CME OnDemand: 2025 AOFAS Annual Meeting-Paper Session 4C

Video Transcription

Video Summary

This session presented several studies on foot deformity corrections focusing on first tarsometatarsal (TMT) joint procedures and bunion surgeries, highlighting outcomes, complications, and novel techniques.<br /><br />Dr. Bopa Kriya reported on first TMT bone block arthrodesis using a precontoured allograft wedge with a two-year follow-up of 52 feet. Significant improvements in pain and function were noted; however, there was a high nonunion rate (42%) and a 27% revision surgery rate. Complications included contractures, wound issues, and implant failures. Notably, increased plantar first metatarsal overload and potential acceleration of hallux rigidus were observed. Dynamic plantar pressure assessment suggested altered load distribution post-surgery.<br /><br />Dr. Johnson discussed correction of dorsal bunion deformity via a double bone block arthrodesis at the naviculocuneiform and intercuneiform joints, targeting the apex of deformity. Radiographic analysis of nine feet showed significant restoration of first ray alignment with no nonunions or infections. Successful adjunctive tendon transfers and soft tissue releases were critical due to the complexity of the deformity.<br /><br />Comparative research on modified Lapidus fusion versus minimally invasive Chevron-Akin (MICA) bunionectomy in patients with asymptomatic flatfoot found both procedures improved PROMIS and radiographic outcomes. Lapidus had better correction in certain angles linked to sagittal collapse, suggesting it may be preferable for patients with more severe medial column collapse.<br /><br />Further, a study using weight-bearing CT coverage maps demonstrated that after MIS bunionectomy, first TMT joint congruency significantly changed with regional decreases and increases in coverage, suggesting pronation rotation of the proximal metatarsal fragment and potential clinical implications like recurrence or arthritis.<br /><br />Another bone block Lapidus series showed restoration of foot alignment but with an 11.9% clinical nonunion rate and 33% tomographic nonunion, emphasizing cautious patient selection and fixation techniques.<br /><br />Lastly, inclusion of an intercuneiform screw in modified Lapidus procedures reduced intercuneiform gapping and hallux valgus recurrence compared to traditional fixation, enhancing midfoot stability.<br /><br />Discussion emphasized the importance of technique precision, patient selection, adequate fixation, and longer-term follow-up to understand fusion success and recurrence risks, with current data suggesting careful counseling regarding complication rates and reoperation likelihood.

Asset Caption

Paper Session 4C

Moderators: Jesse F. Doty, MD, and Sudheer C. Reddy, MD

Outcomes and Complications of 1st Tarsometatarsal
Plantarflexion Bone Block Arthrodesis with a
Pre-Contoured Allograft Wedge: 2-Year Follow-Up
Bopha Chrea, MD; Kenan Najdawi, BS; John Femino, MD;
Arianna Dalamaggas, BS; J. Chris Coetzee, MD

Dorsal Bunion Deformity Correction with a Double
Bone-Block Midtarsal Arthrodesis: Radiographic
Outcomes of a Case Series
Jeffrey Johnson, MD

Comparison of Clinical and Radiographic Outcomes
Between the Modified Lapidus Procedure and MICA
Bunionectomy in Hallux Valgus Patients with
Asymptomatic Flatfoot
Rachel Thompson, BSc; Amanda Zeng, BS; Joseph
Nguyen, MPH; A. Holly Johnson, MD; Scott Ellis, MD

Characterizing First Tarsometatarsal Joint Instability
After Third-Generation Minimally Invasive Bunionectomy:
A Coverage Mapping Assessment
Joaquin Palma, MD; Amanda Zeng, BS;
Brett Steineman, PhD; A. Holly Johnson, MD

Bone-Block Lapidus Arthrodesis in the Treatment of the
Collapsed Foot: Medium-Term Outcomes
Nacime Salomao Barbachan Mansur, MD, PhD;
Canon Cornelius, MD; John Dankert, MD; Albert
Anastasio, MD; Aly Fayed, MD; Francois Lintz, MD, PhD;
Wolfram Grün, MD; Enrico Pozzessere, MD;
Cesar de Cesar Netto, MD, PhD

Intercuneiform Stabilization During a Modified Lapidus
Procedure for Hallux Valgus Results in Decreased
Intercuneiform Gapping and Recurrence Rates
Amanda Zeng, BS; Jaeyoung Kim, MD; Joseph
Nguyen, MPH; Scott Ellis, MD; Matthew Conti, MD

Meta Tag

Content Type Annual Meeting

Year Published 2025

Keywords

first tarsometatarsal joint

bone block arthrodesis

bunion surgery

Lapidus fusion

minimally invasive Chevron-Akin (MICA)

foot deformity correction

nonunion rate

plantar pressure assessment

intercuneiform screw fixation

hallux valgus recurrence

weight-bearing CT coverage