From the Research
A fibrous union one year after a Lapidus procedure is generally considered stable and can be functionally acceptable, though it's not the ideal outcome. Ideally, a Lapidus procedure should result in complete bony fusion (osseous union) rather than fibrous union. However, if the patient is asymptomatic with no pain, no motion at the joint, and good functional outcomes, a fibrous union may not require additional intervention. The stability of a fibrous union depends on several factors including the quality of the fibrous tissue, absence of hardware loosening, and lack of progressive deformity. Patients with a stable fibrous union can typically bear weight normally and perform daily activities without restrictions. If there is pain, progressive deformity, or hardware issues, revision surgery might be necessary. Regular follow-up with weight-bearing radiographs is recommended to monitor for any changes in alignment or progression to nonunion. The decision to intervene surgically for a fibrous union should be based primarily on symptoms rather than radiographic appearance alone 1.
Key Considerations
- The Lapidus procedure is a powerful technique to correct hallux valgus deformities, but it has a high complication rate and a long postoperative rehabilitation period 2.
- The incidence of nonunion after Lapidus arthrodesis using staple fixation is around 8.3% 3.
- A fibrous union can be functionally acceptable if the patient is asymptomatic and has good functional outcomes, but regular follow-up is necessary to monitor for any changes in alignment or progression to nonunion.
- The modified Lapidus procedure can result in a satisfactory clinical outcome in most patients, with meticulous operative technique, rigid internal fixation, and strict postoperative weightbearing restrictions 4.
Recommendations
- Patients with a stable fibrous union can typically bear weight normally and perform daily activities without restrictions.
- Regular follow-up with weight-bearing radiographs is recommended to monitor for any changes in alignment or progression to nonunion.
- The decision to intervene surgically for a fibrous union should be based primarily on symptoms rather than radiographic appearance alone.
- Revision surgery might be necessary if there is pain, progressive deformity, or hardware issues 5.