Carl T Hasselman1*, Bradley Cambell2, Tejas Patel1, Chad M Ferguson2 and Alex J Kline2
1Department of Orthopedic Surgery, University of Pittsburgh Medical Center, USA
2Department of Mechanical Engineering, University of Pittsburgh, USA
Background: The Lapidus procedure is commonly utilized for severe hallux valgus correction, but concerns exist regarding union rates, shortening of the first ray, transfer metatarsalgia and recurrence of deformity. We hypothesized that a Lapidus fusion with an “opening wedge” technique would yield excellent rates of fusion while minimizing shortening of the first ray. Furthermore, we hypothesized that stabilization of the intercuneiform joints using a semi-rigid device would prevent the intermetatarsal angle widening during the postoperative period, thereby causing a recurrence of the hallux valgus.Materials and
Methods: A retrospective review of all hallux valgus corrections performed by a single surgeon over a one year period using an “opening wedge technique” through the first tarsometatarsal joint combined with stabilization of the intercuneiform joints using a suture button device was performed. Specifically, we evaluated successful arthrodesis rates, time to weight bearing, complications, and radiographic parameters including changes in the intermetatarsal angle and hallux valgus angle. Additionally, the magnitude of length change between the first and second ray was evaluated.Results: Thirty four patients (42 feet) were followed for a minimum of 6 months postoperatively. The decrease in the intermetatarsal (IM) angle averaged 8.3 degrees (mean preop IM angle 14.6 degrees and mean post op IM angle 6.3 degrees). The average decrease in the hallux valgus (HV) angle was 21.2 degrees (mean preop HV angle 35.4 degrees and mean post op HV angle 14.2 degrees). The length difference between the first and second rays revealed a minimal change of an increase in 0.89 mm length of the first ray. There were no hardware failures or non unions determined by clinical exam or radiographs. Conclusison: In our experience, the technique described in this paper for hallux valgus correction yielded excellent correction with a low rate of complications and no significant changes in the length of the first ray.
Lapidus; Bunion; Hallux valgus; Metatarsalgia; Opening wedge
Hasselman CT, Cambell B, Patel T, Ferguson CM, Kline AJ. Hallux Valgus Correction by Opening Wedge Lapidus Fusion and Intercuneiform Stabilization. Clin Surg. 2017; 2: 1374.