We compared outcomes of the Lapidus bunionectomy fixated with crossed lag screws versus
a locking plate with a plantar lag screw. Forty patients who underwent Lapidus bunionectomy
between August 2001 and May 2006 were evaluated in a combined retrospective and prospective
fashion. Crossed lag screws were used in 19 of the patients, and a locking plate with
a plantar lag screw was used in 21 of the patients. Other than fixation, the only
interventional difference pertained to postoperative weight bearing, where those receiving
the plate initiated full weight bearing on the operated foot at 4 weeks postoperative,
as compared to 6 weeks for those receiving crossed screws. Overall, the mean preoperative
AOFAS hallux score was 41.75 ± 2.52, and the postoperative score was 90.48 ± 8.41
(P < .0001). The overall mean preoperative first intermetatarsal angle was 15.3° ± 2.32°,
and long term the angle was 5.03° ± 2.86° (P < .0001). When comparisons were made based on the method of fixation, use of an adjunct
Akin osteotomy and surgery performed before 2003 were statistically significantly
associated with crossed screw fixation, and the preoperative AOFAS score was statistically
significantly higher in the locking plate fixation group. There were no statistically
significant differences related to postoperative complications between the 2 fixation
groups. In conclusion, the Lapidus bunionectomy fixated with a locking plate and a
plantar lag screw allows earlier weight bearing in comparison with crossed lag screws,
without a difference in complications. Level of Clinical Evidence: 2
Key Words
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References
- Modified Lapidus procedure for the treatment of hypermobile hallux valgus.Foot Ankle Int. 2000; 21: 816-821
- The modified Lapidus arthrodesis: a retrospective analysis.J Foot Ankle Surg. 1999; 38: 322-332
- Adolescent bunions treated by the modified Lapidus procedure.Bull Hosp Joint Dis. 1987; 47: 109-122
- Clinical results with the Ludloff osteotomy for correction of adult hallux valgus.Foot Ankle Int. 2004; 25: 532-536
- The Lapidus procedure: a prospective cohort outcome study.Foot Ankle Int. 2004; 25: 526-531
- The Lapidus procedure as salvage after failed surgical treatment of hallux valgus.J Bone Joint Surg Am. 2004; 85-A: 60-65
- Modified Lapidus arthrodesis for adolescent hallux abductovalgus.J Foot Ankle Surg. 1999; 38: 8-13
- Critical evaluation of the modified Lapidus procedure.J Foot Ankle Surg. 2001; 40: 71-90
- Metatarsocuneiform arthrodesis for management of hallux valgus and metatarsus primus varus.Foot Ankle. 1992; 13: 107-115
- Modified Lapidus arthrodesis: rate of nonunion in 227 cases.J Foot Ankle Surg. 2004; 43: 37-42
- Lapidus arthrodesis for management of hallux valgus—a retrospective review of 106 cases.J Foot Ankle Surg. 2004; 43: 290-295
- Modified Lapidus procedure for hallux valgus.Foot Ankle. 1989; 9: 262-266
- The Ludloff osteotomy: a critical analysis.J Foot Ankle Surg. 1997; 36: 100-105
- Strength of fixation of Ludloff metatarsal osteotomy utilizing three different types of Kirschner wires: a biomechanical study.Foot Ankle Int. 2003; 24: 805-811
- Angular measurements in the evaluation of hallux valgus deformities: a report of the ad hoc committee of the American Orthopedic Foot and Ankle Society on angular measurements.Foot Ankle Int. 2002; 23: 68-74
- Acetabular dysplasia and familial joint laxity: two etiological factors in congenital dislocation of the hip.J Bone Joint Surg Br. 1970; 52-B: 704-716
- Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes.Foot Ankle Int. 1994; 15: 349-353
- Screw fixation compared to H-locking plate fixation for first metatarsocuneiform arthrodesis: a biomechanical study.Foot Ankle Int. 2005; 26: 984-989
Article info
Footnotes
Financial Disclosure: Wright Medical Technology, Inc., Arlington, TN, funded a portion of this study.
Conflict of Interest: None reported.
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Copyright
© 2009 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.
