A novel construct for Lapidus bunionectomy utilizing nitinol staples

Abstract

The Lapidus bunionectomy is a popular procedure that allows for powerful hallux valgus correction through arthrodesis of the first metatarsal-cuneiform joint. Although widely used since its advent in the 1930s, controversy still exists surrounding what the most superior fixation construct is for this procedure. Commonly used fixation constructs include, but are not limited to, crossed screws, plate and screws, and monorail external fixators. Nitinol staples, although relatively new to the internal fixation world, offer unique advantages that other forms of internal fixation do not. These advantages include easy insertion, dynamic compression, and superelasticity which may impact rates of bunion recurrence, nonunion, and malunion, all of which are of concern with this procedure. This study details a unique surgical technique for the Lapidus bunionectomy utilizing a 2-leg staple dorsally and a 4-leg staple medially in a 90 degree construct. We propose that use of a 4-leg staple medially may mimic the advantages of plantar plating without the difficulty of positioning and obtaining adequate anatomic exposure.