Pertinent Insights On Treating Lapidus Nonunions
- Volume 21 - Issue 1 - January 2008
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With the emergence of newer surgical techniques and implants, there is a relatively low incidence of nonunion after a primary Lapidus arthrodesis. However, despite these technological advances, nonunions do occur and can be very challenging to remedy. In our analysis of 17 patients revised with autogenous bone graft and internal fixation, we were able to demonstrate a favorable rate of union (82 percent).
Noncompliance in the postoperative course and cigarette smoking were both associated with increased rates of nonunion, with the latter proving statistically significant. Strict patient counseling in the preoperative period to support compliance is strongly recommended. Also, one should view active cigarette smoking as a relative contraindication to revision.
Dr. Hamilton is the Director of Research at the San Francisco Bay Area Foot and Ankle Residency Program. He is a Fellow of the American College of Foot and Ankle Surgeons.
Dr. Burks is a Fellow of the American College of Foot and Ankle Surgeons, and is board certified in foot and ankle surgery. Dr. Burks practices in Little Rock, Ark.
1. Catanzariti AR, Mendicino RW, Lee MS, Gallina MR. The modified Lapidus arthrodesis: a retrospective analysis. J Foot Ankle Surg 38: 322–332, 1999.
2. Patel S, Ford LA, Etcheverry J, Rush SM, Hamilton GA. Modified lapidus arthrodesis: rate of nonunion in 227 cases. J Foot Ankle Surg. 2004 Jan-Feb;43(1):37-42.
3. Sangeorzan BJ, Hansen ST Jr. Modified Lapidus procedure for hallux valgus. Foot Ankle Int 9:262–266, 1989.
4. McInnes BD, Bouche´ RT. Critical evaluation of the modified Lapidus procedure. J Foot Ankle Surg 40:71–90, 2001.
5. Myerson M, Allon S, McGarvey W. Metatarsocuneiform arthrodesis for management of hallux valgus and metatarsus primus varus. Foot Ankle Int 13:107–115, 1992.
6. Grace D, Delmonte R, Catanzariti AR, Hofbauer M. Modified Lapidus arthrodesis for adolescent hallux abducto valgus. J Foot Ankle Surg 38:8–13, 1999.
7. Coetzee JC, Resig SG, Kuskowski M, Saleh KJ. The Lapidus procedure as salvage after failed surgical treatment of hallux valgus: a prospective cohort study. J Bone Joint Surg 85A:60–65, 2003.
8. Cohen DA, Parks BG, Schon LC. Screw fixation compared to H-locking plate fixation for first metatarsocuneiform arthrodesis: a biomechanical study. Foot Ankle Int. 2005 Nov;26(11):984-9.
9. Haverstock BD, Mandracchia VJ. Cigarette smoking and bone healing: implications in foot and ankle surgery. J Foot Ankle Surg 37:69–74; discussion, 78, 1998.
10. Butson AR. A modification of the Lapidus operation for hallux valgus. J Bone Joint Surg 62B:350–352, 1980.