IOFix™ with plate construct is similar to locking plate construct for Lapidus bunionectomy procedure outcomes.

BACKGROUND The Lapidus bunionectomy has evolved with advanced fixation constructs since its first description. These new techniques have aimed to reduce complications such as non-union or hardware related symptoms. The IOFix™ system, an intramedullary device that has been designed to enhance stability and compression, may offer outcomes that are comparable to traditional medial locking plate with lag screw constructs.

PURPOSE To compare outcomes of the Lapidus bunionectomy using the IOFix™ and plate construct versus a traditional medial locking plate with a plantar lag screw.

METHODS This IRB-approved retrospective case-control study reviewed 46 patients (23 per cohort) treated by a single surgeon between 2014 and 2022, with minimum 24-month follow-up. Patients underwent Lapidus bunionectomy using either an IOFix™ and dorsal plate (intervention) or a locking plate with plantar lag screw (control). Outcome measures included incidence of non-union, hardware removal, loss of correction (1st IMA >8° or HAA >20°), and AOFAS Hallux scores. Statistical analysis used two-tailed t-tests and Fisher's exact test with significance set at P < 0.05.

RESULTS All cases in both IOFix™ and locking plate groups achieved a union rate of 100 %. There were no reported infections, non-unions, or revision surgeries in either cohort. Hardware removal rates were not significantly different between IOFix™ (26 %) and control (13 %) groups (P = 0.46), and only the dorsal plates were removed. There were no reported cases of removal of the IOFix™ device. AOFAS scores improved significantly in both groups post-operatively (P < 0.0001), with no significant difference between groups pre- or post-operatively. There were no significant differences in demographic data, loss of correction, or complication rates between groups.

CONCLUSION The IOFix™ and dorsal plate construct offers comparable outcomes to traditional locking plate with lag screw fixation in the Lapidus bunionectomy, with similar union rates, clinical outcomes, and hardware-related complications. These findings suggest that IOFix™ is an effective alternative fixation method. Further studies with larger sample sizes and long-term follow-up are warranted.