Deformity Correction and Early Maintenance of Hallux Valgus Correction Treated with Modified Lapidus Procedure: Intermetatarsal Miniature Suture Button vs First Metatarsal to Intermediate Cuneiform Cross-Screw Fixation

Background: Fixation of the first tarsometatarsal joint has been known to improve the rigidity of the construct and reduce angular deformity in surgical correction of hallux valgus. Although some authors employ an intercuneiform screw between the medial and intermediate cuneiform, others provide fixation using a suspensory fixation device between the metatarsals. We aimed to investigate whether there was a difference in clinical outcomes between the suspensory fixation device and the intermediate cuneiform screw. Methods: This was a retrospective comparative study between patients who underwent the modified Lapidus procedure (or 1TMT arthrodesis) using the suture button fixation (MT1-2 SB) and the first metatarsal intermediate cuneiform screw fixation (MT1C2 screw) between January 2015 and January 2023. Demographic variables (age, sex, and body mass index) and outcome variables including union rate, hardware removal, recurrence rate, and revision rate were collected. Patients were matched in a 1:1 fashion for age and body mass index. The radiographic variables are first metatarsal declination angle, intermetatarsal angle (IMA), hallux valgus angle (HVA), and sesamoid station. Results: We had a total of 40 feet in the MT1-2 SB cohort and 40 in the MT1C2 screw cohort. Although there were no differences found in the preoperative measures of angular deformity, we discovered that suture button fixation was associated with a better average postoperative IMA when compared to intermediate cuneiform screw fixation. However, both techniques offered a similar magnitude of initial correction for IMA and HVA. Furthermore, there were no differences in loss of angular correction at an average follow-up period of 2.36 ± 1.91 years in the MT1-2 SB cohort and 2.35 ± 1.62 years in the MT1C2. Conclusion: Suture button fixation and first metatarsal intermediate cuneiform screw fixation demonstrate similar union rates, deformity correction, and maintenance of correction at early follow-up.