Lapidus(1st MTC) fusion using the Paragon 28 Phantom intra-medullary nail system


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Learn the Lapidus(1st MTC) fusion using the Paragon 28 Phantom intra-medullary nail system surgical technique with step by step instructions on OrthOracle. Our e-learning platform contains high resolution images and a certified CME of the Lapidus(1st MTC) fusion using the Paragon 28 Phantom intra-medullary nail system surgical procedure.

A Lapidus fusion may be performed to treat medial column pain due to arthritis, medial column instability and also for hallux valgus deformity, especially in severe deformities and revision cases.

As with other MIS procedures, it avoids soft tissue disruption, with the perceived advantages of rapid and reliable union. Additionally, it has biomechanical advantages over traditional plate and screws in terms of the compression that can be generated and a higher load to failure. Typically non union is one of the most frequent and significant complications of the Lapidus fusion, reaching up to 10% in the classic publications. These implant advantages, inherent in a nail, therefore offer the potential for reducing one of the most significant complications of this highly effective operation.

In the last few years, with the advent of a variety of new surgical procedures and implants, these reported non-union rates have already dropped to approximately half of their previous levels .

Taking in consideration the limited soft tissue damage and implant biomechanical properties, one of the objectives of this technique is trying improve outcomes even more, allowing faster recovering.

The Paragon 28 Phantom intra-medullary nailing system is a unique solution for fixation of the first TMT joint and provides the surgeon with a good range of sizes to allow close matching of a patients anatomy as well as  a compression system that allows excellent on-table compressive performance.

It should be appreciated that an MIS Lapidus fusion is an advanced procedure and should only be undertaken by surgeons who are experienced with both hallux valgus surgery and MIS procedures. It allows one to deal with, and stably fix, multi-planar metatarsal deformity and prepare articular surfaces in a percutaneous manner, which avoids excessive soft tissue stripping and allows faster recovery of the soft tissue envelope.

Readers will also find of interest Mark Davis technique Lapidus fusion using the I.O. Fix implant (Extremity Medical)

and also Mark Herrons technique Basal osteotomy for Hallux Valgus using Arthrex Low Profile Locking Proximal Opening Wedge Osteotomy Plate


Author:Dr Felipe Chaparro Ravazzano MD.

Institution: Clinica Universidad de los Andes, Santiago, Chile.

  • Each operation and the questions associated become a named course in the CPD section
  • The operative technique itself is read as a lesson as is any company implant information if this is being assessed.
  • You’ll need to tick the box to confirm this has been done and can do this immediately if you have already read the op tech.
  • The vast majority of operations have a 10-15 MCQ quiz covering all aspects of the decision making and the technique
  • There are four possible answers of which one is correct (or on occasion more correct) than the others.
  • There are additional quiz modules on the surgical steps, the implants and problem cases being added continually
  • The course is completed once all the lessons are read and quizzes submitted and passed.
  • On successful completion of each quiz you will receive validated CPD points that add to the certificate in your CPD folder.
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  • The timer suspends after 5 minutes though if there is no activity.
  • When you restart you will resume at the same point in the module.
  • Once you have completed each quiz you will need to feedback on the module first then click “submit” and your paper will be marked.
    The pass mark is 75%.
  • If you fall below this level you will be directed back to re-read the slides where you’ve tripped up.
  • Once these have been read you can re-do just the questions you failed on.
  • Once you have passed the quiz you can return at a future stage & resit .

CPD Points:

  • Operation Quiz – 1 CPD point
  • Surgical steps Quiz – 1/4 CPD point
  • Implants Quiz – 1/4 CPD point
  • Problem case Quiz – 1/2 CPD point

One CPD point equates to one hour of academic activity


Welcome to the Professional Development question section. The objective of taking these tests is to demonstrate that you have understood all aspects of the assessment and management of patients requiring surgical intevention. On successful completion you will receive a certificate accredited by both the Royal College of Surgeons of both England and Edinburgh as well as the British Orthopaedic Association.

Our content is designed for both Surgeons in independent practice and Surgeons in training.


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