Emerging Insights On Fixation For Austin/Chevron Bunionectomies

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Author(s): 
Gary M. Lepow, DPM, MS, FACFAS, and Brian D. Lepow, DPM, AACFAS

   For over 30 years, the senior author has utilized various absorbable materials for Austin/Chevron bunionectomies. In a review of those cases, we have found no substantial difference in osteotomy healing in patients with resorbable fixation in comparison to those with rigid fixation, given similar variables including age, vascularity, the presence of diabetes and partial immobilization of weightbearing during the first three to six postoperative weeks.

   Experience with resorbable fixation has anecdotally revealed a slight increase in postoperative inflammation and a potential decrease in restoration of range of motion of the first metatarsophalangeal joint. This appeared to be present primarily with synthetic resorbable fixation devices and there appears to be a marked reduction in postoperative inflammation with the TenFUSE Nail.

   The TenFUSE Nail is fashioned with an octagonal shape containing ridges, which appears to adequately resist rotation and migration. The allograft fixation is available in both a 2.0 mm option as well as a 2.7 mm nail. In most Austin/Chevron procedures, the use of two points of fixation has proven to be the most stable construct. As standard procedure, it is also always recommended to obtain intraoperative radiographs after manual compression and after insertion of the second nail.

   The usual amount of time until disappearance of the allograft on X-ray ranges from eight to 12 months.

   In our clinical use and review of the TenFUSE Nail, we have been impressed with its ease of application, the stability of the fixation construct, the minimal amount of postoperative inflammation, complete healing following creeping substitution and success with early and increased range of motion.

   Gary M. Lepow, DPM, MS, FACFAS, is a Senior Partner at Lepow Foot and Ankle Specialists. He is an Associate Clinical Professor at the Baylor College of Medicine and an Associate Clinical Professor at the University of Texas Medical School in Houston. Dr. Lepow is the Chief of Ambulatory Services/Podiatry with the Harris Health System based in Texas. He is also a Past President of the American College of Foot and Ankle Surgeons.

   Brian D. Lepow, DPM, AACFAS, is an Associate at Lepow Foot and Ankle Specialists. He has received fellowship training in diabetic limb salvage and reconstructive surgery.

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BRIANsays: February 6, 2013 at 9:27 am

"There is no argument that the use of rigid internal fixation with metal screws, staples and/or plates has been the gold standard for bone fixation."

Could not agree more.

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