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Kane LA, Weintraub MLR, Mitchell L, Parker M, King CM, Pollard JD. Secondary Surgery Following Lapidus Bunionectomy. J Foot Ankle Surg 2024:S1067-2516(24)00114-5. [PMID: 38914154 DOI: 10.1053/j.jfas.2024.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 05/22/2024] [Accepted: 05/25/2024] [Indexed: 06/26/2024]
Abstract
While the Lapidus bunionectomy is a common procedure utilized to address hallux valgus, the incidence of secondary surgery is not well established. Our primary goal was to determine the incidence of revision surgery and hardware removal following the Lapidus bunionectomy in addition to the risk factors associated with each. A retrospective nested case-control study of adult patients who underwent a Lapidus bunionectomy for symptomatic hallux valgus over a nine-year period was performed. The incidence rates and 95% confidence intervals (CI) of secondary surgery in the three years following the procedure along with the estimated independent associations and odds ratios between baseline demographic, clinical, and radiographic characteristics were calculated. Of the original cohort of 2,540 patients, 127 were identified (5.0%; CI: 4.1%, 5.8%) who underwent revision surgery and 165 (6.5%; CI: 5.5%, 7.5%) who underwent hardware removal following Lapidus bunionectomy. Initially, the hallux valgus angle, intermetatarsal angle, and tibial sesamoid position were risk factors for revision surgery. However, in adjusted analyses for revision surgery, using a screw for third point of fixation emerged as the only independent risk factor (odds ratio [OR]=3.01; CI: 1.59, 5.69). In adjusted analyses for hardware removal, female sex (OR=2.33; CI: 1.08, 5.00) and third point of fixation (OR=2.92; CI: 1.82, 4.69) emerged as independent risk factors. While the overall risks associated with Lapidus bunionectomy are low and the need for revision surgery are low, this study helps to identify specific risk factors for secondary surgery and hardware removal to help in evaluation and discussion with patients. LEVEL OF EVIDENCE: : 4.
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Affiliation(s)
- Lewis A Kane
- Kaiser Permanente Diablo Service Area, 1425 S Main St., Walnut Creek, CA 94596.
| | | | | | | | - Christy M King
- Department of Podiatric Surgery, Kaiser Permanente Oakland Medical Center, Oakland, CA
| | - Jason D Pollard
- Kaiser Permanente Oakland, 3600 Broadway, Suite 17, Oakland, CA 94611.
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2
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Landsman AS. Working with Industry. Clin Podiatr Med Surg 2024; 41:343-349. [PMID: 38388130 DOI: 10.1016/j.cpm.2023.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Abstract
In 1992, I completed a 9-year dual-degree program where I received both my DPM degree and a PhD in Bioengineering. Upon my graduation, it was apparent that "Industry" had an interest in me. Sponsored research and consulting opportunities where readily available, and I had to learn very quickly to sort the scientific from the sham, and the clinically worthwhile from the worthless. Partnering with Industry has provided me with another avenue to advance my profession, while helping to develop new treatment options that can potentially help many more patients then just the ones I see in my office.
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Affiliation(s)
- Adam S Landsman
- Division of Podiatric Surgery, Department of Orthopedic Surgery and FARIL, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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3
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King CM, Castellucci-Garza FM. The Lapidus Bunionectomy Revolution: Current Concepts and Considerations. Clin Podiatr Med Surg 2024; 41:43-58. [PMID: 37951678 DOI: 10.1016/j.cpm.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2023]
Abstract
Hallux valgus is a common foot deformity in which many surgical techniques have been introduced. Originally, Paul Lapidus detailed a midfoot arthrodesis technique to address the deformity and medial column instability that served as the foundation for the modified Lapidus bunionectomy. The appreciation of the multiplanar nature of hallux valgus deformity continues to evolve and helps to guide the investigation of the ideal surgical correction to yield more predictable results and reduced complications. Various fixation constructs have been used over the years for the Lapidus bunionectomy without a clear superior fixation technique, and literature supports early weight-bearing with each.
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Affiliation(s)
- Christy M King
- Kaiser San Francisco Bay Area Foot & Ankle Residency Program, Kaiser Oakland Foundation Hospital, 275 MacArthur Boulevard, Clinic 17, Oakland, CA 94611, USA; Foot & Ankle Surgery, Orthopedics and Podiatry Department, Kaiser Oakland, Oakland, CA, USA.
| | - Francesca M Castellucci-Garza
- Kaiser San Francisco Bay Area Foot & Ankle Residency Program, Kaiser Oakland Foundation Hospital, Oakland, CA, USA; Foot & Ankle Surgery, Orthopedics and Podiatry Department, Kaiser Antioch, 4501 Sand Creek Road, Antioch, CA 94531, USA
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4
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Dayton M, Dayton P, Togher CJ, Thompson JM. What Do Patients Report Regarding Their Real-World Function Following Triplane Metatarsophalangeal Joint Arthrodesis for Hallux Valgus? J Foot Ankle Surg 2023; 62:905-911. [PMID: 37209902 DOI: 10.1053/j.jfas.2023.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 04/29/2023] [Indexed: 05/22/2023]
Abstract
First metatarsal phalangeal (MTP) joint arthrodesis has been employed for decades for pain related to arthritis and other associated abnormalities. Despite the commonality of the procedure there continues to be questions regarding functional expectations following the procedure especially when employed for correction of hallux valgus deformity. We surveyed 60 patients who had a tri plane MTP joint arthrodesis at mean 28.4 months (median 27.8) regarding their activities of daily living and sports activity through a direct conversation. Secondary endpoints assessed were return to activity, deformity correction and arthrodesis healing rate based on chart review and weightbearing radiographs. The primary outcomes showed robust return to all activities of daily living with 96.7% able to walk without restrictions and or pain, 98.3% were able to walk at a normal pace and 95% responded that loss of motion of their big toe did not affect their daily function. Regarding return to sports all patients that participated in sports before surgery resumed participation after with a trend toward increased sports activity. Early return to walking in a fracture boot was noted in this cohort at mean 4.1 days, return to athletic shoe at mean 6.3 weeks and full unrestricted activity at mean 13.3 weeks with no non-unions identified on radiographic or clinical exam. Deformity correction of the typical components of hallux valgus deformity was similar to previously published studies. This data set supports the hypothesis that patients undergoing first MTP joint arthrodesis can expect rapid and full return to activities of daily living and sports with a low complication rate.
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5
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Nishikawa DRC, Duarte FA, Saito GH, de Miranda BR, de Araújo LM, Fonseca FCP, Mendes AAM, Prado MP. A comparative analysis of clinical, functional and radiographic outcomes of patients with and without fusion between the first and second metatarsals after the lapidus procedure. Foot Ankle Surg 2023; 29:481-487. [PMID: 37407353 DOI: 10.1016/j.fas.2023.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 05/11/2023] [Accepted: 06/12/2023] [Indexed: 07/07/2023]
Abstract
BACKGROUND The aim of this study was to compare the clinical, functional and radiographic outcomes in patients who underwent the original Lapidus procedure (OLP) with fusion and undesired non-fusion between the first (M1) and second (M2) metatarsals. METHODS A retrospective and comparative analysis of 29 patients (38 feet) who underwent the OLP was performed. They were divided in two groups: (1) 23 feet in which fusion occurred and (2) 15 with undesired non-fusion. Clinical and functional data were assessed with the VAS for pain, AOFAS, LEFS and SF-12. SF-12 comprises physical and mental health scales (PCS-12 and MCS-12). Radiographic parameters assessed were bony and soft tissue forefoot widths (BSFW), intermetatarsal-angle (IMA) and HV-angle (HVA). RESULTS Separately, the groups presented significant improvements in all questionnaires (p < 0.001), except on MCS-12 (fusion p = 0.08 and non-fusion p = 0.27). When comparing both groups, patients with fusion had higher AOFAS scores (p < 0.05). Both groups presented the same improvements on BSFW, IMA and HVA (p = 0.09, p = 0.16, p = 0.52 and p = 0.63). CONCLUSION Excellent results were observed, even when without fusion between M1 and M2. Patients who evolved with fusion between the M1 and M2 showed greater improvements in the AOFAS score. LEVEL OF EVIDENCE III, retrospective comparative study.
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Affiliation(s)
- Danilo Ryuko Cândido Nishikawa
- Department of Orthopaedics, Hospital do Servidor Público Municipal de São Paulo (HSPM), 60, Castro Alves Street, Aclimação, CEP: 01532-000 São Paulo, SP, Brazil; Department of Orthopaedic Surgery, Clínica de Ortopedia e Traumatologia Ortocity, 526, Brigadeiro Gavião Peixoto Street, Lapa, CEP: 05078-000 São Paulo, SP, Brazil; Department of Orthopaedic Surgery, Hospital Alemão Oswaldo Cruz, 94, São Joaquim Street, Liberdade, CEP: 01508-000 São Paulo, SP, Brazil.
| | - Fernando Aires Duarte
- Department of Orthopaedic Surgery, Clínica de Ortopedia e Traumatologia Ortocity, 526, Brigadeiro Gavião Peixoto Street, Lapa, CEP: 05078-000 São Paulo, SP, Brazil
| | - Guilherme Honda Saito
- Department of Orthopaedic Surgery, Hospital Sírio-Libanês, 91, Dona Adma Jafet Street, Bela Vista, CEP: 01308-050 São Paulo, SP, Brazil
| | - Bruno Rodrigues de Miranda
- Department of Orthopaedics, Hospital do Servidor Público Municipal de São Paulo (HSPM), 60, Castro Alves Street, Aclimação, CEP: 01532-000 São Paulo, SP, Brazil
| | - Leonardo Mendes de Araújo
- Department of Orthopaedics, Hospital do Servidor Público Municipal de São Paulo (HSPM), 60, Castro Alves Street, Aclimação, CEP: 01532-000 São Paulo, SP, Brazil
| | - Fábio Correa Paiva Fonseca
- Department of Orthopaedics, Hospital do Servidor Público Municipal de São Paulo (HSPM), 60, Castro Alves Street, Aclimação, CEP: 01532-000 São Paulo, SP, Brazil
| | - Alberto Abussamra Moreira Mendes
- Department of Orthopaedic Surgery, Hospital Israelita Albert Einstein, 627, Albert Einstein Avenue, Jardim Leonor, CEP: 05652-900 São Paulo, SP, Brazil
| | - Marcelo Pires Prado
- Department of Orthopaedic Surgery, Hospital Israelita Albert Einstein, 627, Albert Einstein Avenue, Jardim Leonor, CEP: 05652-900 São Paulo, SP, Brazil
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6
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Scheele CB, Kinast C, Lenze F, Wimmer J, Beischl S, Harrasser N. Radiographic Evaluation of First Tarsometatarsal Joint Arthrodesis for Hallux Valgus Deformity: Does the Fusion of the First to the Second Metatarsal Base Reduce the Radiological Recurrence Rate? Foot Ankle Spec 2023:19386400231164209. [PMID: 37148151 DOI: 10.1177/19386400231164209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
BACKGROUND Modified Lapidus arthrodesis (MLA) is a well-established treatment option for symptomatic hallux valgus deformity (HVD). However, recurrence of the deformity remains a concern. The goal of this study was to evaluate the effect of an additional intermetatarsal fusion on the radiographic recurrence rate after first tarsometatarsal (TMT-I) arthrodesis. METHODS This is a retrospective evaluation of 56 feet that underwent TMT-I arthrodesis for moderate to severe HVD. Twenty-three feet received an isolated arthrodesis of the TMT-I joint (TMT-I), whereas 33 feet received an additional fusion between the base of the first and the second metatarsal bone (TMT-I/II). Various radiological parameters were determined preoperatively, 6 weeks and at a mean of 2 years postoperatively. RESULTS The intermetatarsal angle (IMA) and the hallux valgus angle (HVA) were significantly lowered at both follow-up evaluations in both groups. In the TMT-I/II group, the initial reduction of HVA was significantly higher (29.3° vs 21.1°). This difference disappeared by the second follow-up, leaving no significant differences between both techniques at final follow-up. Radiological recurrence rates of HVD were comparable in both groups. CONCLUSIONS Isolated TMT-I arthrodesis provides reliable radiological results in the correction of HVD. Whether additional fusion of the first and second metatarsal base should be routinely performed remains unclear. LEVELS OF EVIDENCE Level 3.
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Affiliation(s)
- Christian B Scheele
- Department of Orthopedics and Sports Orthopedics, Technical University Munich, Klinikum rechts der Isar, Munich, Germany
| | - Christian Kinast
- Department of Orthopedics and Sports Orthopedics, Technical University Munich, Klinikum rechts der Isar, Munich, Germany
| | - Florian Lenze
- Department of Orthopedics and Sports Orthopedics, Technical University Munich, Klinikum rechts der Isar, Munich, Germany
| | - Julia Wimmer
- Department of Orthopedics and Sports Orthopedics, Technical University Munich, Klinikum rechts der Isar, Munich, Germany
| | - Simone Beischl
- Department of Orthopedics and Sports Orthopedics, Technical University Munich, Klinikum rechts der Isar, Munich, Germany
| | - Norbert Harrasser
- Department of Orthopedics and Sports Orthopedics, Technical University Munich, Klinikum rechts der Isar, Munich, Germany
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7
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Dayton M, Dayton P, Togher CJ, Thompson JM. What Do Patients Report Regarding Their Real-World Function Following Triplane Metatarsophalangeal Joint Arthrodesis for Hallux Valgus? J Foot Ankle Surg 2023; 62:254-260. [PMID: 35999115 DOI: 10.1053/j.jfas.2022.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 07/06/2022] [Accepted: 07/10/2022] [Indexed: 02/03/2023]
Abstract
First metatarsalphalangeal (MTP) joint arthrodesis has been employed for decades for pain related to arthritis and other associated abnormalities. Despite the commonality of the procedure there continues to be questions regarding functional expectations following the procedure especially when employed for correction of hallux valgus deformity. We surveyed 60 patients who had a triplane MTP joint arthrodesis at mean 28.4 months (median 27.8) regarding their activities of daily living and sports activity through a direct conversation. Secondary endpoints assessed were return to activity, deformity correction and arthrodesis healing rate based on chart review and weightbearing radiographs. The primary outcomes showed robust return to all activities of daily living with 97% able to walk without restrictions and or pain, 98% were able to walk at a normal pace and 95% responded that loss of motion of their big toe did not affect their daily function. Regarding return to sports all patients that participated in sports before surgery resumed participation after with a trend toward increased sports activity. Early return to walking in a fracture boot was noted in this cohort at mean 4.1 days, return to athletic shoe at mean 6.3 weeks and full unrestricted activity at mean 13.3 weeks with no non-unions identified on radiographic or clinical exam. Deformity correction of the typical components of hallux valgus deformity was similar to previously published studies. This data set supports the hypothesis that patients undergoing first MTP joint arthrodesis can expect rapid and full return to activities of daily living and sports with a low complication rate.
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8
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Thompson JM, Hyer CF. Maintenance of Correction of the Modified Lapidus Procedure With a First Metatarsal to Second Metatarsal Screw With "Spot Weld" Technique: A Retrospective and Radiographic Analysis. J Foot Ankle Surg 2023:S1067-2516(23)00060-1. [PMID: 37031031 DOI: 10.1053/j.jfas.2023.02.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 02/17/2023] [Accepted: 02/19/2023] [Indexed: 04/10/2023]
Abstract
Lapidus first tarsometatarsal (TMT) arthrodesis gained popularity for its ability to correct large deformities especially in cases of medial column instability. Despite solid first TMT fusion, instability between the first and second columns can result in loss of intermetatarsal (IM) angle correction over time. A "spot weld" or fusion between the first and second metatarsal may improve maintenance of correction. This retrospective study reviewed cases of Lapidus arthrodesis with first to second metatarsal base screw fixation for maintenance of IM correction and determine whether a "spot weld" is predictive of maintenance. A total of 90 cases (77 patients) performed by a single surgeon met inclusion with average follow-up of 309 days. First TMT fusion occurred in 87/90 (96.7%) cases with 76 dorsal plate, 10 dorsal staple, and 4 all screws. No incidence of complications related to the 1-2 screw was noted. Mean preoperative IM 1-2 angle 14.90°, mean correction to 6.22° post-operative and final maintained correction at 7.10°, mean loss of correction 0.87°. There were "spot welds" in 65/90 (72.2%) with mean loss of 0.48° versus loss of 1.88° in "no spot weld" subgroup (p < .001). Cases with no spot weld and screw lucency lost 2.25° (p < .001). Loss of IM 1-2 correction can occur due to first and second ray intra-column instability even in cases of solid first TMT arthrodesis. Incorporating a completed "spot weld" with bone grafting and first to second metatarsal screw was found to maintain correction with minimal loss (0.87°).
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9
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Abben KW, Sakow CF, Sorensen T, Chang HC, Boffeli TJ. First Tarsometatarsal Joint Fusion for Hallux Valgus Deformity: A Retrospective Comparison of Two Fixation Constructs Regarding Initial Maintenance of Correction and Complications: Traditional Crossing Screw Fixation Versus Dorsomedial Locking Plate and Intercuneiform Compression Screw. J Foot Ankle Surg 2023; 62:347-354. [PMID: 36272952 DOI: 10.1053/j.jfas.2022.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 09/02/2022] [Accepted: 09/10/2022] [Indexed: 02/03/2023]
Abstract
Various fixation constructs exist to address hallux valgus when performing a first tarsometatarsal joint arthrodesis. The goal of this present study is to compare complication rates, and degree and maintenance of angular correction between a dorsomedial locking plate with intercuneiform compression screw construct versus traditional crossing solid screw fixation construct. The plate plus intercuneiform compression screw construct fixation utilized a combined sagittal saw and curette method of joint preparation while the crossed screw fixation group utilized a curette and bur technique. A retrospective review was conducted of consecutive patients who underwent a midfoot fusion using either constructs. Sixty four total feet in 56 patients were enrolled in the study. Twenty four consecutive patients (32 feet) who underwent a midfoot arthrodesis using the locking plate and intercuneiform fixation were fully fused (100%) by 10 weeks postoperatively, with no incidents of nonunion and one deep vein thrombosis event. Thirty two consecutive patients (32 feet) who underwent midfoot arthrodesis with crossing screw fixation had 2 nonunion events, one that was asymptomatic and the other that required a revision midfoot fusion. There was a statistically significant improvement from the pre-operative intermetatarsal angle, hallux abductus angle compared to the 10 week and 1 year radiographs (p < .05) for the entire cohort for both fixation constructs. There was a statistically significant increase in American College of Foot and Ankle Surgery first ray scores from pre-op to 1 year follow-up for both fixation constructs. Overall, the dorsomedial locking plate plus intercuneiform compression screw fixation construct better maintains Intermetatarsal angle (IMA) correction at midterm follow-up compared to the traditional crossing screw construct. Both cohorts overall demonstrate similar fusion rates at 10 weeks, nonunion events, incidences of broken hardware, hardware removal, deep vein thrombosis, neuritis at 1 year postoperatively, and hallux varus.
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Affiliation(s)
- Kyle W Abben
- Foot & Ankle Surgical Residency Program, Regions Hospital/HealthPartners Institute, TRIA Orthopedics Maple Grove, Maple Grove, MN
| | - Chloe F Sakow
- Foot & Ankle Surgery, Regions Hospital/HealthPartners Institute for Education and Research, Saint Paul, MN.
| | - Tyler Sorensen
- Foot & Ankle Surgery, Regions Hospital/HealthPartners Institute for Education and Research, Saint Paul, MN
| | - Howard C Chang
- Foot & Ankle Surgery, Regions Hospital/HealthPartners Institute for Education and Research, Saint Paul, MN
| | - Troy J Boffeli
- Foot & Ankle Surgery Residency Program, Regions Hospital/HealthPartners Institute for Education & Research, Saint Paul, MN
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10
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Jones JM, Schleunes SD, Vacketta VG, Philp FH, Hentges MJ, McMillen RL, Saltrick KR, Catanzariti AR. First Tarsometatarsal Joint Arthrodesis for Hallux Valgus With and Without Intermetatarsal Screw Fixation: A Comparison of Correction and Maintenance of Correction. J Foot Ankle Surg 2022; 61:1255-1262. [PMID: 35346576 DOI: 10.1053/j.jfas.2022.02.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 02/14/2022] [Accepted: 02/16/2022] [Indexed: 02/03/2023]
Abstract
Tarsometatarsal joint arthrodesis is a commonly accepted procedure for hallux valgus associated with severe deformity and first ray hypermobility or medial column instability. This study evaluates the correction of hallux valgus deformity and the maintenance of correction with and without the use of a stabilization screw between the first and second metatarsal bases. Through retrospective review of first tarsometatarsal joint arthrodesis within our institution we evaluated 63 patients. Twenty-seven patients did not have a first to second metatarsal base screw and were placed into the no screw cohort. Thirty-six patients did have a first to second metatarsal base screw and were placed into the screw cohort. This study population had an osseous union rate of 95%. Clinical and radiographic recurrence occurred in 5 of 63 patients (8%). At 1-y postop the measurements demonstrated that the screw cohort had an average intermetatarsal angle correction of 11.6 degrees while the no screw cohort had an average correction of 7.8 degrees. Additionally, at 1-y postop the screw cohort had greater maintenance of the intermetatarsal angle correction with an average change of 0.5 degrees compared to 2.3 degrees in the no screw cohort. We conclude that the addition of the stabilization screw improves the first tarsometatarsal joint arthrodesis construct resulting in a greater degree of realignment and maintenance of correction.
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Affiliation(s)
- Jacob M Jones
- Resident, Postgraduate Year 3, Division of Foot and Ankle Surgery, West Penn Hospital, Allegheny Health Network, Pittsburgh, PA
| | - Scott D Schleunes
- Resident, Postgraduate Year 2, Division of Foot and Ankle Surgery, West Penn Hospital, Allegheny Health Network, Pittsburgh, PA
| | - Vincent G Vacketta
- Resident, Postgraduate Year 3, Division of Foot and Ankle Surgery, West Penn Hospital, Allegheny Health Network, Pittsburgh, PA
| | - Frances Hite Philp
- Health Outcomes Researcher, AHN Research and Orthopaedic Institutes, Allegheny Health Network, Pittsburgh, PA
| | - Matthew J Hentges
- Attending Faculty of Residency Training Division of Foot and Ankle Surgery, West Penn Hospital, Allegheny Health Network, Pittsburgh, PA
| | - Ryan L McMillen
- Attending Faculty of Residency Training Division of Foot and Ankle Surgery, West Penn Hospital, Allegheny Health Network, Pittsburgh, PA
| | - Karl R Saltrick
- Vice Chair, Division of Foot and Ankle Surgery, West Penn Hospital, Allegheny Health Network, Pittsburgh, PA
| | - Alan R Catanzariti
- Director of Residency Training Division of Foot and Ankle Surgery, West Penn Hospital, Allegheny Health Network, Pittsburgh, PA.
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11
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King CM, Doyle MD, Castellucci-Garza FM, Lyon L, Richey J, Patel S, Collman DR. Addressing Transverse Plane Instability in the Modified Lapidus Arthrodesis: A Comparative Study of Screw Versus Suture and Button Fixation Device Technique. J Foot Ankle Surg 2022; 61:979-985. [PMID: 35491340 DOI: 10.1053/j.jfas.2021.12.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 07/02/2021] [Accepted: 12/13/2021] [Indexed: 02/03/2023]
Abstract
The Lapidus arthrodesis is a powerful procedure for the correction of hallux valgus with metatarsus primus varus. Yet, first ray instability may persist despite correction of the primary deformity with 2 crossed screw fixation. A third screw is often utilized as the additional point of fixation for noteworthy residual transverse plane motion, but it is not without potential complications. The suture and button fixation device may be an appropriate alternative to the third screw construct. This retrospective cohort study identified clinical / radiographic outcomes and complication rates following a third point of fixation with either a screw or suture and button fixation device in patients undergoing a modified Lapidus arthrodesis. One surgeon performed all of the Lapidus procedure with a third screw while the other surgeon performed all with a suture and button fixation device. Of 136 consecutive patients who underwent a modified Lapidus arthrodesis, 83 (61%) patients required a third point of fixation for satisfactory stabilization of the first ray. Surgical technique was similar between the 2 surgeons; however, one utilized the suture and button fixation device method (n = 36), while the other used a third screw for fixation (n = 47). Many of the clinical outcomes, radiographic results, and the union rate were similar between the 2 methods. Nineteen (40%) complications occurred in the third screw group compared to 6 (17%) in the suture and button fixation device group. However, the third screw group demonstrated 100% maintenance of deformity correction at 1 year versus 95% in the suture and button fixation device group. Although fixation with a suture and button fixation device was associated with fewer complications, a larger study is necessary to determine if these variations are statistically significant.
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Affiliation(s)
- Christy M King
- Residency Director and Attending Staff, Department of Orthopedics, Kaiser San Francisco Bay Area Foot and Ankle Residency Program Kaiser Foundation Hospital, Oakland, CA.
| | - Matthew D Doyle
- Foot and Ankle Surgeon, Silicon Valley Reconstructive Foot and Ankle Fellowship, Palo Alto Medical Foundation, Mountain View, CA
| | - Francesca M Castellucci-Garza
- Attending Staff, Kaiser San Francisco Bay Area Foot and Ankle Residency Program, Department of Orthopedics, Kaiser Foundation Hospital, Antioch, CA
| | - Liisa Lyon
- Senior Data Consultant, Division of Research, Kaiser Permanente, Oakland, CA
| | | | - Sandeep Patel
- Attending Staff, Kaiser San Francisco Bay Area Foot and Ankle Residency Program, Department of Orthopedics, Kaiser Foundation Hospital, Antioch, CA
| | - David R Collman
- Attending Staff, Kaiser San Francisco Bay Area Foot and Ankle Residency Program, Department of Orthopedics, Kaiser Foundation Hospital, San Francisco, CA
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12
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Nishikawa DRC, Duarte FA, Saito GH, Pontin PA, Mendes AAM, Prado MP. Intraoperative Technical Tips to Improve Fusion Between the First and Second Metatarsals in the Original Lapidus Procedure. Foot Ankle Spec 2022; 16:159-167. [PMID: 35993303 DOI: 10.1177/19386400221118884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The modified Lapidus procedure (MLP), which consists of fusion between the first metatarsal (M1) and medial cuneiform, has been widely performed with satisfactory clinical outcomes, but it has a variable nonunion rate ranging between 4% and 10% and loss of correction in up to 5.8% of the cases. Excessive motion around the site of tarsometatarsal arthrodesis, specially at the intercuneiform joint, is probably the reason. The original Lapidus procedure (OLP), which includes fusion of the M1 to second metatarsal (M2), may be beneficial in preventing nonunion and recurrence. The objective of this study was to describe intraoperative technical tips in the OLP to improve M1 to M2 fusion, which may prevent complications. Since the Lapidus procedure continues to gain popularity, it is the authors opinion that the OLP requires special attention because it is a more technically demanding surgery compared to the MLP.Level of Evidence: Level V: Expert opinion.
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Affiliation(s)
- Danilo Ryuko Cândido Nishikawa
- Department of Orthopaedics, Foot and Ankle Surgery, Hospital do Servidor Público Municipal de São Paulo, São Paulo, SP, Brazil (DRCN).,Department of Orthopaedic Surgery, Foot and Ankle Surgery, Clínica de Ortopedia e Traumatologia Ortocity, São Paulo, SP, Brazil (DRCN, FAD).,Department of Orthopaedic Surgery, Clínica Care Club, São Paulo, SP, Brazil (DRCN, FAD, PAP).,Department of Orthopaedic Surgery, Hospital Sírio-LIbanês, São Paulo, SP, Brazil (GHS).,Department of Orthopaedic Surgery, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil (AAMM, MPP)
| | - Fernando Aires Duarte
- Department of Orthopaedics, Foot and Ankle Surgery, Hospital do Servidor Público Municipal de São Paulo, São Paulo, SP, Brazil (DRCN).,Department of Orthopaedic Surgery, Foot and Ankle Surgery, Clínica de Ortopedia e Traumatologia Ortocity, São Paulo, SP, Brazil (DRCN, FAD).,Department of Orthopaedic Surgery, Clínica Care Club, São Paulo, SP, Brazil (DRCN, FAD, PAP).,Department of Orthopaedic Surgery, Hospital Sírio-LIbanês, São Paulo, SP, Brazil (GHS).,Department of Orthopaedic Surgery, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil (AAMM, MPP)
| | - Guilherme Honda Saito
- Department of Orthopaedics, Foot and Ankle Surgery, Hospital do Servidor Público Municipal de São Paulo, São Paulo, SP, Brazil (DRCN).,Department of Orthopaedic Surgery, Foot and Ankle Surgery, Clínica de Ortopedia e Traumatologia Ortocity, São Paulo, SP, Brazil (DRCN, FAD).,Department of Orthopaedic Surgery, Clínica Care Club, São Paulo, SP, Brazil (DRCN, FAD, PAP).,Department of Orthopaedic Surgery, Hospital Sírio-LIbanês, São Paulo, SP, Brazil (GHS).,Department of Orthopaedic Surgery, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil (AAMM, MPP)
| | - Pedro Augusto Pontin
- Department of Orthopaedics, Foot and Ankle Surgery, Hospital do Servidor Público Municipal de São Paulo, São Paulo, SP, Brazil (DRCN).,Department of Orthopaedic Surgery, Foot and Ankle Surgery, Clínica de Ortopedia e Traumatologia Ortocity, São Paulo, SP, Brazil (DRCN, FAD).,Department of Orthopaedic Surgery, Clínica Care Club, São Paulo, SP, Brazil (DRCN, FAD, PAP).,Department of Orthopaedic Surgery, Hospital Sírio-LIbanês, São Paulo, SP, Brazil (GHS).,Department of Orthopaedic Surgery, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil (AAMM, MPP)
| | - Alberto Abussamra Moreira Mendes
- Department of Orthopaedics, Foot and Ankle Surgery, Hospital do Servidor Público Municipal de São Paulo, São Paulo, SP, Brazil (DRCN).,Department of Orthopaedic Surgery, Foot and Ankle Surgery, Clínica de Ortopedia e Traumatologia Ortocity, São Paulo, SP, Brazil (DRCN, FAD).,Department of Orthopaedic Surgery, Clínica Care Club, São Paulo, SP, Brazil (DRCN, FAD, PAP).,Department of Orthopaedic Surgery, Hospital Sírio-LIbanês, São Paulo, SP, Brazil (GHS).,Department of Orthopaedic Surgery, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil (AAMM, MPP)
| | - Marcelo Pires Prado
- Department of Orthopaedics, Foot and Ankle Surgery, Hospital do Servidor Público Municipal de São Paulo, São Paulo, SP, Brazil (DRCN).,Department of Orthopaedic Surgery, Foot and Ankle Surgery, Clínica de Ortopedia e Traumatologia Ortocity, São Paulo, SP, Brazil (DRCN, FAD).,Department of Orthopaedic Surgery, Clínica Care Club, São Paulo, SP, Brazil (DRCN, FAD, PAP).,Department of Orthopaedic Surgery, Hospital Sírio-LIbanês, São Paulo, SP, Brazil (GHS).,Department of Orthopaedic Surgery, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil (AAMM, MPP)
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13
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McCabe FJ, McQuail PM, Turley L, Hurley R, Flavin RA. Anatomical reconstruction of first ray instability hallux valgus with a medial anatomical TMTJ1 plate. Foot Ankle Surg 2021; 27:869-873. [PMID: 33353832 DOI: 10.1016/j.fas.2020.11.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 11/22/2020] [Accepted: 11/25/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND First tarsometatarsal joint (TMTJ1) arthrodesis is a powerful tool for hallux valgus correction. Past criticism of the TMTJ1 arthrodesis has focused on high non-union rates, and consequent need for delayed weightbearing as prevention. In this study we present a selection and treatment protocol to minimise non-union while allowing early weightbearing. METHODS All TMTJ1 arthrodesis procedures for hallux valgus performed by the senior surgeon over the period June, 2016 to July, 2019 were included. An anatomically-designed, medial TMTJ1 plate and screw compression was utilised for TMTJ1 arthrodesis. The construct was augmented with synthetic intermetatarsal stabilisation. All patients were kept non-weightbearing for 2 weeks, followed by progressive weightbearing as tolerated for 4 weeks. Minimum follow-up was 1 year. RESULTS 300 modified Lapidus procedures were performed for hallux valgus with mean IMA 17° (Range: 14-29). Mean age was 58 years, with 93% female. 284 (94%) had an Akin osteotomy, while 222 cases (74%) were associated with another forefoot procedure. Patients began progressive weight bearing as tolerated from 2 weeks. All were fully weight bearing by 8 weeks post-operatively. There was a 100% union rate in this group. Mean AOFAS Hallux MTP-IP scores rose from 59 pre-operatively to 97 post-operatively. One plate was removed due to tibialis anterior impingement. There were no recurrences at final follow-up. CONCLUSIONS We describe a selection and treatment protocol for TMTJ1 arthrodesis for hallux valgus. This yields high union rates while allowing early weight bearing. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- F J McCabe
- Department of Trauma & Orthopaedics, St. Vincent's University Hospital, Elm Park, Dublin, D04 T6F4, Ireland.
| | - P M McQuail
- Department of Trauma & Orthopaedics, St. Vincent's University Hospital, Elm Park, Dublin, D04 T6F4, Ireland
| | - L Turley
- Department of Trauma & Orthopaedics, St. Vincent's University Hospital, Elm Park, Dublin, D04 T6F4, Ireland
| | - R Hurley
- Department of Trauma & Orthopaedics, St. Vincent's University Hospital, Elm Park, Dublin, D04 T6F4, Ireland
| | - R A Flavin
- Department of Trauma & Orthopaedics, St. Vincent's University Hospital, Elm Park, Dublin, D04 T6F4, Ireland
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14
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Long J, Lauf JA, Whitehead B, Cheney N, Law TD. Recurrence of Hallux Valgus After Modified Lapidus Procedure With Successful Fusion of the Intermetatarsal and Intercuneiform Joints. Cureus 2021; 13:e15418. [PMID: 34249565 PMCID: PMC8254418 DOI: 10.7759/cureus.15418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2021] [Indexed: 11/05/2022] Open
Abstract
Background The Lapidus procedure has become a popular procedure in correcting hallux valgus deformities and has undergone several modifications in an effort to improve the efficacy of the procedure. The senior author modifies this procedure with the addition of an intermetatarsal and intercuneiform fusion. Our hypothesis is that this will improve the procedure outcomes and decrease deformity recurrence. Methods We reviewed patient charts who underwent the procedure between 2014 and 2017 performed by the senior author. This yielded 47 reviewable cases, with 34 meeting study criteria. The cases were analyzed for standard hallux valgus measurements (intermetatarsal angle [IMA], hallux valgus angle [HVA]) and fusion on X-ray. Results The results of the study showed partial intermetatarsal and intercuneiform fusion failure in seven (20%) cases, and one case where the great toe fell into varus. These cases were excluded. In the remaining cases, there was a statistically significant improvement in the HVA and IMA between the preoperative X-ray and first postoperative X-ray. Additionally, there was no significant difference between HVA and IMA between first and final postoperative radiographs. There was a significant increase in IMA for the fusion failure cases (p=0.001). Conclusion Clinically, our findings demonstrate that successful union is possible with low recurrence and complication rates when using this modification of the Lapidus procedure in patients with hallux valgus deformity.
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Affiliation(s)
- Joseph Long
- Medicine, The Ohio State University College of Medicine, Columbus, USA
| | - Jason A Lauf
- Orthopedic Surgery, Ohio University Heritage College of Osteopathic Medicine, Dublin, USA
| | - Brent Whitehead
- Orthopedic Surgery, Ohio University Heritage College of Osteopathic Medicine, Dublin, USA
| | - Nick Cheney
- Orthopedic Surgery, Ohio University Heritage College of Osteopathic Medicine, Columbus, USA
| | - Timothy D Law
- Family Medicine, Ohio University Heritage College of Osteopathic Medicine, Athens, USA
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15
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Langan TM, Greschner JM, Brandão RA, Goss DA, Smith CN, Hyer CF. Maintenance of Correction of the Modified Lapidus Procedure With a First Metatarsal to Intermediate Cuneiform Cross-Screw Technique. Foot Ankle Int 2020; 41:428-436. [PMID: 31878798 DOI: 10.1177/1071100719895268] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Recurrence of deformity remains a concern when fusing the first tarsometatarsal joint for correction of hallux valgus (HV). A recently described construct adds an additional point of fixation from the plantar medial first metatarsal to the intermediate cuneiform. The purpose of this study was to determine the maintenance of correction of the first and second intermetatarsal angle, hallux valgus angle, and tibial sesamoid position after undergoing a first tarsometatarsal joint arthrodesis using the proposed construct. METHODS A radiographic review was performed of patients with HV treated with a first tarsometatarsal joint arthrodesis with the addition of a cross-screw intermediate cuneiform construct. Three observers reviewed radiographic data, including preoperative weightbearing, first weightbearing, and final weightbearing plain-film radiographs. Initial improvement and maintenance of intermetatarsal angle, hallux valgus angle (HVA), and tibial sesamoid position were evaluated radiographically. A total of 62 patients met inclusion criteria and were included in the study. Mean follow-up time was 9.3 months (SD 6.7). RESULTS Bony union was achieved in 60 of 62 patients (96.7%). Two of 62 patients required revision surgery as a result of recurrence (3.3%). Final mean improvement of the intermetatarsal angle (IMA) was 6.8 degrees (±2.9 degrees), HVA was 14.8 degrees (±7.5 degrees), and tibial sesamoid position was 2.4 (±1.4) positions. Mean loss of IMA correction was 1.5 degrees (±1.6), HVA was 2.9 degrees (±4.8 degrees), and tibial sesamoid position was 0.8 (±0.8). CONCLUSION This study showed that the cross-screw intermediate cuneiform construct for first tarsometatarsal joint arthrodesis had a good union rate, a low complication rate, and maintained radiographic correction. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
| | | | - Roberto A Brandão
- The Centers for Advanced Orthopaedics, Orthopaedic Associates of Maryland Division, Catonsville, MD, USA
| | - David A Goss
- Orthopedic Foot and Ankle Center, Worthington, OH, USA
| | - Clair N Smith
- Clinical Outcomes Research Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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16
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Abstract
The evolution of Lapidus fixation has been strongly associated with the understanding of the anatomy and function of the first tarsometatarsal joint, the mechanism of hypermobility of the first tarsometatarsal joint, and cause of the hallux valgus deformity in 3 dimensions. Some methods, such as plantar plating, nitinol staples, and intramedullary fixation, have proven to be stronger biomechanically in cadaveric testing. Theoretically, stable fixation will reduce the rate of complications, in particular, that of nonunion and allow for early postoperative weight-bearing. Further clinical studies are needed to examine whether current biomechanical studies will translate to relevant clinical outcomes.
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Affiliation(s)
- Shuyuan Li
- Steps2Walk, 1209 Harbor Island Walk, Baltimore, MD 21230, USA.
| | - Mark S Myerson
- Steps2Walk, 1209 Harbor Island Walk, Baltimore, MD 21230, USA
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17
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So E, Van Dyke B, McGann MR, Brandao R, Larson D, Hyer CF. Structures at Risk From an Intermetatarsal Screw for Lapidus Bunionectomy: A Cadaveric Study. J Foot Ankle Surg 2019; 58:62-65. [PMID: 30448378 DOI: 10.1053/j.jfas.2018.08.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Indexed: 02/03/2023]
Abstract
The Lapidus bunionectomy is performed to treat hallux valgus. Recurrence of the deformity remains a concern. A transverse intermetatarsal screw spanning the base of the first metatarsal to the base of the second can increase stability. The neurovascular bundle is located within the proximity of this screw. In this study, we assessed the structures at risks with the use of this technique. In 10 specimens, a guide wire was placed, and a 4.0-mm cannulated screw was inserted. The neurovascular bundle was dissected and inspected for direct trauma to the neurovascular bundle, and the proximity of the screw was measured using a digital caliper. Ten cadaveric specimens were used. The dorsalis pedis artery and deep peroneal nerve were free from injury in 9 of 10 specimens. In those 9 specimens, the neurovascular bundle was located dorsal in relation to the screw. The mean distance of the screw to the neurovascular bundle was 7.1 ± 3.3 mm. The mean distance from the screw to the first tarsometatarsal joint (TMTJ) was 14.7 ± 4.3 mm. The mean distance from the screw as it entered the second metatarsal to the second TMTJ was 18.0 ± 7.2 mm. In 1 specimen, the screw was found to be traversing through the neurovascular bundle. The distance from the screw to the first TMTJ was 15.0 mm. The distance of the screw from where it entered the second metatarsal to the second TMTJ was 24.0 mm. Although the intermetatarsal screw avoided the neurovascular cases in most instances, there is some anatomic risk to the neurovascular bundle. Further study is warranted to evaluate clinical results using the intermetatarsal screw for the modified Lapidus procedure.
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Affiliation(s)
- Eric So
- Resident, Grant Medical Center, Columbus, OH
| | - Bryan Van Dyke
- Fellow, Orthopedic Foot and Ankle Center, Westerville, OH
| | - Maria R McGann
- Fellow, Orthopedic Foot and Ankle Center, Westerville, OH
| | | | - David Larson
- Fellowship-Trained Foot and Ankle Surgeon, Integrative Orthopedics, Phoenix, AZ
| | - Christopher F Hyer
- Fellowship-Trained Foot and Ankle Surgeon, Orthopedic Foot and Ankle Center, Westerville, OH; Fellowship Director, Orthopedic Foot and Ankle Center, Westerville, OH.
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18
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[Lapidus arthrodesis]. DER ORTHOPADE 2017; 46:424-433. [PMID: 28361194 DOI: 10.1007/s00132-017-3411-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The tarso-metatarsal 1 joint (TMT-I) arthrodesis is a treatment option or moderate to severe hallux valgus (HV) deformities. Instability of the TMT1 joint is still a debatable indication. Using stable osteosynthesis techniques allows early postoperative weight bearing. Plantar plating combined with a lag screw is the biomechanical most stable construct. An additional intermetatarsal screw can improve the horizontal stability. Clinical results are good and radiological parameters stay constant, even in the long term.
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