Mehmet AKDEMİR, Ahmet Cemil TURAN, Ali İhsan KILIÇ

Retrospective Comparison of Two Different Fixation Methods for First Metatarsophalangeal Joint Arthrodesis

Background and Purpose: Arthrosis of the first MTP joint is a common condition. Among the available arthrodesis methods, plate/screw and screw methods are the current treatment methods of choice. In this study, we investigate whether there is a difference between these two methods. Methods: Thirty-four toes of 32 patients with advanced arthrosis were included in the study. Eighteen toes were fixed with plates/screws and 16 with cross-screws. In the radiological evaluations, malunion and nonunion were examined. Clinical evaluation was made according to AOFAS-HMI scoring. Results: The mean age of the patients was 57.74 years and the mean follow-up period was 22.21 months. There was no statistically significant difference in clinical scores or union times between the two groups. As complications, superficial skin problems developed in 2 (5.9%) cases, deep infection in 3 (8.8%) cases, and nonunion in 3 (8.8%) cases. There was no statistically significant difference between the two groups in this regard. Conclusion: Plate/screw and cross-screw techniques give similar clinical and radiological results in cases of arthrodesis of the first MTP joint. The cross-screw technique, which can be performed more easily and has lower costs, should be the first choice.

Keywords:

arthrodesis, hallux rigidus hallux valgus, plate, screw,

PDF

___

1.Ho B, Baumhauer J. Hallux rigidus. EFORT Open Rev. 2017 Mar 13;2(1):13-20. doi: 10.1302/2058-5241.2.160031. PMID: 28607766; PMCID: PMC5444234.
2.Lam A, Chan JJ, Surace MF, Vulcano E. Hallux rigidus: How do I approach it? World J Orthop. 2017 May 18;8(5):364-371. doi: 10.5312/wjo.v8.i5.364. PMID: 28567339; PMCID: PMC5434342.
3.Elliott AD, Borgert AJ, Roukis TS. A Prospective Comparison of Clinical, Radiographic, and Intraoperative Features of Hallux Rigidus: Long-Term Follow-Up and Analysis. J Foot Ankle Surg. 2016 May-Jun;55(3):547-61. doi: 10.1053/j.jfas.2016.01.040. Epub 2016 Mar 3. PMID: 26948243.
4.Deland JT, Williams BR. Surgical management of hallux rigidus. J Am Acad Orthop Surg. 2012 Jun;20(6):347-58. doi: 10.5435/JAAOS-20-06-347. PMID: 22661564.
5.McNeil DS, Baumhauer JF, Glazebrook MA. Evidence-based analysis of the efficacy for operative treatment of hallux rigidus. Foot Ankle Int. 2013 Jan;34(1):15-32. doi: 10.1177/1071100712460220. PMID: 23386758.
6.Fuhrmann RA. First metatarsophalangeal arthrodesis for hallux rigidus. Foot Ankle Clin. 2011 Mar;16(1):1-12. doi: 10.1016/j.fcl.2010.12.003. PMID: 21338925.
7.Hoveidaei AH, Roshanshad A, Vosoughi AR. Clinical and radiological outcomes after arthrodesis of the first metatarsophalangeal joint. Int Orthop. 2021 Mar;45(3):711-719. doi: 10.1007/s00264-020-04807-3. Epub 2020 Sep 14. PMID: 32929546.
8.Restuccia G, Cosseddu F, Del Chiaro A, Ceccoli M, Lippi A, Shytaj S. First metatarsophalangeal fusion with dorsal plate: clinical outcomes. J Orthop Surg Res. 2021 Jun 6;16(1):361. doi: 10.1186/s13018-021-02453-y. PMID: 34092260; PMCID: PMC8183079.
9.Chraim M, Bock P, Alrabai HM, Trnka HJ. Long-term outcome of first metatarsophalangeal joint fusion in the treatment of severe hallux rigidus. Int Orthop. 2016 Nov;40(11):2401-2408. doi: 10.1007/s00264-016-3277-1. Epub 2016 Aug 20. PMID: 27542800.
10.Hyer CF, Glover JP, Berlet GC, Lee TH. Cost comparison of crossed screws versus dorsal plate construct for first metatarsophalangeal joint arthrodesis. J Foot Ankle Surg. 2008 Jan-Feb;47(1):13-8. doi: 10.1053/j.jfas.2007.08.016. Epub 2007 Nov 13. PMID: 18156059.
11.Fuld RS 3rd, Kumparatana P, Kelley J, Anderson N, Baldini T, Younger ASE, Hunt KJ. Biomechanical Comparison of Low-Profile Contoured Locking Plate With Single Compression Screw to Fully Threaded Compression Screws for First MTP Fusion. Foot Ankle Int. 2019 Jul;40(7):836-844. doi: 10.1177/1071100719837524. Epub 2019 Mar 17. PMID: 30880450.
12.Womack JW, Ishikawa SN. First metatarsophalangeal arthrodesis. Foot Ankle Clin. 2009 Mar;14(1):43-50. doi: 10.1016/j.fcl.2008.11.008. PMID: 19232991.
13.Hyer CF, Scott RT, Swiatek M. A retrospective comparison of first metatarsophalangeal joint arthrodesis using a locked plate and compression screw technique. Foot Ankle Spec. 2012 Oct;5(5):289-92. doi: 10.1177/1938640012457936. Epub 2012 Aug 30. PMID: 22935413.
14.Ellington JK, Jones CP, Cohen BE, Davis WH, Nickisch F, Anderson RB. Review of 107 hallux MTP joint arthrodesis using dome-shaped reamers and a stainless-steel dorsal plate. Foot Ankle Int. 2010 May;31(5):385-90. doi: 10.3113/FAI.2010.0385. PMID: 20460064.
15.Flavin R, Stephens MM. Arthrodesis of the first metatarsophalangeal joint using a dorsal titanium contoured plate. Foot Ankle Int. 2004 Nov;25(11):783-7. doi: 10.1177/107110070402501105. PMID: 15574236.
16.Maleki F, Ramesh A, Cassar-Gheiti AJ, Fox C, Kelly P, Stephens MM, McKenna JV. Comparison of 4 different techniques in first metatarsophalangeal joint arthrodesis. Ir J Med Sci. 2019 Aug;188(3):885-891. doi: 10.1007/s11845-018-01961-x. Epub 2019 Jan 8. PMID: 30617457.
17.Ettl V, Radke S, Gaertner M, Walther M. Arthrodesis in the treatment of hallux rigidus. Int Orthop. 2003;27(6):382-5. doi: 10.1007/s00264-003-0492-3. Epub 2003 Aug 26. PMID: 12942194; PMCID: PMC3461880.
18.Hoveidaei AH, Roshanshad A, Vosoughi AR. Clinical and radiological outcomes after arthrodesis of the first metatarsophalangeal joint. Int Orthop. 2021 Mar;45(3):711-719. doi: 10.1007/s00264-020-04807-3. Epub 2020 Sep 14. PMID: 32929546.
19.Fanous RN, Ridgers S, Sott AH. Minimally invasive arthrodesis of the first metatarsophalangeal joint for hallux rigidus. Foot Ankle Surg. 2014 Sep;20(3):170-3. doi: 10.1016/j.fas.2014.03.004. Epub 2014 Apr 2. PMID: 25103703.
20.Lunati M, Mahmoud K, Kadakia R, Coleman M, Bariteau J. Complications Associated with the Surgical Management of Hallux Rigidus. Orthop Clin North Am. 2021 Jul;52(3):291-296. doi: 10.1016/j.ocl.2021.03.003. Epub 2021 May 6. PMID: 34053574.
21.Filomeno, P., & López, J. (2018). First metatarsophalangeal joint arthrodesis: functional outcomes using 2 different fixation techniques. Is more expensive better?. Foot & Ankle Orthopaedics, 3(3), 2473011417752674.
22.Moon JL, McGlamry MC. First metatarsophalangeal joint arthrodesis: current fixation options. Clin Podiatr Med Surg. 2011 Apr;28(2):405-19, ix. doi: 10.1016/j.cpm.2011.02.002. PMID: 21669346.