Can Alternative Fixation Foster Better Outcomes With The Akin Osteotomy?

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Surgeons may find success with the Weinert modification of the Akin osteotomy, which the authors believe promotes a more stable fixation with fewer complications and risks.
By Anthony Weinert, DPM, Ali Elkhalil, DPM, and Ahmad Farah, DPM

What Are The Advantages Of The Technique?

      Increasing stability requires a minimum pulling force of monofilament wire, which results in maintaining the cortical stability of drill holes and the lateral hinge. However, the smooth translocation of wire, without locking between the osteotomy site or the drill hole, results in decreased stress forces on osteotomy and minimizes surgical operating time.

      More importantly, decreased surgical duration reduces the amount of anesthesia exposure to the patient in addition to decreasing tourniquet time. Moreover, the use of a suture retriever by a surgeon has the advantage of a greater margin of error in performing the cortical drill hole in that the cortical drill hole does not have to be parallel or congruent.

      The use of a suture retriever is not limited to the above procedure. Utilizing a suture retriever, one could make other types of osteotomy fixations more efficiently. For example, surgeons could use a suture retriever for an Akin osteotomy to facilitate horizontal interosseous wire loop fixation through four cortical holes, which does not require an intact cortical hinge.7

      Surgeons may utilize other types of fixation for base wedge osteotomies at the first ray. However, these fixations are time consuming and require more soft tissue dissection. A suture retriever could facilitate a less intensive dissection with base wedge osteotomies of the first ray, and allow a faster and easier procedure.

In Conclusion

      The focus of this article was to demonstrate the Weinert Modification Akin as a more efficient and practical method of applying monofilament wire fixation. Monofilament wire fixation has been utilized for many years with multiple practical applications.

      However, its use requires a learning curve to become proficient and efficient. The suture retriever is a device that reduces that learning curve and allows a broader spectrum and ease of use for monofilament wire.

      Dr. Weinert is the Chief of Podiatric Medicine and Surgery at Henry Ford Bi-County Hospital in Detroit, Mich.

      Dr. Elkhalil is a resident at Henry Ford Wyandotte Hospital in Wyandotte, Mich.

      Dr. Farah is a resident at Henry Ford Wyandotte Hospital in Wyandotte, Mich.

      Dr. Burks is a Fellow of the American College of Foot and Ankle Surgeons, and is board certified in foot and ankle surgery. Dr. Burks practices in Little Rock, Ark.

      Editor’s note: For related articles, see the August 2006 supplement “Techniques And Experiences In Foot And Ankle Surgery.”

      Also visit the archives at


1. Akin O. The treatment of hallux valgus: a new operative treatment and its result. Med Sentinel 33: 678, 1925.
2. Schwartz N, Hurley JP. Derotational akin Osteotomy: further modification. J Foot Surg 26: 419,1987.
3. Barouk LS. Osteotomies of the great toe. J Foot Surg 31:388, 1992.
4. Boberg A. Surgical procedure of the hallux, in comprehensive textbook of foot surgery, ed by ED McGlamry, AS Banks, MS Downey, P533, Williams & Wilkins, Baltimore, 1992.
5. Langford JH. ASIF Akin Osteotomy: a new method of fixation. JAPA 71: 390, 1981.
6. Levitsky DR, DiGilio J, Kander R, et. al. Rigid compression screw fixation of the first proximal phalanx osteotomy for hallux abducto valgus. J Foot Surg 21:65, 1982.
7. Schlefman SB. Akin Osteotomy with Horizontal Interosseous Wire-Loop Fixation. J Am Podiatr Med Assoc 89(4):1994-198, 1999.

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