Medial Locking Plate Versus Screw Fixation for Fixation of the Ludloff Osteotomy

A prospective cohort study of the Ludloff osteotomy, stabilized with either lag screws or a locking plate, was undertaken from May 2001 to November 2010, involving patients treated for hallux valgus with a first intermetatarsal angle greater than 15°. All patients were assessed using the American Orthopaedic Foot and Ankle Society (AOFAS) and Roles and Maudsley scores before and after surgery. The cohort included 119 procedures in 112 patients, 91 (76.47%) of which were fixated with lag screws and 28 (23.53%) with locking plates. The participants were categorized as active (n = 69 procedures) or athletic (n = 50 procedures). The overall mean patient age was 45.5 ± 14.2 years. No statistically significant differences were found between the fixation groups relative to age, preoperative AOFAS and Roles and Maudsley scores, and postoperative AOFAS scores. Postoperatively, the mean Roles and Maudsley score for the lag screw group was 1.8 ± 0.6 and that for the locking plate group was 2.2 ± 0.7 (p < .009). In both groups, the AOFAS scores improved significantly (p < .0001) after surgery. The mean interval to return to activity in the athletes was 3.6 ± 1.1 months and was 3.9 ± 1.2 weeks in the active group (p = .16). Also, 4 of the active patients (5.8%) failed to return to their desired activity level. Overall, 6 (5%) recurrent hallux valgus deformities were observed, 5 (4.2%) in the lag screw group and 1 (.8%) in the locking plate group (p = .57). Of the 6 recurrences, 5 occurred (4.2%) in patients older than 50 years (p = .05).