Dan Preece DPM PGY-2
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Authors: Blitz N, Lee T, Williams K, Barkan H,
DiDimenico L.
Journal of Foot and Ankle Surgery, Jul/Aug
2010.
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Study Type: Retrospective, multicenter review
of 80 patients. (80 feet in 76 pts)
Study Question: Effects of early weightbearing
on fusion rates following arthrodesis of 1st
met-cuneiform joint.
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Intro: Early studies used fixation of cat gut or
a single screw which showed high levels of
nonunions. 6 weeks of NWB became
standard of care. However non of these
studies were based on today’s fixation
techniques.
Limited data has shown that early weight
bearing yields very low percentages of non
unions with current screw fixation
techniques.
◦ 76 patients, 80 feet from 2002-2007.
◦ Surgeries performed by two surgeons (Blitz,
DiDemenico).
◦ Only surgeries that involved only the first ray were
included (muscle-tendon balancing, austin, akin…).
◦ Pre and Post-Op radiographic angles taken (IM, Hallux
Valgus angle, lateral metatarsal angle)
◦ Outcomes measured were: trabeculation across
osteotomy, pain at surgical site on clinical exam.
◦ Fixation:
 Majority solid screws x 3, 11 pts only received 2
screws, 1 pt received 4.
 Two screws in sagital plane perpendicular to
osteotomy and lagged.
 Third screw medial to lateral across 1-2nd met bases or
into intermediate phalanx and not lagged.
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◦ NWB in Jones dressing/splint or Cam walker x 2-3
weeks.
◦ After 1st post-op visit all placed in CAM walker,
progression to full WB as tolerated.
◦ All pts were fully WB by 6 week visit.
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Pre-Op HVA: 21
Post-Op HVA: 9
Pre-Op IMA: 13
Post-Op IMA: 6.6
Pre-Op LMA: 21.45
Post-Op LMA: 25.8
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Days to partial WB: 15
Days to radiographic union: 44.5
Union Percentage: 100%
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** all P values were .001 or smaller
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Joint preparation approach made no difference.
Curretage vs planar resection with sagittal saw.
Presence or absence of subchondral plate.
2 vs 3 screw fixation had same outcomes.
Autogenous bone graft was used in all cases,
either trephine or from exostectomy. No
difference.
Obesity and smoking made no difference.
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Data gathering stopped at time of
clinical/radiographic fusion. This does not
rule out the possibility of a non-union during
the course of healing/rehab.
Unclear when weightbearing truly began
between the 2nd and 6th week marks. Was
advanced as tolerated. Possible that WB only
began at week 5 and 6.