Lapidus Arthrodesis

Abstract

We are writing in regard to the recent article by Menke et al about Lapidus arthrodesis [Menke CRD, McGlamry MC, Camasta CA. Lapidus arthrodesis with a single lag screw and a locking H-plate. J Foot Ankle Surg 50(4):377–382, 2011]. This is a powerfully corrective procedure that has undergone recent modifications to improve the healing rate and decrease the need for a lengthy non–weight-bearing regimen. A major drawback of the Lapidus procedure has been the morbidity and opportunity cost associated with extensive non–weight-bearing and lost time from work. The authors should be commended for presenting a well performed research study demonstrating the effective use of a lag screw and locked plate construct and early weight-bearing in the Lapidus arthrodesis. This is a construct we strongly believe in and routinely use for this indication. However, there are inconsistencies within this article that we consider important to point out and clarify that further support the superiority of this fixation construct. In the second paragraph, Menke stated, “there has only been 1 published report that describes the use of locking plates for Lapidus arthrodesis.” Unfortunately, this understates the literature support for the use of the lag screw and locking plate construct. In fact, several articles have been published on this very topic and are readily found with a search of the Medline database for “Lapidus + plate.” Some recent examples include a prospective study by Saxena et al (1Saxena A. Nguyen A. Nelsen E. Lapidus bunionectomy: early evaluation of crossed lag screws versus locking plate with plantar lag screw.J Foot Ankle Surg. 2009; 48: 170-179Abstract Full Text Full Text PDF PubMed Scopus (64) Google Scholar) in 2009 using a similar locking plate with a plantar lag screw for 21 patients, with weight-bearing at 4 weeks. Sorensen et al (2Sorensen M.D. Hyer C.F. Berlet G.C. Results of Lapidus arthrodesis and locked plating with early weight bearing.Foot Ankle Spec. 2009; 2: 227-233Crossref PubMed Scopus (40) Google Scholar), also in 2009, reported the lag screw-locking plate for Lapidus and their patients were allowed to weight-bear at 2 weeks. Another inconsistent statement comes in the second to last paragraph, “This pilot study is, to the best of our knowledge, the first clinical investigation to show that a locking H-plate combined with a single interfragmental compression screw is a satisfactory means of fixation for an MC arthrodesis.” The authors go on to incorrectly claim to be the first to study early weight-bearing. In addition to the 2 studies cited earlier, in 2010 Blitz et al (3Blitz N.M. Lee T. Williams K. Barkan H. DiDomenico L.A. Early weight bearing after modified Lapidus arthrodesis: a multicenter review of 80 cases.J Foot Ankle Surg. 2010; 49: 357-362Abstract Full Text Full Text PDF PubMed Scopus (48) Google Scholar) showed favorable results with early weight-bearing at 2 weeks as well with 2-screw construct. As frequent authors and editors ourselves, we realize that many papers are submitted long before publication and thus may not have citations in the very recent months, but several of these referenced studies are from 2009 and available for review (1Saxena A. Nguyen A. Nelsen E. Lapidus bunionectomy: early evaluation of crossed lag screws versus locking plate with plantar lag screw.J Foot Ankle Surg. 2009; 48: 170-179Abstract Full Text Full Text PDF PubMed Scopus (64) Google Scholar, 2Sorensen M.D. Hyer C.F. Berlet G.C. Results of Lapidus arthrodesis and locked plating with early weight bearing.Foot Ankle Spec. 2009; 2: 227-233Crossref PubMed Scopus (40) Google Scholar, 3Blitz N.M. Lee T. Williams K. Barkan H. DiDomenico L.A. Early weight bearing after modified Lapidus arthrodesis: a multicenter review of 80 cases.J Foot Ankle Surg. 2010; 49: 357-362Abstract Full Text Full Text PDF PubMed Scopus (48) Google Scholar, 4Klos K. Gueorguiev B. Mückley T. Fröber R. Hofmann G.O. Schwieger K. Windolf M. Stability of medial locking plate and compression screw versus two crossed screws for Lapidus arthrodesis.Foot Ankle Int. 2010; 31: 158-163Crossref PubMed Scopus (81) Google Scholar, 5DeVries J.G. Granata J.D. Hyer C.F. Fixation of first tarsometatarsal arthrodesis: a retrospective comparative cohort of two techniques.Foot Ankle Int. 2011; 32: 158-162Crossref PubMed Scopus (45) Google Scholar). It is our opinion that readers need to be aware of all appropriate and relevant studies when considering a new technique or change in protocol. A single report is not as valuable as a body of multiple studies in support of change. In addition, it is important for future researchers to understand the importance of a thorough literature review and appropriate source citation.