Maintain the position by placing the graft anteriorly, tapering from front to back. Although the akin osteotomy has limited use as an isolated procedure for surgeons, it is still a valuable adjunct procedure. The role of the akin osteotomy in the surgical management of hallux abducto valgus. The akin osteotomy is a widely used procedure where various fixation methods are available, predominantly with the use of metallic component wire, screw, staple etc. According to the wheeless textbook of orthopaedics, an akin procedure is a closing wedge osteotomy of the first toe hallux proximal phalanx with excision of the medial eminence. The akin osteotomy is most commonly used to accompany a scarf or chevron osteotomy. Retrospective analysis of the akin osteotomy steven douthett, dpm1. Proximal rotational metatarsal osteotomy promo is a technique that allows the surgeon to correct the varus and pronation of the first metatarsal that is observed in most patients with hallux. Akin in 1925 and consists of a closing wedge osteotomy of the proximal phalanx of the hallux. This is the fourth edition of a compact, classic book on the essentials of surgical technique and anatomy, just as the title states. The operation takes about 30 minutes, although you will be in the day surgery unit for longer. Wapners phone number, address, insurance information, hospital affiliations and more. It is a very good, quick reference for common general surgical procedures.
An isolated akin is contraindicated in the treatment of hallux valgus. Lapidus procedure and akin osteotomy the day of the operation the operation is usually performed under a local anaesthetic which means that you will be awake. Fixation of akin osteotomy for hallux abductus with. Results after distal austin and proximal displacement. Osteotomies have been recommended for hv surgery since the last 2 decades, with good success rate and reliable over time. Selection of a particular osteotomy is also dependent on the surgeons familiarity and experience with the various surgical options. Written by over 800 experts from leading institutions around the world, this superbly illustrated fourvolume reference focuses on mastery of operative techniques and also provides a thorough understanding of how to select the best procedure. The primary indication for an akin osteotomy is hallux valgus interphalangeus or in cases in which residual hallux valgus causes pressure on the second toe on the load stimulation test. However, with that technique, we have had cases of fracture while applying the knot. Further, the flexibility of the system allows the surgeon to adapt the osteotomy to the patient. The osteotomy site is fixed with a dynanite nitinol staple, lowprofile quickfix. A distal femoral osteotomy combined with a proximal tibial osteotomy is able to correct the axis of the lower limb while maintaining an acceptable obliquity of the joint line fig. It is usually performed for the correction of a hallux valgus deformity in conjunction with a first metatarsal osteotomy, hallux interphalangeal deformity, and long proximal phalanx.
For mild deformities, a distal metatarsal osteotomy, such as a chevron osteotomy, is sufficient. An akin osteotomy may also allow additional correction but carries its own complications. Dorsallateral incision, from the calcaneo cuboid joint to dre cuboidmeratarsal joint. Wright set industry standards by employing the first dedicated sales force to serving you, the foot and ankle surgeon. The aim of our study was to develop a static, anatomic reconstruction procedure. The akin osteotomy is a medially based closing wedge osteotomy of the proximal phalanx described by of akin 1 in 1925.
The rotation scarf and akin osteotomy for the correction of severe hallux valgus. The akin type procedure has been advocated primarily as a correction of hallux valgus deformity where the joint is left undisturbed and the toe is realigned by a proximal phalangeal osteotomy. Loosen joints are held together with surgical screws, allowing for fusion of the metatarsal to the cuneiform joint, resulting in permanent correction of. A frequently used technique to maintain the reduction of the akin osteotomy with absorbable suture is the use of 2 suture knots through cortical bone across the osteotomy 7, 8, which has also been our previous practice.
Akin osteotomy of the proximal phalanx utilizing the richards mini staple. There are different ways for obtaining this ideal osteotomy direction graphs, equations, etc. You can eat and drink as normal and take any prescribed medications on the day of operation unless advised otherwise. A modified suture technique for fixation of the akin osteotomy.
In his original description, the procedure entailed a resection of the medial exostosis of the first metatarsal head and a section of the base of the proximal phalanx together with a cuneiformshaped. Packed with fullcolor illustrations, pearls, and pitfalls, this technique manual delivers stepbystep guidance on the essential elements of complex foot and ankle surgery. Hundreds of surgical techniques exist for hallux valgus hv, arguably no technique being significantly better than the others. Wiesels operative techniques in orthopaedic surgery.
Last summer i had a bone removed in the large toe on my right foot, bone shaved off and a pin permanently inserted into the toe. The akin procedure is a medial closing wedge osteotomy used to correct hallux valgus interphalangeus. Written by experts from leading institutions around the world, this superbly illustrated volume focuses on mastery of operative techniques and also. Thirdgeneration percutaneous forefoot surgery intechopen. A new surgical technique of ligamentoplasty using the abductor hallucis tendon is described. Dorsalmedial incision, from the talo navicular joint to the cuneiformmetatarsal joint. Wapner is a orthopedic surgeon in philadelphia, pa. Surgical technique for a double osteotomy springerlink. According to the authors, the development of this fixation mica allows it to be used in severe hv deformity maximum displacement of 100%. The aim of this study is to demonstrate the results of our modified akin procedures, where the fixation of the phalangeal osteotomy is achieved by absorbable suture, without metallic component. Mis combines a modified chevronakin technique with internal fixation to add extra stability to the surgical correction. Ensure that the osteotomy remains closed posteriorly. Sixteen patients 25 feet had an akin osteotomy with a scarf procedure. A modified suture technique for fixation of the akin osteotomy article in the journal of foot and ankle surgery.
It is used to correct hallux valgus interphalangeus. With fixation method to get rid of the risk of loss of the surgical reduction of the misalignment, but requires an additional surgical procedure marked by the implementation of a percutaneous. Discussion in foot surgery started by newsbot, jun 21. This surgical technique describes the steps and principles involved when using the lcp pediatric hip plate 2. The local anaesthetic is administered via injections around the.
Myerson, shares his innovative approaches to the reconstructive surgical techniques most frequently seen in practice. Ideal surgical treatment for hallux valgus is still controversial. This author explores when to perform an isolated akin and which procedure to choose, offers a guide to effective fixation and discusses how to. Today, a third generation, minimally invasive surgery mis is available. As a result, wright is the recognized leader of surgical solutions for the foot and ankle. The seri distal metatarsal osteotomy and scarf osteotomy.
The purpose of this chapter is to outline the role of osteotomy of the proximal phalanx of the hallux, the akintype procedure, in the correction of hallux valgus. It contains the chapters on the foot and ankle from sam w. The akin osteotomy is usually a component of a primary procedure in which a hallux valgus deformity is corrected. Management of the second and third metatarsal in moderate. Operative techniques in foot and ankle surgery provides fullcolor, stepbystep explanations of all operative procedures in podiatry. This will continue to be a good reference for general surgeons both during and after training. After the metatarsal osteotomy is performed, an optional phalangeal osteotomy akin osteotomy should be performed depending on the remaining interphalangeal deformity. An akin osteotomy is a medial closing wedge osteotomy of the proximal phalanx of the great toe. A traditional distal metatarsal osteotomy with rigid fixation scarf procedure and a more minimally invasive approach to a distal metatarsal osteotomy, termed seri simple, effective, rapid, inexpensive, have proven successful with shortterm followup. From product concept to development, our goal is simple. John kish, phd2 1foot and ankle surgical residency beaumont hospital wayne, mi 2department of medical education beaumont hospital dearborn, mi statement of purpose the purpose of this study was the investigate the impact of lateral cortical hinge disruption on healing.