Cut Guide System Facilitates Controlled Lapidus Correction

New instrumentation allows surgeons to attain accurate cartilage removal and transverse plane adjustment when treating 1st tarsometatarsal (TMT) joint arthrodesis.

The Paragon 28 (Englewood, CO, USA) Lapidus Cut Guide System is designed to provide a reproducible and streamlined Lapidus procedure, the fusion of the first TMT joint intended to eliminate joint movement and correct the deformity around the first metatarsal. The system allows for controlled cuts that minimize the amount of length lost on the first ray by offering an array of Met-Cuneiform cut guides for resecting the precise amount of bone from the first TMT joint in order to restore the desired intermetatarsal angle.

The guide provides a means of achieving calculated bi-planar correction using transverse cuts, or tri-planar correction with the surgeons preferred method of de-rotation. Eight different angled guides are available in 0° and 8° – 20° of correction. All guides have a built-in 2° dorsal to plantar taper to aid in plantarflexion of the 1st ray, with two slot options available to minimize first ray shortening. The guides allow calculated bi-planar correction using transverse cuts, or tri-planar correction with the surgeons preferred method of de-rotation.

In addition, the system includes an alignment guide to determine if selected cut guide is appropriate for desired correction during; a built in dorsal to plantar taper on cuts made on the metatarsal in two different guide variations, reducing the likelihood of first ray dorsiflexion intraoperatively; a standard cleanup guide to resect an additional 1.5 millimeters on either the metatarsal or cuneiform, if needed; and left/right 4° metatarsal cut guides provide a 4° dorsal to plantar taper for plantarflexion of the 1st metatarsal built into the cut. All guides are coated in titanium nitride for durability and strength.

Trying to create cuts that achieve a precise amount of intermetatarsal correction while simultaneously creating congruent surfaces to promote bony apposition at the fusion site is a technically challenging enterprise. Avoiding plantar gapping by removing the plantar cartilage from the soft tissue attachments can also prove difficult. In addition, dorsiflexion of the first ray can occur during joint preparation as well, which can lead to transfer metatarsalgia.

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