Fusion of the First Metatarsophalangeal Joint: Precontoured or Straight Plate?

Triplanar Correction for First Metatarsophalangeal Fusion

“…A dorsiflexion angle over 15 degrees may result with increased bending of the plate, a potential problem with precontoured plates. A study by Marsland et al found that precontoured plates placed dorsally may lead to excessive dorsiflexion clinically relating to the dorsiflexion angle at the first MTP joint being considerably smaller than the IMA (10). Placement of the plate more proximally resulted in greater dorsiflexion angles regardless of plate type, although the greatest changes were seen with precontoured plates (11).…”

First Metatarsophalangeal Joint Arthrodesis Using Memory Staples: Clinical and Functional Results

“…16 Use of precontoured plates can also be tricky as studies have shown that the dorsal cortical angle and the intramedullary angle measurements do not correlate. 17 The positioning of these precontoured plates can also affect the position of the big toe and lead to excessive dorsiflexion when placed incorrectly. 18 With a concept of providing compression across the fusion surfaces, Memory staples were introduced by Depuy Synthes more than 10 years ago for arthrodesis and phalangeal osteotomies.…”

CORR Insights®: Validation of the Artificial Floor Technique in First Metatarsophalangeal Joint Arthrodesis

“…The first MTPJ position can be characterized by coronal (rotation), axial, and sagittal alignments in which rotation is neutral and axial alignment is 5° to 15° of valgus [1-5, 7-10]. Despite some variations among studies, the consensus is that sagittal alignment ranges from 20° to 25° based on mid-diaphyseal lines of the first metatarsal and proximal phalanx [1, 2, 4, 5, 7, 9].…”

“…The first MTPJ position can be characterized by coronal (rotation), axial, and sagittal alignments in which rotation is neutral and axial alignment is 5° to 15° of valgus [1-5, 7-10]. Despite some variations among studies, the consensus is that sagittal alignment ranges from 20° to 25° based on mid-diaphyseal lines of the first metatarsal and proximal phalanx [1, 2, 4, 5, 7, 9]. Rotation and axial alignments are typically easier to position and maintain visually when rotation is neutral (referenced based on the hallux nailbed relative to the lesser toes) and axial alignment is 5° to 15° of valgus with a 3-mm to 5-mm gap between the hallux and second toe [5].…”