“…For both evaluations, there was a drastic improvement comparing the pre and postoperative status. The results obtained confirm the literature data for arthrodesis, regardless of technique [4].…”
Section: Discussionsupporting
confidence: 88%
“…After an arthrodesis surgery in the lower limb, the recommendation was traditionally to keep patients non-bearing for a minimum of 6 weeks. Currently, there is no more consensus for this practice and the majority of authors are favourable to early postoperative weight bearing [ 4 , 22 ]. We did not report any complication regarding the device or the bone allowing for immediate full weight bearing with a rigid sole shoe.…”
Section: Discussionmentioning
confidence: 99%
“…First MTPJ fusion aims to obtain a stable toe in order to reduce pain and discomfort. This can be obtained through different techniques ranging from the use of Kirchner wires to the application of staples, screws and plates [ 4 ]. Even when compared to alternative techniques—such as total joint replacement—first MTPJ arthrodesis seems to give far better clinical outcomes and lower rate of complications and reinterventions [ 5 ].…”
Background
First metatarsophalangeal joint (MTPJ) fusion is the most effective technique for the treatment of MTPJ primary arthritis, severe hallux valgus and failure of primary corrective surgery of these conditions. It can be achieved through different techniques. We evaluated the outcomes in a cohort of patients treated with dorsal plate arthrodesis.
Materials and methods
We treated 30 feet for 28 patients; the mean follow-up was 35 months. For each foot, we collected radiological and clinical assessment, with the visual analogue scale (VAS) for pain and the Manchester and Oxford Foot questionnaire (MOFQ). The technique consisted in a cup and cone arthrodesis with the application of a low profile dorsal plate. Patients were allowed for immediate weight bearing.
Results
Consolidation was achieved in all cases; in 29 cases, radiographic union was recorded within 6 months from surgery, in one case after 9 months. Comparison between the preoperative and postoperative of VAS and MOXFQ values showed a statistically significant difference (p < 0.05). Only one case developed wound dehiscence as complication.
Conclusions
Even if there is still a debate regarding the best system for MTPJ fusion, we believe cup and cone fusion with dorsal plating is an effective method. Moreover, the stability of the osteosynthesis obtained allows for immediate post-operative weight bearing, making patients able to return soon to their normal life.
Trial registration
We present a retrospective study; all patients enrolled were retrospectively registered.
“…For both evaluations, there was a drastic improvement comparing the pre and postoperative status. The results obtained confirm the literature data for arthrodesis, regardless of technique [4].…”
Section: Discussionsupporting
confidence: 88%
“…After an arthrodesis surgery in the lower limb, the recommendation was traditionally to keep patients non-bearing for a minimum of 6 weeks. Currently, there is no more consensus for this practice and the majority of authors are favourable to early postoperative weight bearing [ 4 , 22 ]. We did not report any complication regarding the device or the bone allowing for immediate full weight bearing with a rigid sole shoe.…”
Section: Discussionmentioning
confidence: 99%
“…First MTPJ fusion aims to obtain a stable toe in order to reduce pain and discomfort. This can be obtained through different techniques ranging from the use of Kirchner wires to the application of staples, screws and plates [ 4 ]. Even when compared to alternative techniques—such as total joint replacement—first MTPJ arthrodesis seems to give far better clinical outcomes and lower rate of complications and reinterventions [ 5 ].…”
Background
First metatarsophalangeal joint (MTPJ) fusion is the most effective technique for the treatment of MTPJ primary arthritis, severe hallux valgus and failure of primary corrective surgery of these conditions. It can be achieved through different techniques. We evaluated the outcomes in a cohort of patients treated with dorsal plate arthrodesis.
Materials and methods
We treated 30 feet for 28 patients; the mean follow-up was 35 months. For each foot, we collected radiological and clinical assessment, with the visual analogue scale (VAS) for pain and the Manchester and Oxford Foot questionnaire (MOFQ). The technique consisted in a cup and cone arthrodesis with the application of a low profile dorsal plate. Patients were allowed for immediate weight bearing.
Results
Consolidation was achieved in all cases; in 29 cases, radiographic union was recorded within 6 months from surgery, in one case after 9 months. Comparison between the preoperative and postoperative of VAS and MOXFQ values showed a statistically significant difference (p < 0.05). Only one case developed wound dehiscence as complication.
Conclusions
Even if there is still a debate regarding the best system for MTPJ fusion, we believe cup and cone fusion with dorsal plating is an effective method. Moreover, the stability of the osteosynthesis obtained allows for immediate post-operative weight bearing, making patients able to return soon to their normal life.
Trial registration
We present a retrospective study; all patients enrolled were retrospectively registered.
“…When considering plate fixation, it is also important to evaluate the plate design, thickness and size. Recent literature supports low profile locking plates for the first MTPJ fusion (24,25,26). Two of the four patients in this study developed non-unions due to hardware failure.…”
“…The other articles were therefore excluded. Ultimately 16 articles were included in the data extraction phase ( 9 , 12 , 16 , 18 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 ). Figure 1 PRISMA flow diagram illustrating search strategy and number of records screened and one included.…”
Purpose
A systematic review to determine the effect of different types of joint preparation, joint fixation, and postoperative weight-bearing protocols on non-union frequency in first metatarsophalangeal joint (MTPJ) arthrodesis in patients with moderate-to-severe hallux valgus.
Material and methods
A systematic literature search (PubMed and EMBASE), adhering to PRISMA guidelines. Data on MTPJ preparation, fixation, weight-bearing, and non-union in patients with moderate-to-severe hallux valgus were collected. Quality assessment was performed using the Coleman Methodology Score.
Results
Sixteen studies (934 feet) were included, generally of medium quality. Overall non-union rate was 7.7%. At 6.3%, convex/concave joint preparation had the lowest non-union rate vs 12.2% for hand instruments and 22.2% for planar cuts. Non-union of 2.8% was found for joint fixation with a plate combined with a lag screw vs 6.5% for plate fixation, 11.1% for crossed screw fixation, and 12.5% for a plate with a cross plate compression screw. A 5.1% non-union frequency was found following postoperative full weight-bearing on a flat shoe vs 9.3% for full weight-bearing on a heel weight-bearing shoe and 0% for a partial weight-bearing regimen.
Conclusion
Based on medium-quality papers, joint preparation with convex/concave reamers and joint fixation with a plate using a lag screw show the lowest non-union rate. Full postoperative weight-bearing in a stiff-soled postoperative shoe is safe and not associated with non-union vs a more protective load-bearing regimen. Further research should focus on larger sample sizes, longer follow-ups, and stronger study designs.
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