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Review
. 2023 Apr 25;8(4):162-174.
doi: 10.1530/EOR-22-0069.

The modified Lapidus fusion: a systematic review of biomechanical studies

Martin Riegger  1   2 , Nermine Habib  3 , Enrique Adrian Testa  2   4 , Jochen Müller  1   2 , Marco Guidi  5 , Christian Candrian  1   2
Affiliations
Review

The modified Lapidus fusion: a systematic review of biomechanical studies

Martin Riegger et al. EFORT Open Rev. .

Abstract

Purpose: The biomechanical characteristics of different techniques to perform the modified Lapidus procedure are controversial, discussing the issue of stability, rigidity, and compression forces from a biomechanical point of view. The aim of this systematic review was to investigate the available options to identify whether there is a procedure providing superior biomechanical results.

Methods: A comprehensive literature search was performed by screening PubMed, Embase, and Cochrane databases until September 2021. There was a wide heterogeneity of the available data in the different studies. Load to failure, stiffness, and compression forces were summarized and evaluated.

Results: Seventeen biomechanical studies were retrieved - ten cadaveric and seven polyurethane foam (artificial bone) studies. Fixation methods ranged from the classic crossed screw approach (n = 5) to plates (dorsomedial and plantar) with or without compression screws (n = 11). Newer implants such as intramedullary stabilization screws (n = 1) and memory alloy staples (n = 2) were investigated.

Conclusion: The two crossed screws construct is still a biomechanical option; however, according to this systematic review, there is strong evidence that a plate-screw construct provides superior stability especially in combination with a compression screw. There is also evidence about plate position and low evidence about compression screw position. Plantar plates seem to be advantageous from a biomechanical point of view, whereas compression screws could be better when positioned outside the plate. Overall, this review suggests the biomechanical advantages of using a combination of locking plates with a compression screw.

Keywords: crossed screw fixation; first metatarsocuneiform arthrodesis; modified Lapidus procedure; plantar plate fixation.

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Conflict of interest statement

The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported.

Figures

Figure 1
Figure 1
Classic crossed screw fixation consisting of a full-threaded compression screw and a partial threaded screw.
Figure 2
Figure 2
Different surgical techniques for plate application. Plate design changes in different positions. Thirteen different plates were retrieved in this systematic review: (A) schematic illustration of a medial plate; (B) schematic illustration of a dorsal plate; (C) schematic illustration of a plantar plate.
Figure 3
Figure 3
Intramedullary stabilization in a dorsoplantar position. Plantar–dorsal position has also been investigated.
Figure 4
Figure 4
A schematic metatarsocuneiform joint fusion with two memory alloy staples. However, the use of one staple has also been investigated.
Figure 5
Figure 5
Flow chart of the search for eligible studies on biomechanical studies of the modified Lapidus procedure.
See this image and copyright information in PMC

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