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Journal Article Presentation: Early Weight Bearing After Modified Lapidus Arthrodesis

Journal Article Presentation: Early Weight Bearing After Modified Lapidus Arthrodesis. Dan Preece DPM PGY-2. Early Weight Bearing After Modified Lapidus Arthrodesis: A Multicenter Review of 80 Cases. Authors: Blitz N, Lee T, Williams K, Barkan H, DiDimenico L.

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Journal Article Presentation: Early Weight Bearing After Modified Lapidus Arthrodesis

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  1. Journal Article Presentation:Early Weight Bearing After Modified Lapidus Arthrodesis Dan Preece DPM PGY-2

  2. Early Weight Bearing After Modified Lapidus Arthrodesis: A Multicenter Review of 80 Cases. • Authors: Blitz N, Lee T, Williams K, Barkan H, DiDimenico L. • Journal of Foot and Ankle Surgery, Jul/Aug 2010.

  3. Early Weight Bearing After Modified Lapidus Arthrodesis • Study Type: Retrospective, multicenter review of 80 patients. (80 feet in 76 pts) • Study Question: Effects of early weightbearing on fusion rates following arthrodesis of 1st met-cuneiform joint.

  4. Intro: Early studies used fixation of cat gut or a single screw which showed high levels of nonunions. 6 weeks of NWB became standard of care. However non of these studies were based on today’s fixation techniques. • Limited data has shown that early weight bearing yields very low percentages of non unions with current screw fixation techniques.

  5. Methods: • 76 patients, 80 feet from 2002-2007. • Surgeries performed by two surgeons (Blitz, DiDemenico). • Only surgeries that involved only the first ray were included (muscle-tendon balancing, austin, akin…). • Pre and Post-Op radiographic angles taken (IM, Hallux Valgus angle, lateral metatarsal angle) • Outcomes measured were: trabeculation across osteotomy, pain at surgical site on clinical exam.

  6. Methods continued: • Fixation: • Majority solid screws x 3, 11 pts only received 2 screws, 1 pt received 4. • Two screws in sagital plane perpendicular to osteotomy and lagged. • Third screw medial to lateral across 1-2nd met bases or into intermediate phalanx and not lagged.

  7. Post-Op Protocol: • NWB in Jones dressing/splint or Cam walker x 2-3 weeks. • After 1st post-op visit all placed in CAM walker, progression to full WB as tolerated. • All pts were fully WB by 6 week visit.

  8. Measures: • Pre-Op HVA: 21 • Post-Op HVA: 9 • Pre-Op IMA: 13 • Post-Op IMA: 6.6 • Pre-Op LMA: 21.45 • Post-Op LMA: 25.8 • Days to partial WB: 15 • Days to radiographic union: 44.5 • Union Percentage: 100% • ** all P values were .001 or smaller

  9. Discussion: • Joint preparation approach made no difference. Curretage vs planar resection with sagittal saw. Presence or absence of subchondral plate. • 2 vs 3 screw fixation had same outcomes. • Autogenous bone graft was used in all cases, either trephine or from exostectomy. No difference. • Obesity and smoking made no difference.

  10. Criticisms: • Data gathering stopped at time of clinical/radiographic fusion. This does not rule out the possibility of a non-union during the course of healing/rehab. • Unclear when weightbearing truly began between the 2nd and 6th week marks. Was advanced as tolerated. Possible that WB only began at week 5 and 6.

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