First Metatarsophalangeal Joint Fusion Using a Fyxis Plate

Marudanayagam, Ashok; Appan, Sadai V

doi:10.1177/230949901402200110

Cited by 11 publications

(14 citation statements)

References 15 publications

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“…Common indications include hallux valgus, hallux rigidus, inflammatory arthropathy, salvage procedures after failed previous surgery and neuromuscular conditions. [2][3][4][5][6] As noted in the literature, successful first MTPJ arthrodesis has been attained with the use of a wide variety of implants ranging from crossed Kirschner wires, cerclage wiring, sutures, staples, axially or obliquely placed compression screws, intramedullary Steinman pins, external compression clamps, and dorsal plate and screw constructs. Most of these methods have demonstrated successful union rates ranging from 70% to 100%.…”

Section: Introductionmentioning

confidence: 99%

“…Most of these methods have demonstrated successful union rates ranging from 70% to 100%. 3,4,6,7 A review of the available biomechanical studies in the literature shows that fixation using a lag screw and a dorsal plate construct has the best overall mechanical stability. 8,9 Small fragment compression plates were frequently used in the past, but because of their size and prominence often caused local irritation and pressure symptoms.…”

Section: Introductionmentioning

confidence: 99%

“…Currently these plate-and-screw constructs are mostly being used in conjunction with a compression cross screw across the arthrodesis site. [3][4][5]11 As these constructs are biomechanically more rigid than previously used implants, the question arises whether an additional compression cross screw is still necessary in order to achieve an adequate union rate when fusing the first MTPJ.…”

Section: Introductionmentioning

confidence: 99%

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The outcome of first metatarsophalangeal joint arthrodesis using a locking compression plate

Meijer¹,

Grabe²,

Greyling³

2020

SA orthop. j.

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BACKGROUND: Arthrodesis of the first metatarsophalangeal joint (MTPJ) is a common and frequently performed procedure in the practice of orthopaedic foot and ankle surgery. Fusion techniques and preferred surgical implants have significantly evolved during recent years. It is however still under debate which surgical device provides the best outcome. One of the modern techniques described includes the use of a dorsal anatomical locking plate. These plates are usually used in combination with an additional compression cross screw across the arthrodesis site. The aim of this study was to assess the outcome of arthrodesis of the first MTPJ using a dorsal locking plate without making use of additional compression cross screw fixation. METHODS: We retrospectively assessed data at an orthopaedic practice specialising in foot and ankle surgery. All patients who had a first MTPJ arthrodesis with an anatomical locking plate system between 2010 and 2016 were identified. No additional compression cross screw fixation was done in any of these cases. Standard standing dorsoplantar and lateral X-rays of the foot were taken six weeks after surgery. As a primary objective, these radiographs were assessed to determine the rate of radiological union. As a secondary objective, any other complications that occurred in the post-operative period were recorded. RESULTS: We included 115 patients in the study. Fifteen of these patients underwent bilateral first MTPJ arthrodesis surgery, making the total number of feet included in the study 130. Of these, 86% (n=99) were female and 14% (n=16) were male. The mean age at the time of surgery was 54.7 years (range 37-74). An observed radiological union rate of 97% at three months after surgery was recorded. A total of four cases (3%) presented with symptomatic non-union. Two of these were successfully revised and progressed to union before the nine-month follow-up. One patient had bilateral surgery for severe rheumatoid arthritis with poor bone quality. No union was achieved even after a revision procedure with bone grafting. A Keller-type resection arthroplasty was eventually performed in this patient. Another secondary complication that was recorded is an overall infection rate of 2%. CONCLUSION: The results of this retrospective study suggest that high union rates and a low incidence of complications can be expected when fusing the first MTPJ with the use of a locking plate system without the need for an additional compression cross screw Level of evidence: Level 4 Keywords: first metatarsophalangeal joint, fusion, arthrodesis, locking plate, union

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

The outcome of first metatarsophalangeal joint arthrodesis using a locking compression plate

Meijer¹,

Grabe²,

Greyling³

2020

SA orthop. j.

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“…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. 1 The plates can also be bulky, creating subsequent symptoms during activities and showing wear over time.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2019

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Background: Open metatarsophalangeal (MTP) arthrodesis using locked plates produces good clinical outcomes. However, arthroscopic fusion with new-generation fully threaded compression screws is emerging as an alternative. The purpose of this study was to compare low-profile contoured locked plates with fully threaded compression screws for first MTP fusion, in a biomechanical cadaveric model. Methods: The first rays of 8 matched pairs of fresh frozen cadaveric feet underwent dissection and dual-energy x-ray absorptiometry (DEXA) scanning to measure bone mineral density (BMD). The “plate” group was prepared with cup-and-cone reamers, and fixation of the MTP joint with 1 compression screw and low-profile dorsal locked plate. The matched-pair “screws” group was prepared through a simulated arthroscopic technique, achieving fixation with 2 new-generation fully threaded compression screws. The plantar MTP gap was recorded with an extensometer during 250 000 90-N cyclic loads followed by a single load to failure. Results: The screw group demonstrated significantly greater stiffness, 31.6 N/mm (plates) and 51.7 N/mm (screws) ( P = .0045). There was no significant difference in plantar gapping or load to failure, 198.6 N (plates) and 290.1 N (screws) ( P = .2226). Stiffness and load to failure were highly correlated to BMD for the screw group, r =0.79 and r = 0.94, respectively, but less so for the plate group, r = 0.36 and r = 0.62, respectively. The maximum metatarsal head height measured on the lateral view was strongly correlated with load to failure for both the plate- and screw-only groups ( r > 0.9). Conclusion: These data demonstrate that hallux MTP arthrodesis utilizing fully threaded compression screws had similar plantar gapping and load to failure when compared with the low-profile locking plate, but with significantly more stiffness. These results support an increased role of fully threaded screws for MTP arthrodesis using either the arthroscopic or open technique. However, with decreased BMD plate fixation may remain the better fixation choice. Clinical Relevance: Our data suggest that with regard to construct stability, fully threaded headless compression screws may be just as effective as low-profile locking plates, but BMD and MTP joint fluoroscopic measurements should be considered in the decision-making process for fixation.

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“…10 There were also several methods of fixations described, such as dorsal plate and compression screws, which had been shown to be the strongest biomechanically. [11][12][13] This procedure is commonly done by open techniques, but arthroscopic technique had been described. 14 This procedure is however not without complications.…”

Section: Introductionmentioning

confidence: 99%

Biomechanical consequences of first metatarsaophalangeal joint arthrodesis on flexor digitorum longus function: A cadaveric study

Tan¹,

Fadil

2019

J Orthop Surg (Hong Kong)

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Background: First metatarsophalangeal joint (MTPJ) arthrodesis is a common treatment modality for hallux rigidus with successful outcomes. However, the effect of arthrodesis on flexor digitorum longus (FDL) is poorly understood. The purpose of this study was to investigate this effect in a biomechanical model. Methods: Ten cadaveric trans-knee amputated specimens were studied. Lesser toe range of motion (ROM) and FDL excursion on simulated FDL contraction were measured in the following three scenarios: (1) before 1st MTPJ arthrodesis, (2) after 1st MTPJ arthrodesis, and (3) after the knot of Henry release. Results: 1st MTPJ arthrodesis reduced both mean lesser toe ROM and FDL excursion. However, there was improvement in these parameters after the knot of Henry release. Conclusions: FDL function was reduced following 1st MTPJ arthrodesis. This effect was contributed by soft tissue connections at the knot of Henry, where FDL crosses flexor hallucis longus (FHL). Therefore, with restriction of FHL movement after 1st MTPJ arthrodesis, FDL movement was also restricted. Clinical Relevance: This result improved our understanding of 1st MTPJ arthrodesis biomechanics and suggested potential benefits of the knot of Henry release in 1st MTPJ arthrodesis to improve FDL function, thereby decreasing the rate of metatarsalgia and other associated problems.

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First Metatarsophalangeal Joint Fusion Using a Fyxis Plate

Abstract: The outcome of fusion of the first MTPJ using the Fyxis plate and compression screws was good.

Cited by 11 publications

References 15 publications

The outcome of first metatarsophalangeal joint arthrodesis using a locking compression plate

The outcome of first metatarsophalangeal joint arthrodesis using a locking compression plate

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

Biomechanical consequences of first metatarsaophalangeal joint arthrodesis on flexor digitorum longus function: A cadaveric study

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