Need for concomitant Akin osteotomy in patients undergoing Chevron osteotomy can be determined preoperatively: a retrospective comparative study of 859 cases

Kaufmann, Gerhard; Hofmann, Maximilian; Braito, Matthias; Ulmer, Hanno; Brunner, Alexander; Dammerer, Dietmar

doi:10.1186/s13018-019-1319-2

Cited by 12 publications

(18 citation statements)

References 27 publications

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“…There was a significant increase (mean, 4.1 degrees, P < .001) in the a1-2 IMA from a mean of 10.9 degrees (range, 8-14) preoperatively to 15.0 degrees (range, [9][10][11][12][13][14][15][16][17][18][19] postoperatively. For the m1-2IMA, there was a significant decrease (mean, 4.6 degrees, P < .001) from a mean of 10.9 degrees (range, 8-14) preoperatively to 6.4 degrees (range, 1-11) postoperatively.…”

Section: Resultsmentioning

confidence: 90%

“…The mean improvement of the m1-2IMA (4.6 degrees) and the mean postoperative m1-2IMA (6.4 degrees) is comparable to multiple prior studies evaluating DCO. 3,5,9,10,12,13,16,20,28,32 Similarly, the HVA was also noted to have significant improvement with a final average measurement of 8.5 degrees. This is consistent with the existing literature, 3,5,9,10,12,13,16,20,28,32 and expected given that the mechanical axis of the first metatarsal was used for the HVA measurement.…”

Section: Discussionmentioning

confidence: 91%

“…10 The cause of recurrent HV is likely multifactorial but the described radiologic risk factors include greater preoperative deformity, incomplete reduction of the sesamoids, metatarsophalangeal joint incongruency, as well as first ray hypermobility. 12,18,21,22,25 Although we excluded any patients with radiographic evidence of first ray instability in this study, increasing the a1-2IMA effectively results in the presence of a metatarsus primus varus and could contribute to HV recurrence following DCO. However, further investigation is warranted to directly link HV recurrence to a change in the anatomic metatarsal axis.…”

Section: Discussionmentioning

confidence: 99%

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Distal Chevron Osteotomy Increases Anatomic Intermetatarsal Angle in Hallux Valgus

Chan

Noori

Chen

et al. 2020

Foot & Ankle Orthopaedics

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Background: Distal chevron metatarsal osteotomy (DCO) is a common technique to address hallux valgus (HV), which involves coronal translation of the capital fragment resulting in a nonanatomic first metatarsal. The purpose of this study was to evaluate the radiographic effect of the DCO on the anatomic vs the mechanical axis of the first metatarsal. Our hypothesis was that patients undergoing DCO would have improvement in the mechanical metatarsal axis but worsening of the anatomic axis. Methods: This was a retrospective case series of consecutive patients who underwent DCO for HV. The primary outcomes were the change in anatomic first–second intermetatarsal angle (a1-2IMA) vs mechanical first–second intermetatarsal angle (m1-2IMA). Secondary outcomes included the change in hallux valgus angle (HVA) and medial sesamoid position. Results: 40 feet were analyzed with a mean follow-up of 21.2 weeks. The a1-2IMA increased significantly (mean, 4.1 degrees) whereas the m1-2IMA decreased significantly (mean, 4.6 degrees) following DCO. There was a significant improvement in HVA (mean, 12.5 degrees). Medial sesamoid position was improved in 21 feet (52.5%). Patients with no improvement in sesamoid position were found to have a larger increase in a1-2IMA (mean, 4.7 vs 3.5 degrees, P = .03) and less improvement in m1-2IMA (mean, 3.8 vs 5.2 degrees, P = .02) compared to patients with improvement in sesamoid position. Conclusion: Distal chevron osteotomy for HV was associated with worsening of the anatomic axis of the first metatarsal despite improvements in the mechanical metatarsal axis, HVA, and medial sesamoid position. Greater worsening of the anatomic axis was associated with less improvement of sesamoid position. Our findings may suggest the presence of intermetatarsal instability, which could limit the power of DCO in HV correction for more severe deformities and provide a mechanism for HV recurrence. Level of Evidence: Level IV, retrospective case series.

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Section: Resultsmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 99%

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Distal Chevron Osteotomy Increases Anatomic Intermetatarsal Angle in Hallux Valgus

Chan

Noori

Chen

et al. 2020

Foot & Ankle Orthopaedics

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“…It was found that the average contribution of the IPA to the total hallux valgus angle (HVA) is 28.3%, which should be considered for correction of hallux valgus. 25 Kaufmann et al 12 found a significantly improved correction of first-ray alignment in a combined chevron and Akin osteotomy compared to an isolated chevron osteotomy with a lower rate of recurrence. This finding was confirmed by another study of this group comparing isolated Scarf osteotomy with combined Scarf and Akin osteotomy (recurrence isolated Scarf 14.7% [n = 184] vs combined procedure 1.6% [n = 63]).…”

Section: Introductionmentioning

confidence: 99%

“…13 Hence, the authors recommend a combined procedure if a preoperative proximal to distal phalangeal articular angle of 8 degrees is present. 12,13…”

Section: Introductionmentioning

confidence: 99%

Minimally Invasive vs Open Akin Osteotomy

et al. 2020

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Background: Minimally invasive techniques of Akin osteotomy have grown in popularity, as early results suggest faster recovery, earlier return to work, and minimized wound healing problems. Preserving lateral cortex integrity during first phalanx osteotomy thereby presents a challenge because of the lack of direct visual control. This retrospective comparative study investigated clinical and radiographic outcomes of minimally invasive and open Akin osteotomy with different fixation methods and analyzed whether or not intraoperative violation of the lateral cortex caused loss of correction or delayed bone healing. Methods: One hundred eighty-four patients (210 feet) with symptomatic hallux valgus and pathologic interphalangeal angle (IPA) of at least 10 degrees underwent surgery combined with Akin osteotomy. Minimally invasive Akin osteotomies were fixed in 124 feet with 2 crossing percutaneous K-wires and compared to 86 Akin osteotomies by open technique with double-threaded (head and shank) screw fixation. At 1 day and 6 and 12 weeks postoperatively, IPA and bony consolidation were radiographically and clinically assessed. Results: Mean preoperative IPA was 13.4 ± 3.6 degrees in minimally invasive (MI) and 13.3 ± 3.5 degrees in open surgery (OS) cases ( P > .05). Intraoperative breach of the lateral cortex occurred in 12 (13.9%) in OS and 64 (51.6%) in MI cases. Whereas the breach occurred in open technique mainly during manual correction by applying a medial closing force, it was caused predominantly by the use of the burr in minimally invasive technique. After 12 weeks, the mean IPA was 4.1 ± 1.4 degrees in MI and 4.8 ± 1.2 degrees in OS cases ( P > .05). Bony consolidation was complete after 6 and 12 weeks in OS and MI, respectively. Three deep infections occurred in the OS Group after Lapidus arthrodesis and 2 deep infections were registered in the MI Group after minimally invasive chevron and Akin osteotomy. The infections were not at the site of the Akin osteotomy. Conclusion: Breach of the lateral cortex did not impair bone healing or correction of IPA. Minimally invasive Akin osteotomy with K-wire fixation provided equivalent correction of IPA compared to open surgery with screw fixation. Level of Evidence: Level III, retrospective comparative series.

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Outcomes After Chevron Osteotomy with and Without Additional Akin Osteotomy: A Retrospective Comparative Study

Kuliński

Michal

Tomczyk

et al. 2023

JOIO

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Background Chevron osteotomy is one of the most common approaches to hallux valgus corrective surgery. This procedure is often combined with Akin osteotomy of the proximal phalanx of the hallux. There are no definitive guidelines specifying the indications for a given osteotomy technique nor data on postoperative loss of correction or the effect of the type of first-ray surgery on the development of adjacent-joint arthritis. The aim of this study was to assess radiographic treatment outcomes via chevron osteotomy with and without Akin osteotomy. Methods The study evaluated 117 patients treated in the period 2016–2019. Ninety-nine of those patients underwent distal chevron osteotomy alone, and 18 patients underwent a combined chevron–Akin double osteotomy. The analyzed radiograms had been obtained preoperatively, at 6 weeks after surgery, and after a long-term follow-up. The following parameters were assessed: the intermetatarsal angle (IMA), hallux valgus angle (HVA), interphalangeal angle (IPA), postoperative recurrence of valgus deformity, adjacent-joint arthritis, and complications. Results Chevron-Akin osteotomy helped maintain lower HVA and IPA values in long-term follow-up in comparison with those in the patients who underwent chevron osteotomy alone. The chevron osteotomy group showed a significant increase in the mean HVA from 18.37° at the first follow-up visit to 20.81° at the last follow-up visit. There were no differences between the groups in terms of the remaining assessed radiographic parameters. Hallux valgus surgery does not increase adjacent-joint arthritis. Conclusion The use of combined chevron-Akin osteotomy does not affect HVA or IMA correction. The combination of chevron and Akin osteotomies reduces the risk of increased HVA and IPA in long-term follow-up. The additional Akin osteotomy does not increase the risk of adjacent-joint arthritis. Combining chevron osteotomy with Akin osteotomy is recommended in hallux valgus deformity correction.

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Need for concomitant Akin osteotomy in patients undergoing Chevron osteotomy can be determined preoperatively: a retrospective comparative study of 859 cases

Cited by 12 publications

References 27 publications

Distal Chevron Osteotomy Increases Anatomic Intermetatarsal Angle in Hallux Valgus

Distal Chevron Osteotomy Increases Anatomic Intermetatarsal Angle in Hallux Valgus

Minimally Invasive vs Open Akin Osteotomy

Outcomes After Chevron Osteotomy with and Without Additional Akin Osteotomy: A Retrospective Comparative Study

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