Immediate Ambulation after a First Metatarsophalangeal Joint Fusion using a Locking Plate: Technique and case reports

Abstract

Purpose: Arthrodesis of the first metatarsophalangeal joint (MTPJ) is a predictable procedure to relieve pain and dysfunction of the first MTPJ. Many fixation techniques have been described. The authors present two cases in which a locking plate was successfully used for first MTPJ fusion. The patients began immediate weight-bearing post-operatively without a delay in union, hardware failure, or malalignment. Methods: A retrospective chart and radiographic review of a 53 year-old male and a 59 year-old female was performed. Serial radiograph was taken to assess fusion at the arthrodesis site. Procedures: Cartilage was resected from the head of the first metatarsal and base of the proximal phalanx preserving the curvature of the joint. The joint was placed in the desired position and interfragmental compression was obtained using a cannulated 4.0-millimeter partially threaded screw from proximal medial to distal lateral with all threads crossed the fusion site. A locking plate was then placed on the dorsal aspect of the joint and secured with locking screws proximal and distal. Results: The patients began ambulating immediately post-operatively with a post-operative shoe. Both patients had successful fusion by 8 weeks with good alignment and intact fixation. Patients returned to regular shoe gear once trabeculation was noted. Conclusion: These 2 case reports suggest excellent results and immediate ambulation with compression screws and locking plates. This clinical report shows promise in regards to early ambulation using locking plate fixation technique and further studies are encouraged.