First metatarsophalangeal arthrodesis using a dorsal plate and a compression screw.
BACKGROUND
Fusion of the first metatarsophalangeal joint is considered a `gold standard' procedure for arthritis and as a salvage procedure for previous failed surgeries. Recent biomechanical studies have shown that a combination of a plate and screw is the most stable construct. Only a few studies have evaluated this combination and they have small cohorts so we are presenting our larger series of patients.


METHODS
Forty-six consecutive cases of first metatarsophalangeal joint fusion performed between April 2006 and April 2008 were performed using a dorsal plate and a compression screw. We analyzed the outcome in terms of fusion rate, patient satisfaction and complication rates. The average followup period was 23 (range, 14 to 37) months. The most common indications were hallux rigidus and severe hallux valgus.


RESULTS
Ninety-eight percent of the cases fused uneventfully by four months. The average time to fusion was 3.1 months. There was one non-union, which remained asymptomatic after metal removal which was the only case requiring removal of metal. There was no hardware failure. The patient satisfaction was 100%. The average AOFAS score was 82.1 (maximum, 90).


CONCLUSIONS
These results show that arthrodesis of the first MTP joint with spherical reamers and a low-profile contoured dorsal titanium plate and compression screw is highly successful, with excellent patient satisfaction and functional outcomes. We recommend the use of specially designed plates against improvised plates as bending leads to poor control over dorsiflexion and may increase the incidence of plate failure.
Kumar
Sujit
S
Registrar, Trauma & Orthopaedics, St Mary's Hospital, Paddington, London, UK. sujit75@doctors.org.uk
Pradhan
Rajib
R
Rosenfeld
Peter F
PF
D000328:Adult; D000368:Aged; D001174:Arthrodesis / Q000295:instrumentation* / Q000379:methods; D001860:Bone Plates; D001863:Bone Screws; D005260:Female; D020859:Hallux Rigidus / Q000601:surgery; D006215:Hallux Valgus / Q000601:surgery; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008683:Metatarsophalangeal Joint / Q000601:surgery*; D008875:Middle Aged; D017060:Patient Satisfaction; D012189:Retrospective Studies