Screw Fixation Compared to H-Locking Plate Fixation for First Metatarsocuneiform Arthrodesis: A Biomechanical Study

Abstract

Screw fixation for first MTC arthrodesis created a stronger and stiffer construct than did the H-locking plate. This was likely due to the mechanical design of the implants. Compression across the MTC joint could be applied with the screws, but the plate relied on a fixed angle design with no compression.

Immediate fullweightbearing after tarsometatarsal arthrodesis for hallux valgus correction—Does it increase the complication rate?

“…So far, a superiority of the dorsomedial angle stable plate over the established screw osteosynthesis could not be demonstrated [15].…”

Biomechanical In Vitro - Stability Testing on Human Specimens of a Locking Plate System Against Conventional Screw Fixation of a Proximal First Metatarsal Lateral Displacement Osteotomy

“…So it was only obvious that the principle of locking plate fixation was applied on first metatarsal osteotomies as well. Nevertheless Cohen found no benefits of the locking plate system compared to crossed screw fixation in the first tarsometatarsal joint arthrodesis [25]. These findings however may be due to the specific design of the locking plate consisting of a relatively soft titanium alloy without possibility of interfragmentary compression and obligatory fixation at the dorsal side of the first metatarsal with the risk of plantar osteotomy gapping.…”

“…A complex plantar dissection necessary to improve the stability by a plantar plate placement [26] was not necessary. Test models described in literature often use feet disarticulated in the ankle, arranged in an unphysiological position, measuring only translational forces or rely on synthetic bone [25, 27-29]. In some studies the locking plate lacked the possibility of interfragmentary compression and three - dimensional aspects were not taken into consideration in contrast to our study [30, 31].…”

“…The authors‘ decision to compare the stiffness of locking plate fixation with that of standard screw fixation was done because they wanted to refer to a basic and well established method of osteosynthesis for metatarsal osteotomies [13, 16, 23, 25]. …”

Percutaneous First Metatarsocuneiform Joint Arthrodesis: Treatment of Severe Recurrent Forefoot Deformity Complicated by an Infected Wound

“…3,10,11 The use of cannulated screws facilitated the fixation process. 6,8 Early weightbearing after the Lapidus procedure is now a viable choice after bunion correction. 4,9,12 Immediate postoperative weightbearing protocol varies among surgeons, institutions and geographic regions.…”