title: Modified Lapidus Procedure with Joint Compression, Meticulous Surface Preparation, and Shear-Strain-Relieved Bone Graft Yields Low Nonunion Rate.
abstract: BACKGROUND
  The modified Lapidus procedure is widely used to correct hallux valgus but has been reported with high nonunion rates. In this study, we retrospectively reviewed the nonunion rate of the modified Lapidus procedure performed with rigid cross screw fixation, meticulous joint preparation, and shear-strain-relieved calcaneal bone graft.
  
  
  OBJECTIVE
  Does the performance of the Lapidus procedure with rigid cross screw fixation, complete joint preparation, and shear-strain-relieved calcaneal bone graft achieve higher union rates than currently reported? If nonunion does occur, what is the clinical course?
  
  
  METHODS
  We reviewed both radiographic and clinical results of the modified Lapidus procedure with the above technique in 171 patients (182 feet). Evaluation included age, gender, tobacco use, diabetic status, and radiographic analysis at least 3 months postoperatively.
  
  
  RESULTS
  The modified Lapidus procedure described above resulted in a union rate of 97.3% (177 of 182 feet). Three of the five feet with radiographic nonunions were clinically symptomatic.
  
  
  CONCLUSIONS
  The union rate of the modified Lapidus procedure is higher than previously reported when performed with rigid cross screw fixation, meticulous joint preparation, and shear-strain-relieved bone graft. Nonunion of the first tarsometatarsal joint should be considered an infrequent occurrence.
authors.affiliation: Hospital for Special Surgery, Foot and Ankle Service, 535 East 70th Street, New York, NY 10021 USA.
authors.forename: Sriniwasan B
authors.initials: SB
authors.lastname: Mani
authors.affiliation: Hospital for Special Surgery, Foot and Ankle Service, 535 East 70th Street, New York, NY 10021 USA.
authors.forename: Eric W
authors.initials: EW
authors.lastname: Lloyd
authors.affiliation: Hospital for Special Surgery, Foot and Ankle Service, 535 East 70th Street, New York, NY 10021 USA.
authors.forename: Aoife
authors.initials: A
authors.lastname: MacMahon
authors.affiliation: Hospital for Special Surgery, Foot and Ankle Service, 535 East 70th Street, New York, NY 10021 USA.
authors.forename: Matthew M
authors.initials: MM
authors.lastname: Roberts
authors.affiliation: Hospital for Special Surgery, Foot and Ankle Service, 535 East 70th Street, New York, NY 10021 USA.
authors.forename: David S
authors.initials: DS
authors.lastname: Levine
authors.affiliation: Hospital for Special Surgery, Foot and Ankle Service, 535 East 70th Street, New York, NY 10021 USA.
authors.forename: Scott J
authors.initials: SJ
authors.lastname: Ellis
keywords: arthrodesis; autograft; bunion; fusion; hallux valgus; lapidus