{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T00:43:23Z","timestamp":1792197803528,"version":"4.4.0"},"reference-count":29,"publisher":"Royal College of Surgeons of England","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["annals"],"published-print":{"date-parts":[[2022,1]]},"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p> 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. <\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p> 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. <\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p> 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\u00b0 with screw fixation and 4.1\u00b0 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 \u00a31,925 for staple fixation and \u00a34,290 for screw fixation. <\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p> Staple and screw fixation are reproducible modalities with satisfactory outcomes, but screw fixation is expensive. We conclude staple fixation is a cost-effective alternative. <\/jats:p><\/jats:sec>","DOI":"10.1308\/rcsann.2021.0029","type":"journal-article","created":{"date-parts":[[2021,7,29]],"date-time":"2021-07-29T09:58:16Z","timestamp":1627552696000},"page":"53-56","source":"Crossref","is-referenced-by-count":6,"title":["Screw versus staple fixation for Akin osteotomy"],"prefix":"10.1308","volume":"104","author":[{"given":"MA","family":"Fazal","sequence":"first","affiliation":[{"name":"Royal Free Hospitals London NHS Foundation Trust"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"H","family":"Simon","sequence":"additional","affiliation":[{"name":"Royal Free Hospitals London NHS Foundation Trust"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"JA","family":"Bacarese-Hamilton","sequence":"additional","affiliation":[{"name":"Royal Free Hospitals London NHS Foundation 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