First Metatarsalphalangeal Joint Arthrodesis: A Retrospective Comparison of Two Methods of Fixation

Abstract

First metatarsalphalangeal joint arthrodesis is a well established and successful treatment; however there still remains controversy over the best choice of construct. We performed a retrospective study of patients undergoing first metatarsalphalangeal fusion over eighteen months (n=52) using either dorsal non-locking plate with additional compression lag screw fixation or dorsal non-locking plate alone. We found when assessing clinical criteria, patients with dorsal non-locking plates and additional compression lag screw fixation had a significantly higher rate of fusion (100% vs 77.8%), significantly higher rate of fusion within the first two months (55.6% vs 83.3%), significantly earlier time to fusion (52.2 days vs 75.6 days), and significantly lower rate of non-union (0% vs 22.2%). When blindly assessing radiographic criteria, the patients treated with the plate and compression screw had a significantly higher rate of fusion and lower rate of non-union (0% vs 33%). There was no statistically significant difference between the frequencies of complications in the groups. We believe that the interfragmentary compression is a crucial factor in achieving good union rates and recommend the use of non-locking pre-contoured plating with additional interfragmentary compression screw as the fixation method of choice for these procedures.

Biomechanical Comparison of Low-Profile Contoured Locking Plate With Single Compression Screw to Fully Threaded Compression Screws for First MTP Fusion

“…In a retrospective study of patients that underwent MTPJ arthrodesis, Rashid et al showed that in patients treated with a plate and lag screw, the complication rate was 26% (6 of 23 patients), and in patients treated with a lag screw or plate alone, the complication rate was 20% (3 of 15 patients). 30 A systematic review of patients that underwent first MTPJ arthrodesis showed a similar complication rate of 23.1% (171 of 741 patients), with the most common complications being nonunion or delayed union and implant removal. 36 The introduction of fully threaded headless lag screws may offer an improved alternative to plate and lag screw arthrodesis.…”

“…22 Success rates have been shown to be between 80% and 100%. 30 Recent plating techniques yielded significant improvements in fixation stability and union rates. 3,[7][8][9][10]13,15,16,21,24,[26][27][28]38,39 While plating techniques are highly successful, they necessitate a relatively large dorsal incision, which can lead to postoperative complications.…”