekh SG. Staple fixation for akin proximal phalangeal osteotomy in the treatment of hallux valgus interphalangeus. Foot Ankle Int. 2015; 36:457–64.

3. Barca F, Busa R. Resorbable poly-L-lactic acid mini-staples for the fixation of Akin osteotomies. J Foot Ankle Surg. 1997; 36:106–11.

4. Akin OF. The treatment of hallux valgus; a new operative procedure and its results. Med Sentinel. 1925; 33:678–9.

5. Chacon Y, Fallat LM, Dau N, Bir C. Biomechanical comparison of internal fixation techniques for the Akin osteotomy of the proximal phalanx. J Foot Ankle Surg. 2012; 51:561–5.

6. Ahn SJ, Kim BH, Song MH, Kang SW, Oh KT, Yoo SH. Transarticular fixation of akin osteotomy on patients with hallux valgus after resection of medial protrusion of base of proximal phalanx. J Korean Foot Ankle Soc. 2013; 17:220–4.

7. Roy SP, Tan KJ. A modified suture technique for fixation of the Akin osteotomy. J Foot Ankle Surg. 2013; 52:276–8.

8. Young KW, Lee KT, Kim JY, Cha SD, Kim ES. Fixation with suture material in Akin osteotomy. J Korean Foot Ankle Soc. 2004; 8:138–41.

9. Schlefman BS. Akin osteotomy with horizontal interosseous wire-loop fixation. J Am Podiatr Med Assoc. 1999; 89:194–8.