Arthrodesis of the first metatarsophalangeal joint using a dorsal titanium contoured plate

Cappagh National Orthopaedic Hospital, Finglas, Dublin 11, Ireland.
Foot & Ankle International (Impact Factor: 1.51). 12/2004; 25(11):783-7.
Source: PubMed


Arthrodesis of the first metatarsophalangeal joint (MTPJ) is used to treat a variety of foot pathologies. Numerous methods of internal fixation and bone end preparation have been reported. In an effort to bring together the best features of the various internal fixation devices, a low-profile contoured titanium plate (LPCT) using a compression screw was designed to be used with a ball-and-socket bone end preparation. A prospective study was carried out to determine the efficacy of this technique.
First MTPJ arthrodesis using an LPCT was done in 12 patients (10 women and two men) either as an isolated procedure (seven patients) or in conjunction with other forefoot procedures (five patients). The changes in the level of pain and activities of daily living were evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) hallux score and the Short-Form 36 (SF-36) score. Time to bone union also was assessed. Mean followup was 18 months (+/-6 months).
Statistically significant increases in the AOFAS hallux score and the SF-36 score were noted (p = .002 and .001, respectively). All radiographs showed bone union at 6 weeks and an appropriate degree of hallux dorsiflexion in relation to the first metatarsal (20 to 25 degrees).
The combination of the LPCT plate and a ball-and-socket bone-end preparation has both operative and biomechanical advantages over other fixation techniques. This combination ensures that the anatomical length of the first ray is only minimally shortened and the angle of plantarflexion of the first metatarsal is maintained, resulting in preservation of medial column stability and a better functional result.

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    • "Our study is therefore a reference because it shows better results with Scarf osteotomy than with MTP1 arthrodesis. Only the study by Flavin and Stephens [26] used the SF36 score and shows an improvement in the global score after arthrodesis of the first metatarsophalangeal joint. "
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    ABSTRACT: INTRODUCTION: Scarf osteotomies of the first metatarsal and metatarsophalangeal arthrodesis are the two most frequent surgical forefoot reconstructive procedures. HYPOTHESIS: We compared functional results of isolated arthrodesis of the first metatarsophalangeal joint with an isolated Scarf osteotomy of the first metatarsal. MATERIALS AND METHODS: This was a retrospective, observational, continuous study of patients operated between 1993 and 2008. After patients who had undergone a procedure on the lateral rays, extremely elderly patients, lost to follow-up patients and those with incomplete questionnaires had been excluded, there remained two comparable groups of 25 patients. Mean age was 60 in the arthrodesis group [41-70] and 59.8 in the Scarf group [47-71]. The Scarf group included 25 hallux valgus (100%) compared to 16 hallux valgus (64%) and nine hallux rigidus (36%) in the arthrodesis group. Complications were recorded. Evaluation of functional results was based on the most recent functional or quality of life scores (AOFAS, FFI, FAAM, SF 36) and a questionnaire on physical and athletic ability. RESULTS: There was no significant difference in the rate of complications between the two groups. There was no difference in pain according to the AOFAS score with 35.6/40 (±6.5) in the Scarf group and 34.5 (±5.9) in the arthrodesis group. Global satisfaction was also similar between the Scarf and arthrodesis groups: 91.4% and 90% of very satisfied or satisfied patients, respectively. The FFI score was higher in the Scarf group than in the arthrodesis group: 8.6 (±20.1) and 19.8 (±17.7) respectively. Functional results were better in the Scarf group than in the arthrodesis group with a FAAM Daily Activity score of 80.2 (±12.1) compared to 68 (±7.2), a FAAM Sports Activity score of 29.7 (±6.7) compared to 25.2 (±7.6) and a FAAM Global Function score of 94% (±10.8) compared to 87% (±15.7), respectively. The Global SF36 score was higher in the Scarf group than in the arthrodesis group: 70.9% (±14.1) and 62.3% (±20.6) respectively, which was due to a higher Mental Health score in the Scarf group: 68.7% (±14.2) and 60.4% (±19.3) respectively. In the area of sports activities the Scarf group practiced more hiking than the arthrodesis group (74% versus 42% respectively). There was no difference for other activities. DISCUSSION AND CONCLUSION: This study provides detailed information on the level of physical and sports activities that are practiced following these procedures, so that the patient can be better informed. LEVEL OF EVIDENCE: Level III. Comparative retrospective.
    Orthopaedics & Traumatology Surgery & Research 08/2012; 98(6). DOI:10.1016/j.otsr.2012.04.016 · 1.26 Impact Factor
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    • "Many approaches and techniques have been described [1] [2] [3] [4] [5] [6] [7] [8] [9] [10]. Various osteosynthesis implants have been employed in order to support fusion [11] [12] [13] [14], the debate as to the best method of fixation being still open. We propose a technique of metatarsophalangeal arthrodesis with preparation and reaming of the articular surfaces to a spherical profile using motorized ball and cup reamers. "
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    ABSTRACT: In a continuous series of 54 MTP-1 arthrodeses using ball and cup reamers, fusion and great toe position were analyzed. The population was mainly female (46 versus 8). Mean age at operation was 61 years. Arthrodesis was for four conditions of symptomatic degenerative disease: 36 severe hallux valgus (>35 degrees ), 7 recurrences of hallux valgus, 9 hallux rigidus and 2 hallux varus. Arthrodesis used a medial approach, articular surface preparation by ball and cup reamers (plus perforation by Kirschner wire), and osteosynthesis with three titanium staples. Pre- and postoperative big toe positions were analysed with the Footlog semi-automated X-ray assessment software. All patients were followed up for a mean 38.6 months (22-56). Overall fusion rate was 94.4%, and 99% for primary arthrodesis. Mean time to union was 56 days (74% in 6 weeks), with 3 non-unions (5.6%), including 2 after hallux valgus recurrence. Mean pre-operative toe valgus was 40 degrees and 14.1 degrees at revision for all groups. 95% of arthrodeses fused at a mean lateral metatarsophalangeal angle of 22.6 (18-26 degrees ). Metatarsus varus exceeded 20 degrees in 8 cases, mainly in the severe hallux valgus group; at revision, the mean first intermetatarsal angle was 10.6 degrees (9-12 degrees ). Arthrodesis of the first metatarsophalangeal joint with ball and cup reamers is a reliable and reproducible technique, giving total correction of big toe valgus. The first intermetatarsal angle was corrected without supplementary osteotomy. Using three pure titanium staples for fixation, rate and time of fusion were in line with reference techniques.
    Foot and Ankle Surgery 03/2010; 16(1):32-7. DOI:10.1016/j.fas.2009.03.008
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    ABSTRACT: Introduction Les ostéotomies du premier métatarsien et l’arthrodèse de l’articulation métatarsophalangienne du premier rayon constituent les deux gestes les plus fréquemment pratiqués au niveau de l’avant-pied. Hypothèse Nous avons comparé le résultat fonctionnel des arthrodèses isolées de l’articulation métatarsophalangienne du premier rayon avec celui d’une ostéotomie SCARF isolée du premier métatarsien. Patient et méthode Il s’agit d’une étude rétrospective, observationnelle, continue de patients opérés entre 1993 et 2008. Après exclusion des patients ayant subi un geste sur les rayons latéraux, des patients d’âges extrêmes, des perdus de vue et questionnaires incomplets, il restait deux groupes de 25 patients comparables. L’âge moyen était de 60 ans pour le groupe Arthrodèse (41–70) et de 59,8 ans pour le groupe Scarf (47–71). Le groupe Scarf comprenait 25 hallux valgus (100 %) contre 16 hallux valgus (64 %) et neuf hallux rigidus (36 %) pour le groupe Arthrodèse. Les complications ont été mesurées. L’évaluation du résultat fonctionnel a été réalisée à l’aide des scores fonctionnels ou de qualité de vie les plus récents (AOFAS, FFI, FAAM, SF 36) et un questionnaire sur les capacités physiques et sportives. Résultats Le taux de complications ne différait pas significativement entre les deux groupes. Il n’existait pas de différence en termes de douleur selon le score AOFAS avec 35,6/40 (± 6,5) pour le groupe Scarf contre 34,5 (± 5,9) pour le groupe Arthrodèse. Le taux de satisfaction globale était lui aussi identique avec 91,4 % et 90 % de patients très satisfaits ou satisfaits. Le score FFI était supérieur pour le groupe Scarf avec 8,6 (± 20,1) contre 19,8 (± 17,7). Le groupe Scarf avait un meilleur résultat fonctionnel que le groupe Arthrodèse avec un score FAAM Activités Quotidiennes de 80,2 (± 12,1) contre 68 (± 7,2), un score FAAM Activités Sportives 29,7 (± 6,7) contre 25,2 (± 7,6) et un score FAAM Fonction Globale estimée 94 % (± 10,8) contre 87 % (± 15,7). Le groupe Scarf avait un score SF36 global supérieur avec 70,9 % (± 14,1) contre 62,3 % (± 20,6). La supériorité se situait au niveau du score Santé Mentale avec 68,7 % (± 14,2) contre 60,4 % (± 19,3). En termes d’activités sportives, le groupe Scarf pratiquait plus la randonnée que le groupe Arthrodèse (74 % contre 42 %). Il n’y avait pas de différence pour les autres activités. Discussion et conclusion Ce travail apporte des informations précises sur les activités physiques et sportives, permettant de mieux informer le patient. Niveau d’évidence Étude rétrospective comparative de niveau III.
    Revue de Chirurgie Orthopédique et Traumatologique 10/2012; 98(6):S189–S195. DOI:10.1016/j.rcot.2012.04.032
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