Cross-screw technique for the modified Lapidus procedure using headless compression screws



modified Lapidus, cross-screw technique, headless compression screw, hallux valgus, first ray instability


Aims: The aim was to evaluate union rates using two cross headless compression screws for the modified Lapidus procedure. This was compared to conventional fixation using solid AO screws and plates, as recorded in the published literature.

Patients and methods: This is a retrospective study of the modified Lapidus procedure performed in patients with a moderate to severe hallux valgus deformity. Union time and patient demographics were retrieved from medical records. Patient demographics included age, sex, smoking habits and other comorbidities. The union rate was compared to the literature using the two-population probability test, with p<0.05 being significant.

Results: Sixty-nine feet in 56 patients were assessed for radiographic union. There were three delayed unions and two non-unions. The union rate of 97% was not statistically different when compared to studies using conventional solid AO screws.

Conclusion: The use of headless compression screws in the fixation of the first tarsometatarsal joint and early mobilisation was found to be comparable to conventional solid AO screws with regard to union rates. The cannulated design enhances ease of insertion and, being headless, minimises the risk of intra-operative fracture and hardware prominence requiring subsequent removal.

Level of evidence: Level 4

Author Biographies

Z Mayet, University of the Witwatersrand

BSc(Wits), MBChB(Medunsa), FC Orth (SA), MMed(Orth)(Wits); The Orthopaedic Foot and Ankle Unit, Netcare Linksfield Hospital, Johannesburg and Consultant, Chris Hani Baragwanath Academic Hospital and University of the Witwatersrand, Johannesburg, South Africa

P N Ferrao, University of the Witwatersrand

MBChB(Pret), FCS(SA)Ortho; The Orthopaedic Foot and Ankle Unit, Netcare Linksfield Hospital, Johannesburg; Consultant, University of the Witwatersrand, Johannesburg, South Africa

Nikiforos S Saragas, University of the Witwatersrand

MBBCh(Wits), FCS(SA)Ortho, MMed(Ortho Surg)(Wits); The Orthopaedic Foot and Ankle Unit, Netcare Linksfield Hospital, Johannesburg; Professor, University of the Witwatersrand, Johannesburg, South Africa






Foot and Ankle