Radiologic Evaluation and Comparative Analysis of First Metatarsal-Cuneiform Fusion Constructs Assessing Outcomes and...

Area of Science:

• Orthopedic Surgery
• Foot and Ankle Reconstruction

Background:

• The Lapidus procedure is a key surgical treatment for hallux valgus, particularly when tarsometatarsal instability is present.
• Optimizing fusion techniques is crucial for long-term stability and correction of the intermetatarsal angle (IMA).

Purpose of the Study:

• To compare the radiographic outcomes of three different Lapidus fusion constructs.
• To identify the most effective construct for improving postoperative stability and maintaining IMA.

Main Methods:

• Retrospective analysis of 32 feet undergoing the Lapidus procedure.
• Comparison of three fixation groups: transverse screw, metatarsal cuneiform screw, and combined fixation.
• Radiographic and clinical assessments at multiple postoperative time points.

Main Results:

• All constructs achieved successful fusion with improved patient outcomes and acceptable complication rates.
• Significant postoperative reduction in IMA was observed across all groups.
• Combined fixation (Group 3) showed superior initial IMA reduction and maintained significantly greater stability at 1 year with lower recurrence rates.

Conclusions:

• The Lapidus procedure is effective for hallux valgus with tarsometatarsal instability using the studied constructs.
• Combined transverse and metatarsal cuneiform screw fixation provides the most stable and durable results, making it a preferred approach.