Minimally invasive Akin osteotomy and lateral release: Anatomical structures at risk-A cadaveric study.
BACKGROUND
Among the many surgical techniques used for hallux valgus correction, different osteotomies may be performed in the proximal phalanx as well as lateral release as associated procedures. The aim of this study is to analyze the anatomical relationships and the risks for the soft tissue lessions when performing the dorsomedial minimally invasive surgery (MIS) portal for the Akin osteotomy, and the MIS dorsolateral portal for lateral release, in order to define a safety zone when conducting the procedure in order to avoid complications.


METHODS
The procedures were carried out on 16 fresh-frozen cadaveric feet. A MIS dorsomedial and dorsolateral portals were performed. The anatomical dissection of the cadaveric pieces was carried out and the different anatomic and surgical relationships were analyzed and measured.


RESULTS
No nerve injury was found. Injury of the extensor hallucis longus (EHL) paratendon were seen in 9 cases (56%). There was no injury of the flexor hallucis longus (FHL) tendon and or collateral plantar nerves. A partial injury of the FHL sheath was observed in 44% of the samples.


CONCLUSIONS
Although percutaneous Akin osteotomy is clinically effective, the possibility of injury of anatomic structures is high (9-55%), however injuries upon vascular or nerve structures were not seen.
Department of Orthopaedics and Traumatology, Austral University Hospital, Buenos Aires, Argentina.
Juan Manuel
JM
Yañez Arauz
Department of Orthopaedics and Traumatology, Austral University Hospital, Buenos Aires, Argentina. Electronic address: javierdv@mac.com.
Jorge Javier
JJ
Del Vecchio
Department of Orthopaedics and Traumatology, Austral University Hospital, Buenos Aires, Argentina.
Mariano
M
Codesido
Department of Orthopaedics and Traumatology, Austral University Hospital, Buenos Aires, Argentina.
Nicolás
N
Raimondi
D002102:Cadaver; D006214:Hallux / Q000033:anatomy & histology* / Q000601:surgery*; D006801:Humans; D019060:Minimally Invasive Surgical Procedures; D010027:Osteotomy / Q000379:methods*; D059348:Peripheral Nerve Injuries / Q000209:etiology / Q000517:prevention & control; D013708:Tendon Injuries / Q000209:etiology / Q000517:prevention & control; D050277:Toe Phalanges / Q000033:anatomy & histology* / Q000601:surgery*
Akin; Anatomy; Cadaveric study; Lateral Release; Minimally Invasive