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Radiographic and Clinical Outcomes of First Tarsometatarsal Joint Arthrodesis With a Biplanar Locking Plate System Versus the Modified Lapidus Technique With Crossed-Screw Fixation: A Retrospective Multicenter Comparison.

Publication ,  Journal Article
Fletcher, AN; Droz, LG; Fuller, R; Rajan, L; Zhu, J; Easley, ME; Nunley, JA; Cody, EA
Published in: HSS J
October 21, 2024

Background: Hallux valgus (HV) is recognized as a triplanar deformity. A biplanar locking plate (BLP) system corrects this deformity through first tarsometatarsal joint (TMTJ) arthrodesis, with specialized reduction tools and cutting guides. Yet the optimal surgical technique and fixation construct for first TMTJ arthrodesis remains controversial. Purpose: We sought to compare the BLP system with a modified Lapidus (ML) technique with crossed-screw fixation in terms of radiographic outcomes, complications, and reoperations. Methods: In this retrospective multicenter study, we identified a series of consecutive patients who underwent first TMTJ arthrodesis for HV with either the ML procedure at institution A or the BLP system at institution B. Patients 18 years of age with a minimum of 6 months of postoperative radiographs were included. There were 130 patients, 65 in each group, including 121 women (93.8%) with a median age of 58 years and mean radiographic follow-up of 7.1 months. Data included preoperative and postoperative HV angle (HVA), intermetatarsal angle (IMA), and tibial sesamoid position (TSP), plus complications and reoperations. Statistical testing included Mann-Whitney U, Wilcoxon signed rank, Fisher exact, McNemar, and multivariable regression. Results: After adjusting for confounding variables, the BLP system was associated with significantly greater improvements in postoperative IMA and HVA but not TSP. There were no significant differences in rates of complications (ML: 18.4%; BLP: 9.2%) or reoperations (ML: 4.6%; BLP: 7.7%). Conclusion: This retrospective multicenter review found that the BLP system was associated with greater improvement in radiographic HV parameters compared with the ML procedure using crossed-screw fixation. Clinical significance is unclear as complication and reoperation rates were similar between groups. Further study in this regard is warranted.

Duke Scholars

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Published In

HSS J

DOI

ISSN

1556-3316

Publication Date

October 21, 2024

Start / End Page

15563316241288514

Location

United States

Related Subject Headings

  • Orthopedics
  • 3202 Clinical sciences
  • 1117 Public Health and Health Services
  • 1103 Clinical Sciences
 

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Fletcher, A. N., Droz, L. G., Fuller, R., Rajan, L., Zhu, J., Easley, M. E., … Cody, E. A. (2024). Radiographic and Clinical Outcomes of First Tarsometatarsal Joint Arthrodesis With a Biplanar Locking Plate System Versus the Modified Lapidus Technique With Crossed-Screw Fixation: A Retrospective Multicenter Comparison. HSS J, 15563316241288514. https://doi.org/10.1177/15563316241288514
Fletcher, Amanda N., Lindsey G. Droz, Robert Fuller, Lavan Rajan, Jiaqi Zhu, Mark E. Easley, James A. Nunley, and Elizabeth A. Cody. “Radiographic and Clinical Outcomes of First Tarsometatarsal Joint Arthrodesis With a Biplanar Locking Plate System Versus the Modified Lapidus Technique With Crossed-Screw Fixation: A Retrospective Multicenter Comparison.HSS J, October 21, 2024, 15563316241288514. https://doi.org/10.1177/15563316241288514.
Journal cover image

Published In

HSS J

DOI

ISSN

1556-3316

Publication Date

October 21, 2024

Start / End Page

15563316241288514

Location

United States

Related Subject Headings

  • Orthopedics
  • 3202 Clinical sciences
  • 1117 Public Health and Health Services
  • 1103 Clinical Sciences