HCA Florida Westside Hospital
Reconstructive Foot and Ankle
bunionectomy, hallux abducto valgus deformity
Medicine and Health Sciences | Podiatry | Surgery
The Lapidus bunionectomy procedure, aimed at correcting hallux valgus deformities, involves realignment of the first metatarsal-cuneiform joint and often necessitates fixation to ensure proper alignment and stability during the healing process. A comprehensive literature review was completed by the authors using Google Scholar, Pubmed, Cochrane Review, and Science Direct using a combination of phrases related to the title of this article to determine the optimal fixation requirements for successful outcomes in Lapidus bunionectomies.
A systematic search of electronic databases that reported on fixation techniques, outcomes, and complications associated with Lapidus bunionectomies. Analysis of these studies revealed a wide range of fixation methods, including staples, screws, plates, and combinations thereof. Postoperative outcomes were assessed based on radiographic alignment, functional recovery, and complication rates.
The findings suggest that the choice of fixation for Lapidus bunionectomies should be tailored to individual patient factors, including age, bone quality, and concurrent medical conditions. Screw fixation emerged as a commonly utilized method, providing stable fixation and satisfactory outcomes across various studies. Additionally, the optimal degree of fixation required remains a subject of debate. Some studies indicated that single screw fixation provided comparable outcomes to double screw fixation, while others favored the use of multiple screws for enhanced stability. Literature indicated that the most stable construct was the plate and screw construct which also allowed for early weight bearing and range of motion.
Complications associated with excessive fixation were also noted, including hardware irritation, prominent hardware, and delayed healing. Conversely, inadequate fixation was associated with postoperative malalignment and reduced stability. Achieving the balance between sufficient fixation for stability and avoiding over-fixation for reduced complications remains crucial.
In conclusion, the optimal amount of fixation for Lapidus bunionectomies remains a nuanced decision that depends on patient-specific factors. Surgeons must tailor their fixation strategies to the individual's anatomical and clinical profile, recognizing that a personalized approach offers the best opportunity for favorable outcomes. Literature indicates that plate and screw construct is the most optimal fixation construct.
Modha, Nehal; Peralta, Diego; and Windram, Warren, "Optimal Fixation Requirements for Lapidus Bunionectomies: A Comprehensive Review and Analysis" (2023). East Florida Research Day 2023. 42.