What is described as the most common intraoperative complication of a Lapidus procedure?

• A. Fragments of resected surfaces due to strong plantar ligament and soft tissue attachments
• B. Excessive bleeding from the dorsal aspect
• C. Nerve injury to the superficial peroneal nerve
• D. Dislocation of the tarsometatarsal joint

Answer: (A)

During a Lapidus procedure, the most common intraoperative issue is fragments breaking off from the bone surfaces you’re trying to create for fusion. The first tarsometatarsal joint has strong plantar-ligamentous and soft tissue attachments on the plantar aspect. When you resect surfaces to prepare a flat, congruent fusion bed, those attachments can pull or shear small pieces of bone away, leaving irregular surfaces or loose fragments that interfere with proper bone contact and compression.

Anticipating this, the surgeon carefully releases the plantar attachments and resects with attention to preserving clean, even surfaces that can be compressed for solid fusion. While other complications like dorsal bleeding, superficial peroneal nerve injury, or intraoperative joint instability can occur, they are not as characteristic or as common as fragmentation from plantar attachments.