Lapidus Arthrodesis by an Anatomic Dorsomedial Plate

Abstract

Background: Arthrodesis of the first tarsometatarsal joint (Lapidus arthrodesis) is a powerful modality for correction of a bunion deformity because it both addresses the instability of the first tarsometatarsal joint and fuses the base of first and second metatarsal. The Lapidus arthrodesis can be modified to fuse only the first tarsometatarsal joint. A comprehensive clinical evaluation and appropriate imaging modalities are essential to ensure the right indications for Lapidus arthrodesis and to provide an excellent surgical outcome. Objectives: The purpose of our study was to present an anatomic dorsomedial low-profile locked compression plate with a dorsal crossing screw, which can be used for both the original and modified Lapidus arthrodesis. Patients and Methods: In total, 24 Lapidus arthrodesis were performed at our institution with the APTUS dorsomedial anatomic angular stable Lapidus plate (Medartis, Switzerland) for the correction of symptomatic bunion deformity. Severity of HV deformity was determined by the Hallux Valgus angle and the Intermetatarsal angle. Results: All original and modified Lapidus arthrodesis healed postoperatively within 3 months. There was significant improvement of radiographic parameters postoperatively with a P-value of <0.05. Conclusions: The Lapidus arthrodesis allows for long-term bunion correction and contributes to the correction of a possible concomitant Pes planovalgus. Modifications to the surgical technique and use of a stable, novel, anatomic locking plate fixation provide high union rates with minimal postoperative complications.