Can We Abandon Saw Wedge Resection in Lapidus Fusion? A Comparative Study of Joint Preparation Techniques Regarding Correction of Deformity, Union Rate, and Preservation of First Ray Length

Category: Bunion; Midfoot/Forefoot; Other Introduction/Purpose: Potential shortening of the first ray is an important consideration when performing a first tarsometatarsal (TMTJ) fusion. However, no previous study has sought to directly quantify the resultant shortening after TMTJ fusion. The purpose of the present anatomic study was to directly assess and compare shortening of the first ray using two joint preparation techniques (curettage, planal resection) for first TMTJ fusion. Methods: Ten pairs of matched lower extremity cadaver specimens were divided into two groups. Preoperative length assessments were performed at the first TMTJ dorsally and plantarly using a digital caliper. In Group 1, joint preparation for first TMTJ fusion was performed with curettage, whereas specimens in Group 2 underwent planal resection. Post-operative length assessments were repeated. All data was analyzed using two-tailed Students t-tests. Results: Mean shortening of the first ray following curettage was 1.1 (range, 0.3 to 2.0) mm dorsally and 1.6 (range, 0.6 to 3.7) mm plantarly; while mean shortening following planal resection was 4.5 (range, 2.7 to 7.9) mm dorsally and 4.6 (range, 2.4 to 8.9) mm plantarly. The measured differences were statistically significant (p <0.001, p=0.001). Conclusion: Both curettage and planal resection resulted in shortening of the first ray after first TMTJ fusion. Planal resection resulted in significantly more shortening, which was also more variable. Surgeons performing first TMTJ fusions may consider curettage over planal resection to mitigate the risk of painful postoperative transfer metatarsalgia.

Download Full-text

A comparative study of preparation techniques for improving the viability of striatal grafts using vital stains, in vitro cultures, and in vivo grafts

Cell Transplantation ◽

10.1016/s0963-6897(96)00087-5 ◽

1996 ◽

Vol 5 (6) ◽

pp. 599-611 ◽

Cited By ~ 22

Author(s):

R Fricker

Keyword(s):

Comparative Study ◽

In Vitro Cultures ◽

Striatal Grafts ◽

Vital Stains ◽

Preparation Techniques

Download Full-text

Multiclass pesticide analysis in fruit-based baby food: A comparative study of sample preparation techniques previous to gas chromatography–mass spectrometry

Food Chemistry ◽

10.1016/j.foodchem.2016.06.010 ◽

2016 ◽

Vol 212 ◽

pp. 528-536 ◽

Cited By ~ 24

Author(s):

Mateus H. Petrarca ◽

José O. Fernandes ◽

Helena T. Godoy ◽

Sara C. Cunha

Keyword(s):

Mass Spectrometry ◽

Gas Chromatography ◽

Sample Preparation ◽

Comparative Study ◽

Baby Food ◽

Gas Chromatography Mass Spectrometry ◽

Pesticide Analysis ◽

Chromatography Mass Spectrometry ◽

Preparation Techniques

Download Full-text

Postoperative Cast Necessity after a Lapidus Arthrodesis

Foot & Ankle International ◽

10.3113/fai.2009.0746 ◽

2009 ◽

Vol 30 (8) ◽

pp. 746-751 ◽

Cited By ~ 20

Author(s):

Sarmad Kazzaz ◽

Dishan Singh

Keyword(s):

Internal Fixation ◽

Hallux Valgus ◽

Surface Preparation ◽

Bone Surface ◽

Union Rate ◽

Bone Resection ◽

Superficial Wound Infection ◽

Non Union ◽

Superficial Wound ◽

First Ray

Background: The incidence of non union following a first tarsometatarsal arthrodesis (Lapidus procedure) has decreased significantly with modern techniques of minimal bone resection, meticulous bone surface preparation and rigid internal fixation. We evaluated whether a postoperative wedge shoe would increase our non-union rate. Materials and Methods: Nineteen adult female patients (27 feet; eight bilateral, five simultaneous) undergoing a first tarsometatarsal arthrodesis for hallux valgus associated with a hypermobile first ray or for recurrent hallux valgus were managed postoperatively by allowing them to bear weight in a wedge shoe instead of a cast. Radiographs were evaluated for signs of fusion. Results: All 27 feet went on to successful union after 6 to 24 weeks. There was one superficial wound infection and one case of recurrence of the hallux valgus. Conclusion: Based on our results, we allow adult patients undergoing a Lapidus type procedure to be managed in a postoperative wedge shoe.

Download Full-text

Fusion Rate of First Tarsometatarsal Arthrodesis in the Modified Lapidus Procedure and Flatfoot Reconstruction

Foot & Ankle International ◽

10.1177/107110070502600906 ◽

2005 ◽

Vol 26 (9) ◽

pp. 698-703 ◽

Cited By ~ 83

Author(s):

Ian M. Thompson ◽

Donald R. Bohay ◽

John G. Anderson

Keyword(s):

Tobacco Use ◽

Revision Rate ◽

Fusion Rate ◽

Union Rate ◽

Radiographic Evidence ◽

Diabetic Status ◽

Reconstruction Methods ◽

First Ray ◽

The Right ◽

Recurrent Deformity

Background: The purpose of this study was to determine the overall first tarsometatarsal joint (TMTJ) union rate in patients after they had a modified Lapidus procedure or a TMTJ arthrodesis as part of a flatfoot reconstruction. Methods: We retrospectively reviewed the charts of 182 patients (201 feet) who had a modified Lapidus procedure or a TMTJ arthrodesis as part of a flatfoot reconstruction between May, 1997, and May, 2001; all had at least a 6-month followup. The data collected included age, gender, tobacco use, diabetic status, complications, and radiographic evidence of union. There were 167 women and 15 men. The right foot was operated on in 106 patients and the left foot in 95. The average age was 53 (range 11 to 87) years. Results: First TMTJ arthrodesis healed uneventfully in 193 (96%), and eight (4%) had nonunions. Of those eight patients with nonunions, five had previous bunion surgeries, two were smokers, and one had diabetes. There were 25 (12%) patients with previous bunion surgeries and five of these (20%) had nonunions. Four patients (2%) had symptomatic nonunions resulting in revision. Of the 21 patients undergoing flatfoot reconstruction, none had a nonunion. Conclusion: One criticism of the modified Lapidus procedure is the unacceptable nonunion rate (10 to 12%). Out of the 201 feet, we had a 4% nonunion rate and a 2% revision rate, which is well below the reported nonunion rates. We also have found that patients with previous bunion surgery and recurrent deformity were at a higher risk for a nonunion. Clinical Relevance: We believe that the modified Lapidus procedure and first TMTJ arthrodesis can achieve acceptable union rates and be successful for correcting hallux valgus with a hypermobile first ray and can also be applied to certain patients undergoing flatfoot reconstruction.

Download Full-text