A Retrospective Comparison of Fixation vs. Nonfixation in Akin Osteotomy during Minimally Invasive Chevron-Akin

Abstract Background: Akin osteotomy is commonly performed in hallux valgus (HV) surgery, with debate over whether screw fixation is necessary. Objectives: This study compared angular correction maintenance, healing time, and complications between screw fixation and nonfixation techniques in patients undergoing minimally invasive Chevron-Akin (MICA) with lesser metatarsal osteotomy. The primary outcome was proximal-distal phalangeal articular angle (PDPAA) change (6 months −1 month); secondary outcomes were healing time and overall complication rate. We tested the null hypothesis that there is no difference in the maintenance of angular correction between fixation and nonfixation, operationalized as the between-group difference in PDPAA change from 1 to 6 months postoperatively. Materials and Methods: This retrospective cohort study enrolled 53 patients (61 feet) undergoing MICA with lesser metatarsal osteotomy between January 2022 and December 2023, divided into fixation (36 feet) and nonfixation (25 feet) groups. Radiographic parameters (HV angle, intermetatarsal angle, interphalangeal angle, and PDPAA) were assessed preoperatively and at 1 and 6 months postoperatively. Complications and healing outcomes were also recorded. Results: Both groups achieved 100% bone union with no significant differences in healing time and complications. Radiographic improvements were significant in both groups. The nonfixation cohort showed a small, borderline increase in PDPAA from 1 to 6 months (angle change + 2.2°; 95% confidence interval: 0.00–4.48; P = 0.05), while no significant change occurred in the fixation group. Conclusions: Screw fixation demonstrated more consistent maintenance of angular correction compared with nonfixation, which showed a small, borderline increase in PDPAA between 1 and 6 months. Although both techniques achieved comparable healing and complication rates, fixation appears to provide greater predictability in preserving correction. Larger, adequately powered prospective studies are needed to confirm whether this radiographic advantage translates into meaningful long-term clinical benefit.