Is Akin fixation necessary in the Percutaneous Chevron and Akin osteotomies (PECA) technique? A retrospective comparative study with 2-year follow-up.

Background: Minimally invasive or percutaneous techniques for correcting hallux valgus (HV) have been increasingly prominent in scientific publications. However, the Akin osteotomy has received little attention. The aim of this study was to evaluate whether there is a difference between fixation or non-fixation of the Akin osteotomy for percutaneous HV correction.

Methods: Thirty-one patients (47 feet) were retrospectively identified, with a minimum 2-year follow-up, and divided into two cohorts: The first cohort comprised 16 patients (24 feet, 8 bilateral) who underwent using the Percutaneous Chevron and Akin (PECA) technique with Akin osteotomy fixation, while the second cohort included 15 patients (23 feet, 8 bilateral) without Akin fixation. Pre- and post-operative radiographic and clinical outcomes, including assessment of pain measured on the Visual Analog Scale, function evaluated using the American Orthopedic Foot and Ankle Society score, range of motion, and personal satisfaction, were conducted.

Results: Both groups showed improvement in all parameters after the surgical procedure (p < 0.05), except for the reduced range of motion (p < 0.001). There was no difference between the groups in radiographic angles, function, personal satisfaction, range of motion, and complications (p > 0.05).

Conclusion: The non-fixation of the Akin osteotomy in the PECA technique for HV did not show clinical, radiographic, or complication differences when compared to Akin osteotomy fixation with a screw. Both groups demonstrated significant improvement in all parameters. However, a reduced range of motion (stiffness) was noted in the final evaluation.

Level of evidence: Level III, retrospective comparative study.