Low Profile Medial Locking plate augmentation Lapidus Arthrodesis with an early weight bearing protocol: Clinical and Radiographic Analysis

Transcription

1 Low Profile Medial Locking plate augmentation Lapidus Arthrodesis with an early weight bearing protocol: Clinical and Radiographic Analysis James Cottom, DPM Anand Vora, MD

2 Low Profile Medial Locking plate augmentation Lapidus Arthrodesis with an early weight bearing protocol: Clinical and Radiographic Analysis Anand Vora, MD My disclosure is listed in the Final AOFAS Program Book. I have a potential conflict with this presentation due to: Consultant Arthrex James Cottom, DPM Consultant Arthrex

3 Introduction Lapidus powerful procedure Many fixation techniques described Plating constucts improved stability as compared to screws only Results of surgical construct utilizing a plantar to dorsal lag screw fixation coupled with a low profile medial locking plate with early weight bearing protocol is described

4 Methods 88 consecutive patients 17 of 88 patients revision hallux valgus procedures 2 surgeon series Age, sex, follow-up, time to weight bearing, radiographic fusion time, pre-operative /postoperative intermetatarsal (IM) angle, hardware removal, pre-operative / post-operative AOFAS midfoot scores, associated procedures analyzed

5 Surgical Technique Modified McBride soft tissue release Preparation of 1 st MTC joint Dorsal to plantar 4.0 or 4.5 mm lag screw Dorsomedial low profile locking plate Soft tissue strapping wrap CAM walker boot Weight bearing at first followup visit or when wound healed

6 Additional procedures Bone marrow aspirate 66 patients (surgeon JC) Calcaneal autograft 22 patients (surgeon AV) Lesser metatarsal osteotomy 51 procedures Duvires condylectomy 19 procedures Chevron osteotomy 4 patients Akin osteotomy 10 patients Tailors bunion 4 patients

7 Mean f/u 16.7 months Results Radiographic fusion average 51 days Weight bearing at average 10.9 days 85 of 88 patients radiographic union (2 of 3 nonunion required additional surgery) AOFAS midfoot ave pre to post patients requiring removal of hardware 2 patients symptomatic hallux varus (1 of which required additional surgery) 6 patients recurrant hallux valgus

8 Results Medial locking plate fixation with plantar to dorsal lag screw fixation for Lapidus arthrodesis allows early weight bearing with acceptable outcome and complication rates

9 References Sangeorzan BJ, Hansen ST Jr. Modified Lapidus procedure for hallux valgus. Foot Ankle Int. 1989; 9: Hansen ST Jr. Hallux valgus surgery: Morton and Lapidus were right! Clin Podiatr Med. 1996;13: Myerson MS, Badekas A. Hypermobilitly of the first ray. Foot Ankle Clin. 2000; 5: Hass Z, Hamilton G, Sundstrom D, Ford L. Maintenance of correction of the first metatarsal closing base wedge osteotomies versus modified Lapidus arthrodesis for moderate to severe hallux valgus deformity. J Foot Ankle Surg. 2007; 46: Faber FW, Mulder PG. Verhaar JA. Role of first ray hypermobility in the outcome of the Hohmann and the Lapidus procedure. A prospective, randomized trial involving one hundred and one feet. J Bone Joint Surg Am. 2004; 86: Coetzee JC, Wickum D. The Lapidus procedure: a prospective cohort outcome study. Foot Ankle Int. 2004; 25: Myerson MS, Allon S, McGarvy W. Metatarsocuneiform arthrodesis for management of hallux valgus and metatarsus primus varus. Foot Ankle Int. 1992; 13: Klos K, Gudorguiev B, Muckley T, Frober R, Gunther HO, Schwieger K, Windolf M. Stability of medial locking plate and compression screw versus two crossed screws for lapidus arthrodesis. Foot Ankle Int. 2010; 31: Scranton PE, Coetzee CJ, Carreira D. Athrodesis of the first meatarsocuneiform jont: a comparative study of fixation methods. Foot Ankle Int. 2009; 30: Campbell JT, Schon LC, Parks BG, Wang Y, Berger BI Mechanical comparison of biplanar proximal closing wedge osteotomy with plantar plate fixation versus crescentic osteotomy with screw fixation for the correction of metatarsus primus varus. Foot Ankle Int. 1998;19: Richter M, Gosling T, Zech S, Allami M, Geerling J, Droste P, Krettek C. A comparison of plates with and without locking screws in a calcaneal fracture model. Foot Ankle Int. 2005; 26: