title: Staple fixation for akin proximal phalangeal osteotomy in the treatment of hallux valgus interphalangeus.
abstract: BACKGROUND
  The Akin proximal phalangeal osteotomy is commonly used in conjunction with metatarsal osteotomies to treat hallux valgus. Multiple fixation methods including suture, wire, screw, and staple fixation have been described. The aims of this study were to assess the intraoperative and postoperative complications and to evaluate short-term postoperative outcomes in patients who underwent Akin osteotomy with staple fixation.
  
  
  METHODS
  Forty-four patients (51 feet) with painful hallux valgus were retrospectively reviewed at an average of 40.4 ± 15.8 (range, 25.9 to 79.9) weeks following an Akin osteotomy with staple fixation. Patient reported preoperative and postoperative Visual Analog Score (VAS) (0 to 10, 0 = no pain) was recorded. Level of activity was reported postoperatively. Hallux valgus angles (HVAs), intermetatarsal angles (IMAs), and hallux valgus interphalangeus angles (IPAs) were evaluated on preoperative as well as final postoperative radiographs. Postoperative clinical and radiographic examinations were used to evaluate for complications.
  
  
  RESULTS
  Mean VAS improved from 4.4 ± 2.6 to 1.0 ± 1.2 (P < .001). Activity level was classified as ability to bear weight as tolerated 3/51 (5.9%), ambulate 1 to 4 blocks 2/51 (3.9%), ambulate a minimum of 6 blocks 18/51 (35.3%), and ambulate an unlimited distance 28/51 (59.4%). Average HVA, IMA, and IPA improved from 25.6 ± 10.0 degrees to 14.1 ± 8.1 degrees (P < .001), 13.1 ± 4.6 degrees to 8.0 ± 3.0 degrees (P < .001), and 7.9 ± 3.4 degrees to -3.1 ± 6.4 degrees (P < .001), respectively. No major postoperative complications, including infections, nonunions, or recurrent deformities, were recorded. Two patients sustained breaches of the lateral cortex, but this was without appreciable complication. Three patients (5.9%) reported unilateral proximal-medial great phalanx tenderness. There was 1 revision for persistent deformity, specifically in the HVA and IPA angles.
  
  
  CONCLUSIONS
  Akin osteotomy with staple fixation was a safe and effective procedure as part of a hallux valgus correction with improvement in pain and hallux valgus deformity with a low risk for complications.
  
  
  METHODS
  Level IV, case series.
authors.affiliation: Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA Julie.Neumann.MD@gmail.com.
authors.forename: Julie A
authors.initials: JA
authors.lastname: Neumann
authors.affiliation: Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA.
authors.forename: Kathleen D
authors.initials: KD
authors.lastname: Reay
authors.affiliation: Duke University Medical Center, Durham, NC, USA.
authors.forename: Kendall E
authors.initials: KE
authors.lastname: Bradley
authors.affiliation: Department of Orthopaedic Surgery, Duke University Medical Center, North Carolina Orthopaedic Clinic, Durham, NC, USA.
authors.forename: Selene G
authors.initials: SG
authors.lastname: Parekh
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D006215:Hallux Valgus / Q000601:surgery*; D006801:Humans; D008297:Male; D008683:Metatarsophalangeal Joint / Q000601:surgery; D008875:Middle Aged; D010027:Osteotomy / Q000295:instrumentation* / Q000379:methods; D010147:Pain Measurement; D010149:Postoperative Pain / Q000503:physiopathology*; D016059:Range of Motion, Articular / Q000502:physiology; D020127:Recovery of Function; D012189:Retrospective Studies; D017792:Surgical Stapling; D014945:Wound Healing / Q000502:physiology
keywords: bunion; hallux valgus; osteotomy