The Latest Advancements in Lapidus Hallux Valgus Surgery
The Latest Advancements in Lapidus Hallux Valgus Surgery
Correcting hallux valgus is one of the most common procedures undertaken by foot and ankle specialists. There have been some advancements in understanding said deformity. Now the focus is primarily on surgically correcting the first tarsometatarsal joint.
The recent developments in hallux valgus correction have focused on triplane corrections that utilise proprietary systems. These systems are effective in obtaining corrections and maintaining them.
The Lapidus procedure is advised for patients with more severe bunions or who suffer from hypermobility.
How is Lapidus fixation evolving?
We will start by talking about fixing a Lapidus bunionectomy. It is known that you will get a union if the fixation is stable and the joint is adequately prepared.
The following fixation devices have been observed to have failed in these cases:
- K-wire fixation
- crossing screw fixation
- staple fixation
- locking plates using and not using lag screws
- external fixators
Mr Kaser Nazir uses a locking plate, locking screws and lag screws that provide a more stabile result with a non-union rate as low as 2%.
Key principles in joint preparation
Surgeons can prepare joints for such fusion by using hand instrumentation. They should also use an osteotome with this. They may or may not use a curette in such surgeries, a curette is a good choice when they are worried about over-shortening the metatarsal for a patient who has already had a short first ray.
At times, the patient may have a concomitant second MPJ (metatarsophalangeal joint) pathology because of lesser metatarsal overload. In such cases, the surgeons focus on having a weight-bearing and functional metatarsal.
Pertinent considerations for Lapidus modifications
Often after performing a lapidus bunionectomy, there is a recurrence of the deformity and this is one of the most frustrating problems that surgeons face. The belief in these instances is that it is the instability of the first ray that affects the first metatarsal joint.
If you have fused the joint why should the deformity recur? This can happen because the instability also affects the more proximal joints – intercuneiform and naviculocuneiform joints. There have been several complications with several of the new kinds of added fixation maneuvers. This is why it is important that your surgeon uses a fixation that has reliable results.
Conclusion
Using Lapidus in bunion surgery is well supported in terms of literature. It is important that your surgeon uses equipment that provides a reliable outcome with low non-union rate.
