A retrospective study of two Lapidus groups, each with a different method of rail application

To date, few studies discussing the use of rail external fixation for the Lapidus procedure have presented acceptable complication rates. At least 1 study has suggested the technique is not recommended for routine use with this procedure. We present 2 methods of external fixation application and 2 protocols of early postoperative weightbearing in 25 patients, with a marked decrease in complication rates from previously published studies. A retrospective study of 25 patients (within 2 patient groups) was performed, with a mean follow-up of 20 (range 12 to 38) months. Age, sex, incidence of fusion, interval to fusion, weightbearing status, and complication rates were evaluated. All subjects underwent Lapidus bunionectomy with joint preparation using sagittal planning. The fusion sites for group A fixation included a medially placed external fixation rail. Group B fixation included an interfragmentary screw and dorsal rail placement. Weightbearing was allowed in group A on day 1 and in group B on day 14. Our patient population consisted of 19 females (76%) and 6 males (24%). The mean patient age was 45.6 (range 28 to 63) years. The overall incidence of fusion was 96% (24 of 25), with complete union, although 1 patient's union was delayed. The mean interval to union for group A was 7.6 (range 6 to 8) weeks and for group B, was 9 (range 8 to 13) weeks. The primary complication encountered was pin tract infection in 11 patients (44%). The use of rail external fixation for Lapidus bunionectomy using either of the outlined techniques resulted in significant reduction of previously reported complication rates and allowed for early weightbearing.