RESEARCH ARTICLE


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



M.A Rashid*, M Parnell, W.S Khan , A Khan
Department of Trauma and Orthopaedics, Southend University Hospital NHS Foundation Trust, Essex, SS0 0RY, UK


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© Rashid et al.; Licensee Bentham Open.

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

* Address correspondence to this author at the Department of Trauma and Orthopaedics, Southend University Hospital NHS Foundation Trust, Essex, SS0 0RY, UK; Tel: +44 (0) 1702 435555; Fax: +44 (0) 1702 435556; E-mail: mamunalrashid@hotmail.com


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.

Keywords: Arthrodesis, methods of fixation, first metatarsalphalangeal joint, retrospective study.