Screw versus staple fixation for Akin osteotomy

M A Fazal, H Simon, J A Bacarese-Hamilton, P Ray, M S Shahid

Research output: Contribution to journalArticlepeer-review


INTRODUCTION: Akin osteotomies are commonly fixed with a screw or staple. Hardware-related symptoms are not uncommon. We compared the outcomes and costs of the two implants.

METHODS: We evaluated 74 Akin osteotomies performed in conjunction with first metatarsal osteotomy for hallux valgus. The osteotomy was fixed with a headless compression screw in 39 cases and a staple in 35 cases. We looked at the implant-related complications, removal of metalwork, revision, non-union and cost. Pre- and postoperative hallux valgus interphalangeal (HI) angles and length of the proximal phalanx were measured.

RESULTS: There was 100% union, no failure of fixation, no revision surgery and no delayed union in either group. The radiological prominence of screws was significant ( p=0.02), but there was no significant difference in soft-tissue irritation ( p=0.36) or removal of implants ( p=0.49). Two cortical breaches (5.8%) occurred in staple fixation and 4 (10.2%) in screw fixation (not statistically significant (NS), p=0.50). The mean improvement in HI angle was 4.3° with screw fixation and 4.1° with staple fixation (NS, p=0.69). The mean shortening of the proximal phalanx was 2.5mm with screw fixation and 2.3mm with staple fixation (NS, p=0.64). The total cost was £1,925 for staple fixation and £4,290 for screw fixation.

CONCLUSIONS: Staple and screw fixation are reproducible modalities with satisfactory outcomes, but screw fixation is expensive. We conclude staple fixation is a cost-effective alternative.

Original languageEnglish
Pages (from-to)53-56
Number of pages4
JournalAnnals of the Royal College of Surgeons of England
Issue number1
Publication statusPublished - Jan 2022


  • Bone Screws/economics
  • Female
  • Hallux Valgus/surgery
  • Humans
  • Male
  • Metatarsal Bones/surgery
  • Middle Aged
  • Osteotomy/economics
  • Retrospective Studies
  • Sutures/economics

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