First Metatarsophalangeal Joint Arthrodesis: Does the Addition of a Lag Screw to a Dorsal Locking Plate Influence Union Rate and/or Final Alignment after Fusion

Cone, Brent; Staggers, Jackson; Naranje, Sameer; Hudson, Parke; Ingram, Joseph; Shah, Ashish

doi:10.1053/j.jfas.2017.09.003

Cited by 20 publications

(15 citation statements)

References 21 publications

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Section: Discussionsupporting

confidence: 66%

“…13 The aim of first MTPJ arthrodesis is to achieve an immobile, pain-free joint that contributes to forefoot stability, improved gait and, ultimately, an improvement in quality of daily living. 6,14 This procedure is frequently performed in the practice of orthopaedic foot and ankle surgery and has a multitude of indications. Common indications include hallux valgus, hallux rigidus, inflammatory arthropathy, salvage procedures after failed previous surgery and neuromuscular conditions.…”

Section: Discussionmentioning

confidence: 99%

“…Common indications include hallux valgus, hallux rigidus, inflammatory arthropathy, salvage procedures after failed previous surgery and neuromuscular conditions. [2][3][4][5][6] As noted in the literature, successful first MTPJ arthrodesis has been attained with the use of a wide variety of implants ranging from crossed Kirschner wires, cerclage wiring, sutures, staples, axially or obliquely placed compression screws, intramedullary Steinman pins, external compression clamps, and dorsal plate and screw constructs. Most of these methods have demonstrated successful union rates ranging from 70% to 100%.…”

Section: Introductionmentioning

confidence: 99%

“…Most of these methods have demonstrated successful union rates ranging from 70% to 100%. 3,4,6,7 A review of the available biomechanical studies in the literature shows that fixation using a lag screw and a dorsal plate construct has the best overall mechanical stability. 8,9 Small fragment compression plates were frequently used in the past, but because of their size and prominence often caused local irritation and pressure symptoms.…”

Section: Introductionmentioning

confidence: 99%

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The outcome of first metatarsophalangeal joint arthrodesis using a locking compression plate

Meijer¹,

Grabe²,

Greyling³

2020

SA orthop. j.

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BACKGROUND: Arthrodesis of the first metatarsophalangeal joint (MTPJ) is a common and frequently performed procedure in the practice of orthopaedic foot and ankle surgery. Fusion techniques and preferred surgical implants have significantly evolved during recent years. It is however still under debate which surgical device provides the best outcome. One of the modern techniques described includes the use of a dorsal anatomical locking plate. These plates are usually used in combination with an additional compression cross screw across the arthrodesis site. The aim of this study was to assess the outcome of arthrodesis of the first MTPJ using a dorsal locking plate without making use of additional compression cross screw fixation. METHODS: We retrospectively assessed data at an orthopaedic practice specialising in foot and ankle surgery. All patients who had a first MTPJ arthrodesis with an anatomical locking plate system between 2010 and 2016 were identified. No additional compression cross screw fixation was done in any of these cases. Standard standing dorsoplantar and lateral X-rays of the foot were taken six weeks after surgery. As a primary objective, these radiographs were assessed to determine the rate of radiological union. As a secondary objective, any other complications that occurred in the post-operative period were recorded. RESULTS: We included 115 patients in the study. Fifteen of these patients underwent bilateral first MTPJ arthrodesis surgery, making the total number of feet included in the study 130. Of these, 86% (n=99) were female and 14% (n=16) were male. The mean age at the time of surgery was 54.7 years (range 37-74). An observed radiological union rate of 97% at three months after surgery was recorded. A total of four cases (3%) presented with symptomatic non-union. Two of these were successfully revised and progressed to union before the nine-month follow-up. One patient had bilateral surgery for severe rheumatoid arthritis with poor bone quality. No union was achieved even after a revision procedure with bone grafting. A Keller-type resection arthroplasty was eventually performed in this patient. Another secondary complication that was recorded is an overall infection rate of 2%. CONCLUSION: The results of this retrospective study suggest that high union rates and a low incidence of complications can be expected when fusing the first MTPJ with the use of a locking plate system without the need for an additional compression cross screw Level of evidence: Level 4 Keywords: first metatarsophalangeal joint, fusion, arthrodesis, locking plate, union

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Section: Discussionsupporting

confidence: 66%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

The outcome of first metatarsophalangeal joint arthrodesis using a locking compression plate

Meijer¹,

Grabe²,

Greyling³

2020

SA orthop. j.

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“…There are multiple surgical techniques for arthrodesis of the first MTPJ utilizing different ways to prepare the bone surfaces and a wide variety of techniques of internal and external fixation, all of which may have their place in various instances [5]. Dorsal plate and lag screw fixation provides reliable biomechanical stability for the fusion [8,9,10]. The reported rate of bone healing and consolidation of the fusion site ranges between 77 % and 100 % with the mean of 90 % [11,12,13].…”

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confidence: 99%

Long-term functional results of first metatarsophalangeal joint arthrodesis for hallux rigidus

Ilchenko¹,

Korolev²,

Карданов³

2020

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Introduction First metatarsophalangeal joint (MTPJ) osteoarthritis hallux rigidus (HR) is the most common arthritic condition in the foot and occurs in 2.5-7.8 % of the population over 50 years. First MTPJ arthrodesis is currently considered to be the gold standard for the treatment of end-stage HR. When treating the advanced stage of HR, arthrodesis has long been established as an effective surgical procedure providing very predictable and satisfying results. Although the surgical authors prefer joint-sparing procedures first MTPJ fusion when required is the joint destructive procedure of choice in severe HR to eliminate or minimize pain, stabilize the first MTPJ and allow the hallux to bear weight. Functional outcomes achieved with fusion are also consistent with those from other surgical procedures. The purpose of this study is to evaluate long-term functional outcomes of first MTPJ arthrodesis. Material and methods Clinical and functional outcomes of MTPJ arthrodesis performed for 19 patients (25 feet) with grade 3 or 4 HR using the Coughlin and Shurnas Classification System between September 2010 and December 2017 were reviewed. The patients' mean age was 60 years (range, 35 to 86 years). The median interval between surgery and the last follow-up was 5 years (interquartile range, 1.5 to 8 years). Ultimately, outcome assessment relied on patient satisfaction, radiographic examination, visual analogue scale (VAS), the American Orthopaedic Foot & Ankle Society (AOFAS) and the Foot and Ankle Ability Measure (FAAM) scores. Results AOFAS score was rated as good in 92 % of the cases (23/25), as fair in 8 % (2/25) with neither excellent nor poor results recorded. The median AOFAS score increased from preoperative 43.0 to postoperative 85.0 that was statistically significant (p < 0.05). Postoperative median FAAM Activities of Daily Living (ADL) was 99 %, median subjective ADL was 90 %, median FAAM sport was 84 %, and median subjective sport was 80 %. Patient subjective assessment was scored as "excellent" in 36 % of cases (9/25), "good" in 56 % (14/25), "fair" in 8 % (2/25) with no "poor" results recorded. The median VAS pain score decreased from 6 at baseline to 1 point postsurgery (p < 0.05). Conclusion First MTPJ arthrodesis was shown to be a very effective, reliable and lasting primary procedure for severe HR that provided 92% of good outcomes in our series. The procedure can be advocated as a predictable and excellent option for Coughlin and Shurnas grades 3 and 4 HR facilitating high success rates in pain relief and restoration of function.

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Minimally-invasive hallux arthrodesis with endomedullary and a crossed screw fixation

Carlucci

Parise

Araujo

et al. 2020

Foot and Ankle Surgery

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First Metatarsophalangeal Joint Arthrodesis: Does the Addition of a Lag Screw to a Dorsal Locking Plate Influence Union Rate and/or Final Alignment after Fusion

Cited by 20 publications

References 21 publications

The outcome of first metatarsophalangeal joint arthrodesis using a locking compression plate

The outcome of first metatarsophalangeal joint arthrodesis using a locking compression plate

Long-term functional results of first metatarsophalangeal joint arthrodesis for hallux rigidus

Minimally-invasive hallux arthrodesis with endomedullary and a crossed screw fixation

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