Arthrodesis of the first metatarsophalangeal joint: The “when and how”

Koutsouradis, Panagiotis; Savvidou, Olga D.; Stamatis, Emmanouil D.

doi:10.5312/wjo.v12.i7.485

Cited by 16 publications

(15 citation statements)

References 49 publications

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“…First metatarsophalangeal joint (FMPJ) arthrodesis is a commonly performed procedure for symptomatic end‐stage hallux rigidus (grades 3 and 4) [1, 2]. The procedure can also be considered in selected cases of severe hallux abducto valgus (HAV) deformity associated with degenerative joint disease and as a salvage option for previously failed first ray procedures [3]. Nix et al [4] found HAV occurrence in 23% of people aged 18 to 65 and 35.7% in those over 65.…”

Section: Introductionmentioning

confidence: 99%

First metatarsophalangeal joint arthrodesis/fusion: a systematic review of modern fixation techniques

Kang

Bridgen

2022

Journal of Foot and Ankle Research

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Background First metatarsophalangeal joint arthrodesis is commonly performed for symptomatic end-stage hallux rigidus. It has been postulated to produce good results in the literature. Various fixation techniques offer differences in union rates, complications and functional outcomes, stirring debates about which produces the best outcomes for patients. Therefore, this review aims to synthesise and compare the outcomes of modern fixation techniques used for first metatarsophalangeal joint (FMPJ) arthrodesis. Methods The electronic database searched were PubMed, CINAHL, Cochrane Library, and Google Scholar. The critical appraisal skills programme tool for cohort study was used. The interventions consisted of screw(s), plate(s), and staple(s). Studies comprising outdated fixation techniques such as suture, metallic wire, external fixation, Rush rods or Steinmann pins were excluded. Participants were adults over 18 years, undergoing FMPJ arthrodesis in the UK. Studies with the population consisting primarily of revision cases, patients with rheumatoid arthritis or diabetes were excluded. Results Seven UK studies included 277 feet and a 95.7% overall union rate at a mean union time of 83.5 days. Staples had the highest union rate of 98.2% at mean union time of 84 days, followed by plates (95.2%, 92 days), and finally screws (94.9%, 71 days). The overall complication incidence is 5.8%. All of the fixation techniques produced good functional outcomes postoperatively. Conclusions Whilst staple techniques showed the highest union rate, plating techniques are preferable over screws or staples for better results across several outcome measures, including reduced complication incidence, stability, early ambulation, and good functional outcome. The Manchester-Oxford Foot Questionnaire and EuroQol-5Dimensional are recommended as measurement tools to assess functional outcomes following FMPJ arthrodesis.

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Section: Introductionmentioning

confidence: 99%

First metatarsophalangeal joint arthrodesis/fusion: a systematic review of modern fixation techniques

Kang

Bridgen

2022

Journal of Foot and Ankle Research

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“…The metatarsal and phalanx bones’ shape are modelled as cylindrical. During arthrodesis in the standard fixation technique [ 35 ], the bones of the MTP-1 joint are brought closer to each other. However, due to the possible lack of congruency of the MTP-1 joint [ 36 ], an average small gap of 1 mm is assumed [ 32 , 37 ] between the metatarsal’s and phalanx’s cortical fracture bone fragments.…”

Section: Methodsmentioning

confidence: 99%

Comparative analysis of mechanical conditions in bone union following first metatarsophalangeal joint arthrodesis with varied locking plate positions: A finite element analysis

Sabik,

Daszkiewicz,

Witkowski

et al. 2024

PLoS ONE

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Background First metatarsophalangeal joint arthrodesis is a typical medical treatment performed in cases of arthritis or joint deformity. The gold standard for this procedure is arthrodesis stabilisation with the dorsally positioned plate. However, according to the authors’ previous studies, medially positioned plate provides greater bending stiffness. It is worth to compare the mechanical conditions for bone formation in the fracture callus for both placements of the locking plate. Methods Two finite element models of the first metatarsophalangeal joint with the dorsally and medially positioned plate were defined in the Abaqus software to simulate differentiation of the fracture callus. A simplified load application, i.e. one single step per each day and the diffusion of the mesenchymal stem cells into the fracture region were assumed in an iterative hardening process. The changes of the mesenchymal stem cells into different phenotypes during the callus stiffening were governed by the octahedral shear strain and interstitial fluid velocity according to Prendergast mechanoregulation theory. Basing on the obtained results the progress of the cartilage and bone tissues formation and their distribution within the callus were compared between two models. Findings The obtained results suggest that after 6 weeks of simulation the healing progress is in general comparable for both plates. However, earlier closing of external callus was observed for the medially positioned plate which had greater vertical bending stiffness. This process enables faster internal callus hardening and promotes symmetrical bridging.

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“…25 The incidence of nonunion is expected to be <10% based on existing literature. [31][32][33][34] (2) Malunion can occur due to improper alignment of the bones and/or poor patient compliance with postoperative care. The incidence of malunion is around 6.1% with most occurring dorsally (87.1%).…”

Section: Complicationsmentioning

confidence: 99%

“… Nonunion of the arthrodesis site can occur due to inadequate joint preparation or mechanical failure of the fixation construct 25 . The incidence of nonunion is expected to be <10% based on existing literature 31–34 Malunion can occur due to improper alignment of the bones and/or poor patient compliance with postoperative care.…”

Section: Complicationsmentioning

confidence: 99%

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Minimally Invasive Fusion of the First Metatarsophalangeal Joint: A Technical Report

Ghandour,

Knebel,

Eftekhari

et al. 2023

Techniques in Foot &Amp; Ankle Surgery

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Hallux rigidus, a common arthritic condition of the forefoot, affects a significant portion of the population, with ~8% of the population developing it at some point in their lives. Failure of first-line nonoperative treatment options may necessitate surgical treatment in symptomatic patients. Traditional surgical approaches include cheilectomy for milder cases and open arthrodesis for severe cases. The minimally invasive surgery approach to first metatarsophalangeal joint fusion is a novel technique that utilizes small incisions and arthroscopy for joint fusion. Fusion rates of 93% to 97% and low complication rates were reported by several studies on this technique. The technique involves percutaneous portal development, joint preparation and debridement, joint reduction, and fixation using k-wires and compression screws. The proper positioning of the toe is crucial to ensure optimal functional outcomes. Indications for this technique include advanced arthritis, significant scar tissue, and patient concern for cosmetic outcomes. Contraindications include poor bone quality, revision fusion, significant bone loss, active infection, or vascular compromise. Preoperative planning involves a comprehensive physical examination and imaging to assess the extent of the arthritis and any associated deformities. Complications of the procedure may include nonunion, malunion, iatrogenic thermal burns, and asymmetrical joint preparation. Postoperative management includes weight-bearing restrictions, regular follow-up visits, and gradual progression to normal activities. Preliminary results demonstrate promising outcomes for minimally invasive surgery first metatarsophalangeal fusions.

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Arthrodesis of the first metatarsophalangeal joint: The “when and how”

Cited by 16 publications

References 49 publications

First metatarsophalangeal joint arthrodesis/fusion: a systematic review of modern fixation techniques

First metatarsophalangeal joint arthrodesis/fusion: a systematic review of modern fixation techniques

Comparative analysis of mechanical conditions in bone union following first metatarsophalangeal joint arthrodesis with varied locking plate positions: A finite element analysis

Minimally Invasive Fusion of the First Metatarsophalangeal Joint: A Technical Report

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