title: Quality of Early Union After First Metatarsophalangeal Joint Arthrodesis.
abstract: The aim of the present retrospective cohort study was to assess the quality of union and the clinical outcomes in patients who had undergone first metatarsophalangeal joint (MTPJ) fusion using a dorsal plate and plantar lag screw. From March 2011 to December 2012, the clinical and radiographic data of 39 patients (41 feet) who had undergone first MTPJ fusion using a compressive locking plate were retrospectively reviewed. All patients had undergone postoperative computed tomography at 6 weeks postoperatively to assess union. The average metatarsophalangeal angles improved from 23° ± 16° preoperatively to 14° ± 5° postoperatively. The dorsiflexion of the hallux at the preoperative assessment averaged 17° ± 11° and 23° ± 5° postoperatively. At 6 weeks postoperatively, the computed tomography scans demonstrated 3 complete fusions (7.3 %) and 38 partial unions (92.7%). Also at 6 weeks, the mean ± standard deviation joint bridging was 54% ± 14.6%. The forefoot American Orthopaedic Foot and Ankle Society scale score had improved significantly from 50 ± 13 preoperatively to 80 ± 7 at >1 year of follow-up (p = .001). Hardware removal was performed in 8 cases because of pain in 7 and infection in 1. Revision arthrodesis was required in 2 cases because of nonunion. At 6 weeks postoperatively, partial bony joint bridging could be observed in most cases after arthrodesis of the first MTPJ with the dorsal fusion plate.
authors.affiliation: Surgeon, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zürich, Switzerland. Electronic address: florian@wanivenhaus.at.
authors.forename: Florian
authors.initials: F
authors.lastname: Wanivenhaus
authors.affiliation: Surgeon, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zürich, Switzerland.
authors.forename: Norman
authors.initials: N
authors.lastname: Espinosa
authors.affiliation: Surgeon, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zürich, Switzerland.
authors.forename: Philippe M
authors.initials: PM
authors.lastname: Tscholl
authors.affiliation: Surgeon, Department of Orthopaedics, University Hospital Bern, Bern, Switzerland.
authors.forename: Fabian
authors.initials: F
authors.lastname: Krause
authors.affiliation: Surgeon, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zürich, Switzerland.
authors.forename: Stephan H
authors.initials: SH
authors.lastname: Wirth
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001174:Arthrodesis / Q000295:instrumentation / Q000379:methods*; D001860:Bone Plates; D001863:Bone Screws; D015331:Cohort Studies; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D020859:Hallux Rigidus / Q000000981:diagnostic imaging / Q000601:surgery*; D006215:Hallux Valgus / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D008683:Metatarsophalangeal Joint / Q000000981:diagnostic imaging / Q000601:surgery*; D008875:Middle Aged; D010147:Pain Measurement; D011786:Quality Control; D011859:Radiography / Q000379:methods; D016059:Range of Motion, Articular / Q000502:physiology*; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D016896:Treatment Outcome
keywords: arthrodesis; first metatarsophalangeal joint (MTPJ); fixation; hallux rigidus; osteoarthritis; plate fixation