Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
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.

PubMed Disclaimer

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

References

    1. Truslow W. Metatarsus primus VARUS or hallux valgus? Bone and Joint Surgery 19257. Available at: https://journals.lww.com/jbjsjournal/Fulltext/1925/07010/METATARSUS_PRIM.... - PubMed
    1. Kleinberg S. The Operative cure of hallux valgus and bunions. American Journal of Surgery 19321575–81. ( 10.1016/S0002-9610(3291000-9) - DOI
    1. Lapidus PW. Operative correction of metatarsus primus Varus in hallux valgus. Surgery, Gynecology and Obstetrics 193458183–191.
    1. Lapidus PW. A quarter of a century of experience with the operative correction of the metatarsus varus primus in hallux valgus. Bulletin of the Hospital for Joint Diseases 195617404–421. - PubMed
    1. Butson AR. A modification of the Lapidus operation for hallux valgus. Journal of Bone and Joint Surgery. British Volume 198062350–352. ( 10.1302/0301-620X.62B3.6997319) - DOI - PubMed

LinkOut - more resources