ABSTRACT To assess whether surgical treatment with predominantly volar locking plates has superior clinical and radiographic outcomes to conservative treatment with cast immobilization in the treatment of distal radius fractures by reviewing and investigating the literature with a high level of evidence. Thus, we systematically searched PubMed, Web of Science, and Embase databases for clinical trials comparing surgical and conservative treatments for distal radius fractures. Data extraction was performed to access parameters that included: wrist functional assessment, such as mobility and grip strength; subjective outcomes, such as DASH score, PRWE score, and quality of life score (EQ‐5D); radiographic assessment (palmar inclination, ulnar variance, and articular subluxation, etc.); and complications, such as fracture nonunion, reoperation, infection, and neurologic symptoms, and then to conduct data organization and quantitative synthesis. Finally, a total of 19 clinical trials with 2729 patients were included in this report, including 1378 in the conservative treatment group and 1351 in the surgical treatment group. In terms of recovery of wrist function, wrist joints undergoing cast immobilization gained a greater range of extension (MD 1.5°, p = 0.02), whereas surgical treatment of the range of wrist rotation was significantly greater than with conservative treatment (MD 3°, p = 0.03), and wrist grip strength was significantly improved (MD 2 kg, p = 0.04). There were no significant differences between the two groups of patients in terms of wrist flexion and anterior rotation activities. In terms of patient subjective scores, patients in the plaster immobilization group showed significant improvement in PRWE scores compared with the surgical treatment group at 3 and 12 months after treatment (MD 3–7 points, p < 0.05). There was no significant difference between the two groups in terms of ulnar varus and dorsal tilt angle correction (p > 0.05). At the level of complications, the overall complication rate was significantly lower in patients who underwent surgical treatment than in the conservative treatment group (202/1046 [19.3%] vs. 361/1065 [33.9%], p = 0.001). The conclusions drawn were that when treating distal radius fractures, surgical treatment with predominantly metacarpal plate fixation achieves superior anatomical fracture repositioning and a lower complication rate compared to cast immobilization. However, no significant advantage was demonstrated in terms of recovery of wrist function and subjective patient perception. Overall, surgical treatment is an appropriate choice for patients with high motor function requirements who need to recover quickly, whereas more conservative treatments can be considered for patients with lower functional requirements.
Bharat Dave, Ajay Krishnan, Ravi Ranjan Rai
et al.
Advances in surgical visualization have transformed spine and neurosurgery, with the exoscope (EX) emerging as a promising alternative to the operating microscope. Offering high-definition 3D, 4K imaging with light-emitting diode–based illumination, the EX enhances precision while reducing heat generation and surgeon fatigue. Its ergonomic design, compact camera head, and extended working distance improve workflow, minimize interference with instruments, and promote surgeon comfort during prolonged procedures. Educational benefits are notable as the surgical team and trainees can share the same high-quality view. Integration of EX with its endoscope allows seamless toggling between exoscopic and endoscopic views, enhancing access to hidden structures. Additionally, near-infrared spectroscopy enables real-time tumor identification, improving the safety and completeness of resection. Despite challenges such as adaptation to screen-based coordination and cost, the EX represents a significant advancement in surgical visualization.
Abstract A biologically - validated biodegradable material must comfortably stay in the physiological environment it is placed in, before finally disappearing over the intended period of time with adequate rates of degradation. The primary objective and utility of such a material is to eliminate the requirement of secondary surgery in applications involving bone implants. In recent decades, biodegradable alloys have exhibited enhanced biocompatibility, and improved mechanical and biodegradation properties. This has generated renewed interest in the design of bone implants made up of such materials that can successfully support fractured bone till the culmination of the healing process. However, striking a balance between two seemingly conflicting requirements, namely - sustaining the strength of the implant till the bone acquires the desired strength of its own, and allowing the implant to keep losing strength with its gradual degradation – may be rather complex. To manage this, different healing phases and the associated bone - biodegradable implant interface mechanobiology needs to be focused upon. An adequate and/or optimal design of the implant is based on mechanical properties, degradation rates of implant and bone-biodegradable implant interface interactivity. This review mainly focuses on bone - biodegradable implant interface with due consideration accorded to the mechanical properties, degradation rates and healing process in a standard duration.
ABSTRACT Aims/Introduction Diabetic foot ulcer (DFU) is a prevalent complication of diabetes characterized by heightened inflammation and impaired wound‐healing processes. Interleukin‐37 (IL‐37) is a natural suppressor of innate inflammation. Here, we aim to investigate the potential of IL‐37 in enhancing the healing process of diabetic wounds. Materials and Methods The skin samples of DFU and non‐diabetic patients during foot and ankle orthopedic surgery were collected. The IL‐37 transgenic mice (IL‐37Tg) were created using CRISPR/Cas‐mediated genome engineering. Mice were administered streptozotocin (STZ, 150 mg/kg) to induce a diabetic model. After 4 weeks, an equidistant full‐thickness excisional wound measuring 8 mm was created on the central back of each mouse and allowed to heal naturally. Body weight and blood glucose levels were measured weekly. The wound area was measured, and skin samples were collected on Day 10 for further Quantitative polymerase chain reaction (qPCR) and WB detection and RNA sequencing analysis. Results The proinflammation cytokines such as TNF‐α and IL‐1β and the MAPK signaling pathway were significantly increased in the wound margin of DFU patients. Compared with diabetic mice, diabetic IL‐37Tg mice showed a significantly accelerated healing process. The enriched signaling pathways in RNA sequencing included cytokine–cytokine receptor interaction, TNF signaling pathway, and NOD‐like receptor signaling pathway. Through QPCR and WB detection, we found that IL‐37 could inhibit the activated MAPK and NOD‐like signaling pathway, reducing TNF‐α, IL‐1β, and NLRP3 expression in the diabetic wound. Conclusions IL‐37 promotes skin wound healing in diabetic mice, providing a new possible target for treating diabetic wounds.
Diseases of the endocrine glands. Clinical endocrinology
Background: Annulus fibrosus (AF) is an important part of the intervertebral disc (IVD) and its injury leads to back pain and impaired mobility. The stem/progenitor cells are essential for the maturation and repair of the AF, however, the identity of AF stem/progenitor cells remain elusive. Methods: In this study, we sorted cells from the murine IVDs and performed the single-cell RNA sequencing. Using single-cell transcriptomics, genetic lineage tracing, in vitro stem cell experiment, ablation models and cell transplantation, we elucidate the role of AF progenitor cells in maturation and injury. Results: On the basis of single-cell RNA-sequencing (scRNA-seq) analysis of the intervertebral disc, we found that the transcription factor Scleraxis (Scx) can specifically label a progenitor cell population of the outer AF. By lineage tracing assay, Scx-lineage AF cells proliferate mainly prior to sexual maturity, but barely proliferate after age of 8 weeks. The Scx-expressing AF cells are enriched for stem/progenitor cell markers and show a higher proliferative capacity and differentiation potential than the Scx− cells. The ablation of Scx-expressing AF cells impairs the maturation of AF. The Scx+ AF cells are enriched for TGFβ signaling. Transplantation of Scx-lineage cells to injured AF with Connective tissue growth factor (CTGF) improved the AF healing. Conclusions: Scleraxis-expressing progenitor cells are critical for the maturation of AF and demonstrate therapeutic potential for AF regeneration. The translational potential of this article: These findings expand the important role of stem cells in maturation and repair and provide new strategy for cellular therapy of AF repair.
João Magalhães MSc, Roberto Zambelli PhD, Otaviano Junior
et al.
Research Type: Level 3 - Retrospective cohort study, Case-control study, Meta-analysis of Level 3 studies Introduction/Purpose: Surgical site infections (SSIs) account for 31% of all hospital-acquired infections, significantly impacting postoperative recovery and healthcare costs. Foot and ankle surgeries present infection rates between 0.5% and 6.5%, with trauma cases and comorbidities being key risk factors. Despite previous studies, long-term data on infection incidence and predictive factors remain limited. This 7-year cohort study aimed to determine the incidence of SSIs in foot and ankle surgeries and identify independent predictors of infection, particularly differentiating superficial and deep infections. Understanding these risk factors is essential for optimizing infection control protocols and refining perioperative management strategies to improve surgical outcomes. Methods: This retrospective cohort study included 2,180 patients undergoing foot and ankle surgery between 2014 and 2020 in a private hospital. Elective and trauma-related procedures were included, excluding cases of pre-existing infections, open fractures, and septic arthritis. SSIs were classified as superficial (requiring local wound care or oral antibiotics) or deep (requiring surgical debridement or implant removal). Data on age, sex, diabetes mellitus (DM), systemic arterial hypertension (SAH), smoking, ASA score, and BMI were collected. Multivariate logistic regression was used to assess independent predictors of SSIs, with statistical significance set at p < 0.05. The primary outcome was infection incidence, while secondary outcomes included risk factor analysis and infection severity stratification. Results: The overall SSI incidence was 4% (83/2,180 cases), with 2.8% superficial and 1.2% deep infections. Smoking (OR 2.9, 95% CI 1.4–5.3, p = 0.001) and ASA score >2 (OR 3.4, 95% CI 1.2–8.4, p = 0.013) were independent predictors of infection. The deep infection group had significantly higher rates of smoking (p = 0.002), systemic hypertension (p = 0.018), and trauma-related procedures (p = 0.049). No significant associations were found between infection and diabetes mellitus (p = 0.404) or obesity (p = 0.816). Trauma surgeries, particularly ankle fractures, had the highest infection rates, reinforcing the need for enhanced infection control measures in high-risk patients. Conclusion: This 7-year cohort study confirmed a 4% SSI incidence in foot and ankle surgeries, with smoking and ASA score >2 emerging as significant risk factors. Trauma-related procedures, particularly ankle fractures, had higher infection rates, emphasizing the importance of preoperative risk stratification and perioperative infection control. Surprisingly, diabetes and BMI were not significant predictors, possibly due to effective preoperative optimization. These findings support the implementation of targeted preventive strategies, particularly in high-risk patients, to reduce infection rates and improve surgical outcomes. Characterization of the sample according to the presence of infection This table presents the demographic and clinical characteristics of patients undergoing foot and ankle surgery, stratified by infection status (no infection, superficial infection, and deep infection). Trauma cases (p = 0.049), arterial hypertension (p = 0.018), ASA score ≥ II (p < 0.001), smoking (p = 0.002), and overweight status (p = 0.002) were significantly associated with infection. Diabetes mellitus (p = 0.687) and BMI (p = 0.321) were not statistically significant predictors. The findings suggest that preoperative risk factors such as smoking, ASA score, and hypertension should be considered in infection prevention strategies for foot and ankle surgery patients.
Md. Israt Hasan, Masrufa Tasnim, Syed Mozaffar Ahmed
et al.
A 35-year-old individual with carpal tunnel syndrome presented with tingling and numbness in the left thumb, index, and middle finger. A 3D printed CTS splint was crafted to immobilize the affected wrist joint, aiding pharmacotherapy. At six weeks, evaluations included the Boston Carpal Tunnel Questionnaire (BCTQ), Visual Analogue Scale (VAS) for pain, and Evaluation of Satisfaction with assistive Technology (QUEST) version 2.0.9. Substantial improvements were observed in Bangla-BCTQ scores (symptom severity scale: 3.68 vs. 1.27; functional status scale: 2.74 vs. 1.31), VAS (70 vs. 30), and QUEST scores. 3D printing technology may contribute to better personalized musculoskeletal care enhancing quality of life.
Darius Luke Lameire MD, Hassaan Abdel Khalik MMI, MD, Christopher Del Balso MBBS, MSc, FRCSC
et al.
Background: There is currently a scarcity of information and consensus for transportal (arthroscopic or fluoroscopic) joint preparation during tibiotalocalcaneal (TTC) fusion, and therefore this review aims to summarize the available techniques and to evaluate the outcomes after this procedure. Methods: A systematic electronic search of MEDLINE, EMBASE, and Web of Science was performed for all English-language studies published from their inception to April 4, 2022. All articles addressing arthroscopy in TTC nailing were eligible for inclusion. The PRISMA Checklist guided the reporting and data abstraction. Descriptive statistics are presented. Result: A total of 5 studies with 65 patients were included for analysis. All studies used arthroscopic portals for tibiotalar and subtalar joint preparation (in 4 studies) prior to TTC nailing, with 4 studies using an arthroscope and 1 study using fluoroscopy. The overall major complication rate was 13.8%; however, there was only 1 instance of deep wound infection (1.5%) and 4 instances of surgical site infections (6.2%). Full fusion was achieved in 86% of patients with an average time to fusion of 12.9 weeks. The mean American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score preoperatively was 34.0 and postoperatively was 70.5. Conclusion: Although limited by the number of studies, transportal joint preparation during TTC nail ankle fusion is associated with good rates of complications and successful fusion. Level of Evidence: Level III, systematic review of Level III-IV studies.
Jan Gewiess, MD, Christoph Sprecher, PhD, Stefan Milz, MD
et al.
Background: Fracture classifications of the distal clavicle are based on ligamentous integrity. The influence of osseous microarchitecture on fracture occurrence, morphology, and the lesion’s stability has not yet been investigated. We aimed to characterize osseous microarchitecture according to common fracture classification systems based on ligamentous integrity and investigated the possible effects of age, gender, and osteoporosis in distal clavicle fractures. Methods: N = 20 human cadaveric distal clavicles were scanned using XtremeCT with an isometric voxel size of 82 μm. In the sagittal plane, each data set was evaluated in 11 sections of approximately 7 mm thickness. Three topographic regions were defined: the bone lateral to the trapezoid (LTR), intertubercular (ITR), and medial to the conoid (MCR) ligament. Cortical bone mineral density (BMD) [mgHA/cm3] and cortical porosity (1- (BV/TV) [%]) were determined and evaluated relative to age and gender. Results: Along the mediolateral axis, there was an >20-fold increase in median cortical porosity (P ≤ .001). There were significant differences in cortical porosity between LTR and ITR (P ≤ .001) but not between ITR and MCR (P = .09). In ITR, cortical porosity was significantly greater in >60-year-old compared to younger donors (P = .01). For BMD, there was an >2-fold decrease toward the distal apex (P ≤ .001). BMD was significantly greater in ITR compared to LTR (P ≤ .001) and in MCR compared to ITR (P = .02). In ITR and MCR, clavicles of >60-year-old donors had significantly lower BMD values compared to younger donors (P < .01). Across all 3 regions, frequency distribution of low bone mass did not significantly differ between <60-year-olds and >60-year-olds (P > .6). Conclusion: The distal clavicle features a characteristic bony microarchitecture. The present study revealed a significant difference in bone quality of lateral, intertubercular, and medial zones of the distal clavicle and could specify target areas and strategies for surgical treatment of unstable fractures. Age, gender, and osteoporosis have a limited effect on bone quality and fracture genesis. In contrast, ligamentous quality is supposed to exert a substantial influence on fracture characteristics, especially in ITR. Fracture morphology of the distal clavicle is determined by a bony-ligamentous conjunction, which remains to be characterized.
Orthopedic surgery, Diseases of the musculoskeletal system
RAQUEL BERNARDELLI IAMAGUCHI, GUILHERME MOREIRA DIAS, FERNANDA DO CARMO IWASE
et al.
ABSTRACT We observe delayed referrals to appropriate Microsurgery Unit and definitive treatment of traumatic limb amputations. Cases with wrist proximal amputations have a deadline for surgical replantation as these configure life-threatening injuries. Objective: To analyze patients with traumatic proximal wrist upper limb amputations with prolonged ischemic time who underwent temporary artery catheterization to assess stump viability and results. Methods: A case-series study including all patients with a proximal wrist upper limb amputation and a cold ischemic time equal to or above six hours from 2017 to 2021. Results: In total, two surgeons operated eight patients who had experienced forearm amputation injuries. Median ischemia time totaled eight hours. All patients required additional surgeries, most commonly split-thickness skin graft or fixation revision (three patients). This study obtained five successful macroreimplantations. The mean cold ischemia time was longer in the group with successful macroreimplantations (7.4 hours) than of the unsuccessful group (9 hours). Conclusion: Macroreplantations require immediate referral to microsurgery and, although temporary artery catheterization helps surgical decision making, the technique seems to fail to influence outcomes. Level of Evidence IV, Retrospective Case Series.
Shuhei Otsuki, Kuniaki Ikeda, Takashi Ishitani
et al.
Abstract Purpose Although the effects of lateral hinge fractures (LHF) on bone union and clinical outcomes after opening‐wedge high tibial osteotomy (OWHTO) have been established, the effects of LHF after opening‐wedge distal tibial tubercle osteotomy (OWDTO) are unclear. We hypothesised that LHF after OWDTO would be associated with delayed bone union and result in poorer clinical outcomes than expected for LHF after OWHTO. Methods This study enrolled 100 patients, with 50 OWDTO patients (18 men; mean age, 63.2 years) and 50 OWHTO patients compared based on the propensity score matched analysis. The effect of LHF on bone union was compared between the groups. Clinical outcomes were assessed using the Lysholm score and the Knee Injury and Osteoarthritis Outcome Score (KOOS) at the mean follow‐up of 28 months. Results There was no between‐group difference in the incidence rate of LHF. However, the rate of bone union at the anterior flange in the presence of an LHF was significantly lower in the OWDTO (26%) than in the OWHTO (80%) 3 months postoperatively (p < 0.05), but no difference was observed 12 months postoperatively. The Lysholm score was significantly lower for patients with LHF following OWDTO than for OWDTO patients without LHF or OWHTO patients with/without LHF 3 and 12 months postoperatively (p < 0.001); Lysholm score and KOOS were not different at the final follow‐up. Conclusions LHF after OWDTO was associated with delayed bone union and poor clinical outcomes until 12 months. This information can guide decisions regarding the indications and the management of patients after OWDTO. Level of evidence IV
Delaney Harbold, Laura M. Dearolf, Jennifer Buckley
et al.
Orthopedic surgery lags behind the other surgical specialties in terms of reaching gender equality, and women remain underrepresented in the field. The reason for this disparity is multifaceted, with lack of exposure and mentorship frequently cited as two key reasons women fail to choose orthopedic surgery as a specialty. Recognizing these gender differences, The Perry Initiative was founded to increase young women’s exposure to the field, provide mentorship opportunities, and recruit women into orthopedic surgery and related engineering fields. The purpose of this article is to describe the measurable impact of The Perry Initiative on increasing the number of women matriculating into orthopedic residencies. Though roughly half of medical school graduates today are women, only 16% of active orthopedic surgery residents are women. To date, The Perry Initiative has reached over 12,000 women in high school and medical school, and of the program participants who are eligible to match into any residency program, 20% matched into orthopedic surgery residencies. This indicates that the women who participated in Perry Initiative outreach programs are entering orthopedic surgery at a rate that is higher than the current rate of women entering orthopedic surgery. The model behind The Perry Initiative’s outreach efforts can be scaled and expanded, ideally reaching more women and making progress towards closing the gender gap within orthopedic surgery and achieving greater gender diversity.
Timon Röttinger, MD, Leonard Lisitano, MD, Andreas Wiedl, MD
et al.
Background: Mobile-bearing unicompartmental knee arthroplasty (MB-UKA) is a proven implant that has reliably delivered excellent results for decades. Based on the constrained implant design in MB-UKA, the occasional occurrence of anterior impingement should be expected. However, surprisingly, there are no clinical reports. Methods: From 2016 to 2020, 14 patients with anterior medial knee pain were admitted to our arthroplasty center after MB-UKA implantation elsewhere. After taking the medical history and clinical examination, radiological imaging of the implant in at least 2 planes, including a whole-leg anteroposterior view, was performed. The “Knee Society Score (KSS)” and the “Knee Injury and Osteoarthritis Outcome Score (KOOS)” were recorded. Anterior impingement was diagnosed by reviewing the typical findings and specific exclusion of other diagnoses. Results: The 14 patients showed a KSS of 46.6 and a KOOS of 51.5. The average pain level on the “Visual Analog Scale” was 7.8. The positioning of the implants showed consistently noticeable deviations from the standard recommendations. All 14 patients were treated by removing the MB-UKA and changing to a complete TKA. At the 12-month follow-up, the average Visual Analog Scale score was 1.8, and KOOS and KSS were 86 and 82, respectively. Conclusions: The potential risk of anterior impingement in MB-UKA can be assumed. Diagnosis requires a detailed collection of medical history and clinical details combined with accurate radiological imaging. The cause of anterior impingement in MB-UKA is multifactorial and refers in our small group to the sum of minor deviations in implant positioning compared to the general recommendations.
Abstract Background Periprosthetic fractures are increasingly encountered in hip arthroplasty. The Vancouver classification system is widely used. Little knowledge exists regarding the association of the Vancouver classification with either cemented or uncemented stems. The aim was to analyse a series of fractures and determine associations. Methods A series of consecutive patients over 8 years was identified including only post-operative fractures of primary hip arthroplasties. Baseline and radiographic characteristics were recorded including the type of stem fixation (cemented or uncemented) and Vancouver classification. Statistical analysis was performed to determine the association of the Vancouver classification between cemented and uncemented stems. Results A total of 172 patients were identified (84 cemented stems, 88 uncemented stems). There were 30 Vancouver A fractures (12 cemented vs.18 uncemented, p > 0.05), 125 Vancouver B fractures (63 cemented vs. 62 uncemented, p > 0.05) and 17 Vancouver C fractures (9 cemented vs. 8 uncemented, p > 0.05). The Vancouver B2 fracture occurred most frequently (N = 95; 44 cemented vs. 51 uncemented, p > 0.05) and consists of four distinct fracture patterns: the previously described comminuted ‘burst’, clamshell and spiral patterns and the newly observed ‘reverse’ clamshell. The burst and spiral fracture patterns are significantly associated with cemented stems, and the clamshell pattern is significantly associated with uncemented stems. Conclusions Vancouver A, B and C fractures occur equally in cemented and uncemented stems. Awareness of four distinct Vancouver B2 fracture patterns, including the newly observed reverse clamshell, will aid surgeons in predicting stem instability.
Orthopedic surgery, Diseases of the musculoskeletal system
Danilo Ryuko Cândido Nishikawa MD, Fernando Aires Duarte MD, Guilherme Honda Saito MD
et al.
Category: Midfoot/Forefoot, Trauma Introduction/Purpose: Acute avulsion fractures of the base of the fifth metatarsal are common and usually treated non- surgically with satisfactory outcomes. Forms of conservative treatments are described such as elasticated bandaging, immobilization in a cast, walking boot and hard-soled-shoes. The aim of this study was to compare the clinical and functional outcomes, time to return to the previous activities, time and rate of fracture healing of the patients with avulsion fracture of the base of the fifth metatarsal treated in a hard-soled-shoes (HSS) or in a walking boot (WB). Our null hypothesis is that a less rigid immobilization without restriction of the ankle yields the same final results. Methods: A retrospective and comparative study of 72 patients with acute avulsion fractures of the base of the fifth metatarsal treated with the WB or the HSS, from March 2014 to November 2018. The average age of the patients was 41,25 (range, 11-88) and there were 56 female and 16, male. 39 were treated with the WB and 33, with the HSS. Patients with comorbities that could interfere in the rate and time of bony healing (diabetes and inflammatory joint disease), associated ankle ligament lesions and loss of follow-up were excluded. Patients were followed regularly until they were clinically asymptomatic and able to return to their previous activities (work, daily activities, sports). We retrospectively reviewed medical records containing the visual analogue scale (VAS) for pain and the american orthopaedic foot and ankle society (AOFAS) score of each visit as well as radiographic exams to evaluate time and rate of fracture healing. Results: Patients of both groups had similar VAS and AOFAS scores in 8 (p=0,34 and p=0,83) and 12 (p=0,25 and p=0,79) weeks. Age and gender distribution in the two groups were equal (p=0,23 and p=0,34, respectively). Time taken to return to the previous activities were not significant different between both groups, with the HSS group taking 8,33 weeks and the WB taking 9,73 weeks (p=0,10). The mean time for bone consolidation was significant higher in the HSS group, taking 8,64 weeks while in the WB took 7,18 weeks (p<0,001). Only 1 case of non-union was observed in the WB group and none in the HSS group. Conclusion: Our study concluded that avulsion fractures of the base of the fifth metatarsal can be treated equally with the HSS or the WB. Both types of immobilization showed to be equivalent in terms of clinical and function evaluation, return to the previous activities without difference in the rate of the fracture consolidation.
Ademola Shofoluwe MD, Kurt Krautmann MD, Lucas Marques BS
et al.
Category: Bunion, Midfoot/Forefoot Introduction/Purpose: The lapidus procedure is a longstanding operation performed for the treatment of hallux valgus deformity with a concomitant hypermobile first ray. Orthopaedic surgeons have a myriad of options to choose from in performing the lapidus procedure. The implantation of orthopaedic implants comes with the risk of iatrogenic injury to surrounding anatomy. Several cadaveric studies in the humerus and femur have described potential neurovascular structures at risk during placement of intramedullary nail systems. The purpose of this study was to determine the proximity of nail insertion and interlocking mechanisms in the Lapidus Phantom Intramedullary Nail System (Paragon 28, Inc.) to neurologic and tendinous structures in the foot. Methods: A titanium intramedullary nail was inserted from the first metatarsal to the medial cuneiform spanning the first tarsometatarsal joint in 10 fresh-frozen cadaver feet. K-wires were inserted in the proximal lateral, proximal medial, and distal medial-to-lateral interlock screw paths. The tibialis anterior tendon, extensor hallucis longus tendon, and superficial peroneal nerve were carefully dissected and exposed, and the distance from each of these anatomic landmarks were then measured and recorded from four different aspects of the nail: Proximal lateral interlocking screw path, proximal medial interlocking screw path, nail insertion, distal interlocking screw path. Distances were averaged, ranges were determined. Results: The tibialis anterior tendon was in closest proximity to the proximal medial interlock K-wire with an average distance of 0.4 mm. The proximal medial interlock bisected the tibialis anterior tendon in three of the specimens. The extensor hallucis longus tendon was in closest proximity to the nail insertion with an average distance of 1.2 mm. A branch of the superficial peroneal nerve was in closest proximity to the distal interlock K-wire with an average distance of 7.5 mm, however, the nerve came in direct contact with the proximal medial interlock K-wire in two of the specimens. Conclusion: The Lapidus intramedullary nail’s proximal medial interlock screw poses the greatest threat to the tibialis anterior tendon, with the distance from the tendon to the interlock K-wire being 3 mm or less in all specimens tested. The extensor hallucis longus tendon is at risk of injury with insertion of the nail. Medial to lateral interlocking poses the greatest danger to a branch of the superficial peroneal nerve. Blunt dissection should be performed using this system with a path to bone before instrumentation to reduce the risk of nerve and tendon injury in the foot.