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