Comparison of Lapidus procedure fixation methods for hallux valgus: a 10-year retrospective analysis
DOI:
https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20232604Keywords:
Lapidus procedure, Halux valgus, Dorso-medial plate, Distal metatarsal articular angleAbstract
Background: The purpose of this study was to identify the type of Lapidus fixation method used in Leeds Teaching Trust Hospital that produces the best post-operative radiographical measurements.
Methods: Thirty-five patients who underwent the Lapidus procedure were reviewed. Pre-operative and post-operative X-rays were measured to obtain angles; hallux valgus angle (HVA), first intermetatarsal angle (IMA), distal metatarsal articulate angle (DMA), meary angle (MA), and metatarsal declination angle (MDA). The fixation groups compared were dorso-medial plate vs dorsal plate vs medial plate and plate-single screw versus plate-crossed screw. The change in angle (Δ-angles) between pre-operative and post-operative were measured and the groups were compared. The fixation method that resulted in the largest Δ-angles and is statistically significant will be regarded as a superior fixation type within that group.
Results: Groups with plate-single screw fixation showed a statistically significant (p<0.05) larger change in distal metatarsal articulate angle compared to plate-crossed screw fixation. Dorso-medial plate showed largest Δ-angles in the plate group although none were statistically significant.
Conclusions: Fixation systems with single-screw result in better radiographical measurements compared to crossed-screws, significantly with the distal metatarsal articular angle. Dorso-medial plates result in better radiographical measurements followed by dorsal plate and then medial plate. However, these findings need validation with a randomized controlled trial before being generalized.
References
Glasoe WM, Yack HJ, Saltzman CL. Anatomy and biomechanics of the first ray. Phys Ther. 1999;79(9):854-9.
Klos K, Simons P, Hajduk AS, Hoffmeier KL, Gras F, Fröber R, Hofmann GO, Mückley T. Plantar versus dorsomedial locked plating for Lapidus arthrodesis: a biomechanical comparison. Foot Ankle Int. 2011;32(11):1081-5.
Gutteck N, Wohlrab D, Zeh A, Radetzki F, Delank KS, Lebek S. Comparative study of Lapidus bunionectomy using different osteosynthesis methods. Foot Ankle Surg. 2013;19(4):218-21.
Lee KM, Ahn S, Chung CY, Sung KH, Park MS. Reliability and relationship of radiographic measurements in hallux valgus. Clin Orthop Relat Res. 2012;470(9):2613-21.
Piqué-Vidal C, Vila J. A geometric analysis of hallux valgus: correlation with clinical assessment of severity. J Foot Ankle Res. 2009;2:15.
Seo JH, Ahn JY, Boedijono D. Point-Connecting Measurements of the Hallux Valgus Deformity: A New Measurement and Its Clinical Application. Yonsei Med J. 2016;57(3):741-7.
Heineman N, Liu G, Pacicco T, Dessouky R, Wukich DK, Chhabra A. Clinical and imaging assessment and treatment of hallux valgus. Acta Radiologica. 2020;61(1):56-66.
Bouaicha S, Ehrmann C, Moor BK, Maquieira GJ, Espinosa N. Radiographic analysis of metatarsus primus elevatus and hallux rigidus. Foot Ankle Int. 2010;31(9):807-14.
Henry JK, Shakked R, Ellis SJ. Adult-Acquired Flatfoot Deformity. Foot Ankle Orthop. 2019;4(1):2473011418820847.
Riskowski J, Dufour AB, Hannan MT. Arthritis, foot pain and shoe wear: current musculoskeletal research on feet. Curr Opin Rheumatol. 2011;23(2):148-55.
Gribbin CK, Ellis SJ, Nguyen J, Williamson E, Cody EA. Relationship of Radiographic and Clinical Parameters With Hallux Valgus and Second Ray Pathology. Foot Ankle Int. 2017;38(1):14-9.
Palomo-López P, Becerro-de-Bengoa-Vallejo R, Losa-Iglesias ME, Rodríguez-Sanz D, Calvo-Lobo C, López-López D. Impact of Hallux Valgus related of quality of life in Women. Int Wound J. 2017;14(5):782-5.
López DL, Callejo González L, Losa Iglesias ME, Canosa JL, Sanz DR, Lobo CC, et al. Quality of Life Impact Related to Foot Health in a Sample of Older People with Hallux Valgus. Aging Dis. 2016;7(1):45-52.
Menke CR, McGlamry MC, Camasta CA. Lapidus arthrodesis with a single lag screw and a locking H plate. J Foot Ankle Surg. 2011;50(4):377-82.
Lalevée M, Barbachan Mansur NS, Lee HY, Maly CJ, Iehl CJ, Nery C, et al. Distal Metatarsal Articular Angle in Hallux Valgus Deformity. Fact or Fiction? A 3-Dimensional Weightbearing CT Assessment. Foot Ankle Int. 2022;43(4):495-503.
Cruz EP, Wagner FV, Henning C, Sanhudo JAV, Pagnussato F, Galia CR. Comparison between simple radiographic and computed tomographic three-dimensional reconstruction for evaluation of the distal metatarsal articular angle. J Foot Ankle Surg. 2017;56(3):505-9.
Vittetoe DA, Saltzman CL, Krieg JC, Brown TD. Validity and reliability of the first distal metatarsal articular angle. Foot Ankle Int. 1994;15(10):541-7.
Saxena 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(2):170-9.
Jastifer JR, Alrafeek S, Howard P, Gustafson PA, Coughlin MJ. Biomechanical Evaluation of Strength and Stiffness of Subtalar Joint Arthrodesis Screw Constructs. Foot Ankle Int. 2016;37(4):419-26.
Terjesen T, Apalset K. The influence of different degrees of stiffness of fixation plates on experimental bone healing. J Orthop Res. 1988;6(2):293-9.
Alshalawi S, Teoh KH, Alrashidi Y, Galhoum A, Wiewiorski M, Herrera-Perez M, et al. Lapidus Arthrodesis by an Anatomic Dorsomedial Plate. Techniques in Foot Ankle Surg. 2020;19(2):89-95.
Drummond D, Motley T, Kosmopoulos V, Ernst J. Stability of Locking Plate and Compression Screws for Lapidus Arthrodesis: A Biomechanical Comparison of Plate Position. J Foot Ankle Surg. 2018;57(3):466-70.
López-López D, Larrainzar-Garijo R, De-Bengoa-Vallejo RB, Losa-Iglesias ME, Bayod-López J. Effectiveness of the Lapidus plate system in foot surgery: A PRISMA compliant systematic review. Int Wound J. 2022;19(3):507-14.
