First metatarsophalangeal fusion using joint specific dorsal plate with interfragmentary screw augmentation: Clinical and radiological outcomes

Hallux interphalangeal involvement after metatarsophalangeal joint arthrodesis. Treatment and Results

“…There are several forms and systems of joint preparation. Likewise, several methods or configurations of osteosynthesis have been described to achieve a higher consolidation rate on the arthrodesis site and to promote the ability to bear weight and early rehabilitation (1,4,6,7,9,11,12,14,15) .…”

“…The following complications were observed after first MTPJ arthrodesis: nonunion, malposition, pain related to hardware requiring reintervention for removal, discomfort due to loss of mobility, metatarsalgia, and IP joint arthrosis or pain (1)(2)(3)(8)(9)(10)(11)13,(14)(15)(16)(17)(18) . IP joint involvement is one of the most frequent complications, with a prevalence ranging from 30 to 60% (10,13,16,17) .…”

“…Most authors agree that IP involvement is closely related to the position of arthrodesis, and it is well know that this complication may be mitigated by reducing overload or stress on the IP joint and that the fixation angle of MTPJ should be from 15° to 30° of valgus in the sagittal plane and from 15° to 30° of dorsiflexion in the lateral plane (7,10,13,14,16) . Moreover, these authors found that a dorsiflexion angle below 20° was associated with a greater rate of IP arthrosis (7,14,16) .…”

“…First metatarsophalangeal joint (MTPJ) arthrodesis is a procedure commonly used for the treatment of severe hallux valgus, hallux rigidus, rheumatoid arthritis, hallux varus, and recurrence or failure of previous operations (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13) . Reported complications include nonunion, malposition, consolidation defects, hardware-related pain, dissatisfaction due to loss of joint mobility, difficulty in wearing shoes, and interphalangeal (IP) joint arthrosis (2,3,(8)(9)(10)(11)(13)(14)(15)(16)(17)(18) . The latter is one of the major causes of discomfort after first MTPJ arthrodesis in the long term (16,17) .…”

Treatment of hallux rigidus with percutaneous arthrodesis

“…O tempo médio de consolidação foi de 8 semanas. Estudos mostram que o tempo médio de consolidação radiográfica é de 8 a 12 semanas para a técnica percutânea e de até 16 semanas para a técnica aberta (4,23) . É provável que os três casos de não consolidação se devam a uma ressecção insuficiente da cartilagem articular da falange, que em geral possui osso mais resistente do que a cabeça do primeiro metatarso.…”