Screw versus staple fixation for Akin osteotomy

Background Proximal row carpectomy (PRC) and four-corner arthrodesis (FCA) are common treatments for stage II scapholunate advanced collapse (SLAC) and scaphoid nonunion advanced collapse (SNAC) wrists, with similar functional and patient-reported outcomes reported in the peer-reviewed literature. Questions Study questions included (1) whether surgical encounter total direct costs (SETDCs) differ between PRC and FCA, and (2) whether SETDC differs by method of fixation for FCA. Patients and Methods Consecutive adult patients (≥ 18 years) undergoing PRC and FCA between July 2011 and May 2017 at a single tertiary care academic institution were identified. Patients undergoing additional simultaneous procedures were excluded. Using our institution's information technology value tools, we extracted prospectively collected cost data for each surgical encounter. SETDCs were compared between PRC and FCA, and between FCA subgroups (screws, plating, or staples). Results Of 42 included patients, mean age was similar between the 23 PRC and 19 FCA patients (51.2 vs. 54.5 years, respectively). SETDCs were significantly greater for FCA than PRC by 425%. FCA involved significantly greater facility costs (2.3-fold), supply costs (10-fold), and operative time (121 vs. 57 minutes). Implant costs were absent for PRC, which were responsible for 55% of the SETDC for FCA. Compared with compression screws, plating and staple fixation were significantly more costly (70% and 240% greater, respectively). Conclusion SETDCs were 425% greater for FCA than PRC. Implant costs for FCA alone were 130% greater than the entire surgical encounter for PRC. For FCA, SETDC varied depending on the method of fixation. Level of Evidence This is a level III, cost analysis study.

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Arthroscopic staple fixation in the management of displaced anterior cruciate ligament avulsion fractures

Indian Journal of Orthopaedics Surgery ◽

10.18231/2395-1362.2018.0026 ◽

2018 ◽

Vol 4 (2) ◽

pp. 121-125

Keyword(s):

Anterior Cruciate Ligament ◽

Cruciate Ligament ◽

Avulsion Fractures ◽

Anterior Cruciate Ligament Avulsion ◽

Anterior Cruciate ◽

Staple Fixation

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Double First Metatarsal and Akin Osteotomy for Severe Hallux Valgus

Foot & Ankle International ◽

10.1177/1071100715589173 ◽

2015 ◽

Vol 36 (10) ◽

pp. 1215-1222 ◽

Cited By ~ 12

Author(s):

Shafic Said Al-Nammari ◽

Theodoros Christofi ◽

Callum Clark

Keyword(s):

Hallux Valgus ◽

First Metatarsal ◽

Akin Osteotomy ◽

Severe Hallux Valgus

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Third-Generation Minimally Invasive Chevron-Akin Osteotomy for Hallux Valgus Produces Similar Clinical and Radiological Outcomes as Scarf-Akin Osteotomy at 2 Years: A Matched Cohort Study

Foot & Ankle International ◽

10.1177/10711007211049193 ◽

2021 ◽

pp. 107110072110491

Author(s):

Adriel You Wei Tay ◽

Graham S. Goh ◽

Kevin Koo ◽

Nicholas Eng Meng Yeo

Keyword(s):

Minimally Invasive ◽

Hallux Valgus ◽

Physical Component Score ◽

Control Group ◽

Component Score ◽

Vas Score ◽

Sf 36 ◽

Significant Difference ◽

Akin Osteotomy ◽

New Generation

Background: The minimally invasive chevron-Akin (MICA) osteotomy is an increasingly popular technique for the correction of hallux valgus. However, there is a paucity of literature comparing it with traditional open techniques. The purpose of this study was to compare the clinical and radiological outcomes of the MICA osteotomy using a new-generation MICA screw and scarf-Akin osteotomy for hallux valgus correction. Methods: Thirty cases of MICA osteotomy were propensity score matched 1:1 with a control group of 30 scarf-Akin osteotomy cases. The groups were matched for age, sex, body mass index, preoperative visual analog scale (VAS) score, American Orthopaedic Foot & Ankle Society (AOFAS) metatarsophalangeal-interphalangeal (MTP-IP) score, 36-Item Short-Form Health Survey (SF-36) physical component score (PCS) and mental component score (MCS), preoperative hallux valgus angle (HVA) and intermetatarsal angle (IMA), and concomitant procedures. Outcomes were compared at 6 and 24 months postoperatively. Early postoperative VAS scores were also compared. Results: Both groups demonstrated significant improvements in VAS score, AOFAS score, and SF-36 PCS and MCS at 6 and 24 months postoperatively. For the MICA group, HVA improved from 23.5 to 7.7 degrees, and IMA improved from 13.5 to 7.5 degrees. For the scarf-Akin osteotomy group, HVA improved from 23.7 to 9.3 degrees, and IMA improved from 13.6 to 7.8 degrees. The first 24-hour postoperative VAS score was significantly lower in the MICA group compared with the scarf-Akin group (2.0 ± 2.0 vs 3.4 ± 2.6, P = .029). However, there was no significant difference in clinical or radiological outcomes between the groups at 6 and 24 months. Conclusion: The MICA procedure with the new-generation MICA screw is an attractive option for the correction of hallux valgus, yielding similar midterm radiological and clinical outcomes compared with the well-established scarf-Akin osteotomy. The first 24-hour postoperative VAS score in the MICA group was also statistically lower, although its clinical significance remains to be determined. Level of Evidence: Level III, retrospective comparative study.

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