Can we correct first metatarsal rotation and sesamoid position with the 3D Lapidus procedure?

ObjectiveWe examine the technique and radiographic outcomes obtained with triplanar first tarsometatarsal arthrodesis (3D Lapidus) for the surgical correction of hallux valgus (HV). This procedure, apart from correcting angular deformity 1st–2nd intermetatarsal angle, HV angle, etc., is specifically intended to act on first ray pronation and place the sesamoids in their normal position, to alleviate the metatarsalgia often occurring in HV before and after surgery, possibly caused by their abnormal position.This study aims to examine the radiographic outcomes of the 3D Lapidus procedure.Materials and methodsRetrospective study of 37 feet operated on from April 2019 to December 2019, with a minimum 1-year follow-up (mean 420 days), using the 3D Lapidus procedure. Radiographic outcomes were evaluated.ResultsThe intermetatarsal angle decreased from a mean value of 16.42° to 5.62° (p < 0.0001). The HV angle decreased from a mean value of 32.12° to 8.05° (p < 0.0001). The preoperative first metatarsocuneiform angle, with a mean value of 21.86°, was null after arthrodesis (p < 0.0001). The tibial sesamoid position, according to the Hardy and Clapham classification, decreased from a mean value of 4.84 to 1.27 after surgery, within normality (p < 0.0001).DiscussionCorrection of the deformity in a single plane is generally insufficient. It is necessary to act on the three planes of space to correct the deformity, obtain good outcomes, and avoid recurrence.ConclusionsRadiographic outcomes of triplanar correction with the 3D Lapidus procedure are excellent, achieving statistically significant differences in all parameters studied.     

Screw only versus screw plus plate in isolated talonavicular arthrodesis

BackgroundWe aimed to compare outcomes of treatment of isolated talonavicular arthrodesis (ITNA) with screw only or screw plus plate, respectively.MethodsWe retrospectively evaluated 40 consecutive cases of ITNA [two-screw fixation patients: Group 1 (23 cases); screw-plus-plate fixation patients: Group 2 (17 cases)]. Outcome measures included radiographic findings, Foot and Ankle Outcome Scores (FAOS), and visual analogue scale (VAS) scores.ResultsNonunion occurred more frequently in group 1 (21.7%) than in group 2 (5.9%), but there was no statistical significance (p = 0.216). Although the preoperative FAOS and VAS score showed similar results between both groups, there were significantly better clinical outcomes in two of five FAOS domains and VAS scores at 3 months postoperative and final follow-up (p < 0.05).ConclusionAlthough union rates were not significantly different, nonunion occurred more frequently in screw only group and we obtained more favorable clinical outcomes in screw plus plate group.     

A case of ankle osteoarthritis associated with lateral premalleolar bursitis caused by chronic ankle instability

IntroductionLateral premalleolar bursitis develops on the dorsolateral aspect of the foot anterior to the lateral malleolus, distinct from lateral malleolar bursitis located just around the lateral malleolus.Presentation of caseA 71-year-old woman visited an orthopedic clinic about 40 years after an episode of ankle sprain and was diagnosed with lateral premalleolar bursitis and osteoarthritis of the left ankle. Stress radiography revealed left ankle anterolateral malleolar bursitis with varus and anterior instability. We opted for less invasive arthroscopic ankle arthrodesis over open resection to stop the communication of the bursitis with the ankle joint. The lateral premalleolar bursitis was located just over the anterolateral portal. The remaining cartilage in the talotibial joint was removed and the subchondral surface was exposed and curetted down to a bleeding surface by ankle arthroscopy. The talotibial joint was fixed with 3 6.0-mm cannulated cancellous screws. The foot and ankle were immobilized by cast for 4 weeks. Bony union was achieved about 8 weeks postoperatively. The patient could perform daily activities without pain and with no recurrence of the lateral premalleolar bursitis at the 1.5-year follow-up.DiscussionTo our knowledge, this is the first report on arthroscopic arthrodesis for ankle osteoarthritis with recalcitrant lateral premalleolar bursitis caused by the check valve mechanism of chronic ankle instability after old ankle sprain.ConclusionWe report a case of arthroscopic arthrodesis for osteoarthritis of the ankle associated with lateral premalleolar bursitis caused by the check valve mechanism of chronic ankle instability after old ankle sprain.     

Komplikationen der Tarsometatarsale I Arthrodese (modifizierte Lapidus Arthrodese)

BackgroundFirst tarsometatarsal arthrodesis, or known as modified Lapidus arthrodesis, is a powerful procedure for hallux valgus correction. Historically there have been high reported complication rates including nonunion, dorsiflexion malunion and transfer metatarsalgia, due to the high lever at the TMT I joint.MethodsThe development of new biomechanically more stable fixation methods has revolutionized the classic Lapidus arthrodesis in recent decades, so that more progressive mobilization regimens could be established.ResultsThe current clinical and radiological results of modern Lapidus arthrodesis using plate fixation confirm that nonunion rates could be drastically reduced. However, the rates of symptomatic transfer metatarsalgia remained unchanged.ConclusionOn the basis of new fixation methods, the modified Lapidus arthrodesis became a low-complication and satisfactory surgical method. The influence of first ray shortening and dorsiflexion malunion on the development of a transfer metatarsalgia has not yet been fully clarified.