Biomechanical Comparison of Two Fixation Methods for First Metatarsophalangeal Joint Arthrodesis

Abstract

The stronger and stiffer intramedullary screw technique offers mechanical advantages over the crossed interfragmentary screw technique.

Hallux Metatarsophalangeal Joint Arthrodesis With a Hybrid Locking Plate and a Plantar Neutralization Screw

“…Multiple retrospective studies have evaluated the results of first MTP joint arthrodesis, 1,2,[4][5][6][7][8][9][11][12][13]16,[20][21][22][23]25,[28][29][30][31] but we are aware of only 1 prospective study 15 evaluating this procedure. Many methods for achieving union have been developed and include sutures, 4 cerclage wire, 12,31 Kirschner wires, 11,13,14,21,28 Steinmann pins, 7,21,22 screws, 2,11,12,20,21,23,24,29 and plates. 1,5-9, 30 Politi et al 27 demonstrated that dome-shaped joint preparation coupled with a dorsal plate and a crossed screw was the most stable construct in synthetic bone models.…”

Evaluation of the Intermetatarsal Angle After the Arthrodesis of the First Metatarsophalangeal Joint for Treatment of the Hallux Valgus

“…Although the immediate postoperative radiograph was produced without weight–bearing while the late postoperative radiograph was produced with weight-bearing, we do not believe that this could have been the cause of the angular difference observed between them. In our view, this loss (without statistical significance: p > 0.05) occurred because of the fixation with Kirschner wires that was used on some feet, a method that provides less stability 22 , 23 . Kirschner wires were chosen based on the bone quality observed by the surgeon during the operation.…”

“…Many techniques for performing arthrodesis of the first metatarsophalangeal joint have been described, with consolidation rates ranging from 80 to 100% 5 , 6 , 7 , 8 , 9 , 10 . Biomechanical studies using different types of fixation have shown that the most stable fixation method is one that combines a traction screw and a dorsal plate 22 , 23 . In evaluating the intermetatarsal angle, we found that the mean was 10 degrees on immediate postoperative radiographs and 10.2 degrees on late postoperative radiographs.…”

Highlights of the Eighteenth Annual Summer Meeting of the American Orthopaedic Foot and Ankle Society July 12–14, 2002, Traverse City, Michigan

“…In 10 pairs of cadaver feet, first MP joint arthrodesis was done with cup-and-cone joint surface preparation and fixation with either two crossed 4.0 mm partially-threaded cannulated cancellous screws or a single 6.5 mm partially-threaded intramedullary cancellous lag screw placed parallel to a 1.6 mm Kirschner wire. 59 Load-to-failure testing with a plantar to dorsal load showed that intramedullary fixation was stiffer and stronger than crossed screw fixation. 59…”

“…59 Load-to-failure testing with a plantar to dorsal load showed that intramedullary fixation was stiffer and stronger than crossed screw fixation. 59…”