title: First Metatarsalphalangeal Joint Arthrodesis: A Retrospective Comparison of Two Methods of Fixation.
abstract: First metatarsalphalangeal joint arthrodesis is a well established and successful treatment; however there still remains controversy over the best choice of construct. We performed a retrospective study of patients undergoing first metatarsalphalangeal fusion over eighteen months (n=52) using either dorsal non-locking plate with additional compression lag screw fixation or dorsal non-locking plate alone. We found when assessing clinical criteria, patients with dorsal non-locking plates and additional compression lag screw fixation had a significantly higher rate of fusion (100% vs 77.8%), significantly higher rate of fusion within the first two months (55.6% vs 83.3%), significantly earlier time to fusion (52.2 days vs 75.6 days), and significantly lower rate of non-union (0% vs 22.2%). When blindly assessing radiographic criteria, the patients treated with the plate and compression screw had a significantly higher rate of fusion and lower rate of non-union (0% vs 33%). There was no statistically significant difference between the frequencies of complications in the groups. We believe that the interfragmentary compression is a crucial factor in achieving good union rates and recommend the use of non-locking pre-contoured plating with additional interfragmentary compression screw as the fixation method of choice for these procedures.
authors.affiliation: Department of Trauma and Orthopaedics, Southend University Hospital NHS Foundation Trust, Essex, SS0 0RY, UK.
authors.forename: M A
authors.initials: MA
authors.lastname: Rashid
authors.affiliation: Department of Trauma and Orthopaedics, Southend University Hospital NHS Foundation Trust, Essex, SS0 0RY, UK.
authors.forename: M
authors.initials: M
authors.lastname: Parnell
authors.affiliation: Department of Trauma and Orthopaedics, Southend University Hospital NHS Foundation Trust, Essex, SS0 0RY, UK.
authors.forename: W S
authors.initials: WS
authors.lastname: Khan
authors.affiliation: Department of Trauma and Orthopaedics, Southend University Hospital NHS Foundation Trust, Essex, SS0 0RY, UK.
authors.forename: A
authors.initials: A
authors.lastname: Khan
keywords: Arthrodesis; first metatarsalphalangeal joint; methods of fixation; retrospective study