Abstract
First metatarsocuneiform arthrodesis (Lapidus procedure) can provide powerful correction
of mild to moderate hypermobile or severe hallux valgus, although a period of non–weight
bearing may be necessary. The purpose of this retrospective investigation was to compare
patients who underwent a modified Lapidus arthrodesis with 2 screws plus an additional
“neutralization” Kirschner-wire with immediate partial weight-bearing in a removable
boot, with a control group without the Kirschner-wire who were non–weight bearing
for 6 weeks in a short leg cast. A total of 41 consecutive patients from January 2004
to January 2007 were included in this comparative cohort study. There were no significant
radiographic changes between immediate and final 6-month postoperative radiographs
in regard to first intermetatarsal angle (°) and first ray elevation measurements
(first to second metatarsal head elevation [mm] and Seiberg index [mm]) within groups
(P = .49, .47, and .54, and 95% confidence intervals of [–2.1, 1.2], [–0.32, 2.03],
and [–0.82, 0.44], respectively) or between groups (P = .259, .67, and .083, and 95% confidence intervals of [–4.2, 1.2], [–1.39, 0.91],
and [–1.77, 0.12], respectively), as computed with paired 2-sample t tests. Stratified Mantel-Haenszel analyses revealed both groups to be comparable
relative to severity of deformity, gender, age, smoking history, perioperative immunosuppressant
use, and other comorbidities. No nonunions or malunions where observed in either group.
The use of a temporary Kirschner-wire as a third point of fixation may enable immediate
protected weight bearing, by minimizing load placed on the crossed lag screw construct,
in patients undergoing modified Lapidus arthrodesis.
Level of Clinical Evidence
Keywords
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Article info
Publication history
Published online: July 20, 2010
Footnotes
Financial Disclosure: None reported.
Conflict of Interest: None reported.
Identification
Copyright
© 2010 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.
