From the Research
Misdiagnosed radiographic nonunion after Lapidus surgery is relatively rare, occurring in approximately 2.7% of cases when evaluated one year post-surgery, as reported in the study by 1. This discrepancy happens because radiographic assessment alone can be misleading - X-rays may show what appears to be incomplete fusion even when the joint is clinically stable. The key issue is that radiographic nonunion doesn't necessarily correlate with clinical nonunion or poor outcomes. Many patients with apparent radiographic nonunion remain asymptomatic with good foot function. This occurs because fibrous tissue at the fusion site can provide adequate stability despite incomplete osseous bridging visible on imaging. For accurate assessment, surgeons should combine radiographic findings with clinical evaluation, including pain levels during midfoot manipulation and weight-bearing function. Some studies, such as 2 and 3, discuss the use of teriparatide in treating delayed union and nonunion, but these are not directly relevant to the question of misdiagnosed radiographic nonunion after Lapidus surgery. CT scans offer more detailed evaluation when there's uncertainty. Treatment decisions should be based primarily on clinical symptoms rather than imaging alone, as asymptomatic radiographic nonunions typically don't require revision surgery. This distinction is important because unnecessary revision surgeries for stable, asymptomatic radiographic nonunions can lead to complications without improving patient outcomes. Some key points to consider include:
- 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, as shown in 1.
- Nonunion of the first tarsometatarsal joint should be considered an infrequent occurrence, according to 1.
- The use of teriparatide in treating delayed union and nonunion is a topic of ongoing research, as discussed in 2 and 3, but is not directly relevant to the question of misdiagnosed radiographic nonunion after Lapidus surgery.