SLR - July 2018 - Robert A. Rawski
Reference: Sinnett T, Fang Y, Nattfogel E, O-Gorman A, Charalambides C. Suture Fixation of an Akin Osteotomy: A Cost-Effective and Clinically Reliable Technique. Foot and Ankle Surgery. 2017 March; 23(1):40–43.Scientific Literature Review
Reviewed By: Robert A. Rawski, DPM
Residency Program: Columbia St. Mary’s Hospital, Milwaukee, WI
Podiatric Relevance: Often, the Akin osteotomy is used as an adjunct procedure to osteotomies of the first metatarsal for the correction of hallux valgus. Its indication is for the correction of a hallux valgus interphalangeus. Numerous fixation techniques are available ranging from staples and screws to wires. These fixations are effective, but they may be accompanied by complications. Irritation and implant migration may necessitate removal. Suture fixation of osteotomies offers a cost-effective method with reliable results without the risk of implant complication.
Methods: Two case series were reviewed and compared. One series was that of a single surgeon who performs Akin osteotomies using the suture fixation technique. A 2 mm solid drill was used to make two holes 5 mm proximal and 5 mm distal to the planned osteotomy. Wedge osteotomy was performed preserving lateral cortex. Monofilament absorbable 1/0 suture on a curved needle (Monocryl) was passed through one hole into the osteotomy site and out the second hole. The osteotomy site was then closed and compressed while the knot was secured. Posterior splint for two weeks then weightbearing as tolerated in a heel wedge shoe for a total of six weeks. The other series was that of a surgeon who performs Akin osteotomies using staple fixation technique. Wedge osteotomy was performed as above, and an 8 mm 90° Marquardt staple was inserted across site. Postoperative management was much the same as above. Data was collected, and postoperative follow-up was 6 weeks, which included radiographs. The hallux valgus (HV) and hallux interphalangeal (HI) angles pre- and postoperatively were recorded. Length of the proximal phalanx was also recorded. A cost analysis was performed.
Results:
Suture fixation series:
No evidence of nonunion, delayed union or excessive bone callus. No loss of correction or reports of discomfort by the patient at the site of the osteotomy.
Staple fixation results:
No evidence of nonunion, delayed union or excessive bone callus. No loss of correction or reports of discomfort by the patient at the site of the osteotomy. No reported complications.
Statistical analysis demonstrated no significant difference in either the preop or postop measurements in the two case series.
A cost analysis comparing the material cost of the two different fixation types was performed and showed the average staple cost to be £56.75 or about $75 (Marquardt) and the suture costing only £1.39 or about $2 (Monocryl, Ethicon).
Conclusions: Several fixation techniques have been described for the Akin osteotomy. They vary in complexity both with regard to surgical technique and need for special instrumentation. They also vary in cost and complication rates. This study describes how suture fixation provides a comparable outcome to other techniques and reduces overall operative costs.