Abstract
Lapidus (first tarsometatarsal joint) arthrodesis is an established and widely used
procedure for the management of moderate to severe hallux valgus, especially in cases
involving hypermobility of the first tarsometatarsal joint. Multiple fixation methods
are available, and several previous investigations have studied the relative strengths
of these methods, including dorsomedial and plantar plating comparisons. However,
these studies compared plates of varying designs and mechanical properties and used
varying modes of compression and interfragmentary screw techniques. The present study
mechanically investigated the resulting motion, stiffness, and strength of identical
locking plate constructs fixed at various anatomic positions around the first tarsometatarsal
joint. In a bench-top study, fourth-generation composite bones were divided into 3
fixation groups, each having identical interfragmentary screw applications, and randomized
to 1 of 3 plate positions: dorsal, medial, or plantar. The plates applied in each
case were identical locking plates, precontoured to fit the anatomy. Each construct
was experimentally tested using a cantilever bending approach. The outcomes obtained
were stiffness, yield force, displacement at yield, ultimate force, and displacement
at ultimate force. The plantar plate position showed superior initial stiffness and
force to ultimate failure. The plantar and medial plate positions exhibited superior
force to yield. The medial plate position was superior regarding displacement tolerated
before the yield point and catastrophic failure. The dorsal plate position was not
superior for any outcome measured. Plantar and medial plating each offered biomechanical
benefits. Clinical studies using similarly matched constructs are required to show
whether these findings translate into improved clinical outcomes.
Level of Clinical Evidence
Keywords
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Article info
Publication history
Published online: February 19, 2018
Footnotes
Financial Disclosure: The present study was supported by the John Peter Smith Hospital Research Intramural Fund (teaching hospital-based funding for materials in the amount of $5307).
Conflict of Interest: None reported.
Identification
Copyright
© 2017 by the American College of Foot and Ankle Surgeons. All rights reserved.
