Abstract
Aims: The aim was to evaluate union rates using two cross headless compression screws for the modified Lapidus procedure. This was compared to conventional fixation using solid AO screws and plates, as recorded in the published literature. Patients and methods: This is a retrospective study of the modified Lapidus procedure performed in patients with a moderate to severe hallux valgus deformity. Union time and patient demographics were retrieved from medical records. Patient demographics included age, sex, smoking habits and other comorbidities. The union rate was compared to the literature using the two-population probability test, with p<0.05 being significant. Results: Sixty-nine feet in 56 patients were assessed for radiographic union. There were three delayed unions and two non-unions. The union rate of 97% was not statistically different when compared to studies using conventional solid AO screws. Conclusion: The use of headless compression screws in the fixation of the first tarsometatarsal joint and early mobilisation was found to be comparable to conventional solid AO screws with regard to union rates. The cannulated design enhances ease of insertion and, being headless, minimises the risk of intra-operative fracture and hardware prominence requiring subsequent removal. Level of evidence: Level 4
Highlights
In 1934 Lapidus described a method of fusing the first tarsometatarsal joint for the treatment of hallux valgus
The hallux valgus and metatarsus primus varus are corrected in the coronal plane; plantar angulation can be increased in the sagittal plane; and the pronation deformity is corrected in the axial plane
We present a technique for the modified Lapidus procedure using two 4.7 mm cannulated headless compression screws for fixation, as well as a retrospective review of our cases
Summary
In 1934 Lapidus described a method of fusing the first tarsometatarsal joint for the treatment of hallux valgus. Theories regarding the cause of hallux valgus has evolved in recent years, and the concept of first ray instability has become more important.[2,3,4,5,6,7,8,9] Currently, the modified Lapidus procedure is seen as a very powerful procedure with the ability to correct deformities in three different planes simultaneously.[2,3,4,5,6,7,8,9] The hallux valgus and metatarsus primus varus are corrected in the coronal plane; plantar angulation can be increased in the sagittal plane; and the pronation deformity is corrected in the axial plane. Coetzee et al have emphasised the need for proper surgical technique and attention to detail to minimise complications.[10]
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