Low-profile Titanium Plate Construct for Early Weightbearing with First Metatarsophalangeal Joint Arthrodesis

Abstract First metatarsophalangeal joint arthrodesis is a useful procedure for various first ray pathologic entities. Multiple constructs for fixation have provided successful fusion. A retrospective study of 21 feet (18 patients) was performed after first metatarsophalangeal joint fusion using cros...

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Bibliographic Details
Published in:The Journal of foot and ankle surgery 2013-07, Vol.52 (4), p.460-464
Main Authors: Mann, Joshua J., DPM, Moon, Jared L., DPM, Brosky, Thomas A., DPM, FACFAS
Format: Article
Language:English
Subjects:
Adult
Aged
Arthrodesis - instrumentation
Bone Plates
Bone Screws
Bone Wires
bunion
Female
Follow-Up Studies
hallux abductovalgus
hallux rigidus
Hallux Rigidus - diagnostic imaging
Hallux Rigidus - physiopathology
Hallux Rigidus - surgery
Humans
Male
metatarsal
Metatarsophalangeal Joint - diagnostic imaging
Metatarsophalangeal Joint - physiopathology
Metatarsophalangeal Joint - surgery
Middle Aged
Orthopedics
osteoarthritis
phalanx
Postoperative Period
Prosthesis Design
Radiography
Retrospective Studies
surgery
Titanium
Weight-Bearing
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Summary:Abstract First metatarsophalangeal joint arthrodesis is a useful procedure for various first ray pathologic entities. Multiple constructs for fixation have provided successful fusion. A retrospective study of 21 feet (18 patients) was performed after first metatarsophalangeal joint fusion using crossed Kirschner wires or compression fixation with cannulated screws followed by the application of a 2-hole low-profile partially locking titanium plate. The median age was 59 (range 41 to 76) years, and we had 4 smokers and 3 patients with diabetes in our series. Postoperatively, a compression dressing with a posterior splint was applied. The patients then transitioned to a controlled ankle motion walker, and all patients reported full weightbearing by 2 weeks postoperatively. The mean follow-up duration was 11.43 (range 6 to 27) months. The overall primary fusion rate was 95.24% (20 of 21). Two nonunions occurred; one was asymptomatic and successfully consolidated at 12 months. The second nonunion required revisional surgery with an autogenous bone graft to heal successfully. This patient was noncompliant with the postoperative regimen and had a 48-pack year history of tobacco usage. Our results have shown early weightbearing after first metatarsophalangeal joint arthrodesis can be successfully initiated with splintage or lag screw fixation and a 2-hole, low-profile, partially locking titanium plate.
ISSN:1067-2516
1542-2224
DOI:10.1053/j.jfas.2013.03.008