A Consecutive Case Series of 166 First Metatarsophalangeal Joint Fusions Using a Combination of Cup and Cone Reamers and Crossed Cannulated Screws

Fusion of the first metatarsophalangeal joint (MTPJ) is the reference standard surgery for significant hallux rigidus. A number of different techniques for first MTPJ fusion have been reported. We describe our technique of first MTPJ fusion using cup and cone reamers for joint surface preparation an...

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Bibliographic Details
Published in:The Journal of foot and ankle surgery 2018-05, Vol.57 (3), p.462-465
Main Authors: Asif, Muhammad, Qasim, Sultan N., Kannan, Sudhir, Bhatia, Maneesh
Format: Article
Language:English
Subjects:
Adult
Aged
arthritis big toe
Arthrodesis - instrumentation
Arthrodesis - methods
Bone Plates
Bone Screws
Cohort Studies
Female
first MTPJ fusion
Follow-Up Studies
hallux rigidus
Hallux Rigidus - diagnostic imaging
Hallux Rigidus - surgery
hallux valgus
Hallux Valgus - diagnostic imaging
Hallux Valgus - surgery
Humans
Male
Metatarsophalangeal Joint - diagnostic imaging
Metatarsophalangeal Joint - surgery
metatarsophalangeal joint arthrodesis
Middle Aged
Pain Measurement
Radiography
Retrospective Studies
Treatment Outcome
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Summary:Fusion of the first metatarsophalangeal joint (MTPJ) is the reference standard surgery for significant hallux rigidus. A number of different techniques for first MTPJ fusion have been reported. We describe our technique of first MTPJ fusion using cup and cone reamers for joint surface preparation and 2 crossed cannulated screws for fixation. To the best of our knowledge, this is the single largest series using this technique. The present study reports on a single-surgeon, consecutive series of 166 consecutive cases in 147 patients who had undergone first MTPJ fusion. The demographic data and comorbidities of the patients were collected from the digital medical records, and the radiographs were evaluated by 2 of us (S.Q., M.A.) independently to document fusion status. Radiologic nonunion was seen in 11 of 166 cases (6.6%). The mean duration of follow up was 60 ± 29.5 (minimum 26, maximum 183) days. However, only 4 of the 11 cases (36%) of nonunion were clinically symptomatic and underwent revision using a bone graft and locking plate. A statistically significant difference was found in union rates among males and females (p = .01). Other factors, such as diabetes (p = .2), inflammatory arthritis (p = .5), steroids (p = .6), smoking (p = .5), hallux valgus deformity (p = .5), and concomitant forefoot surgery, did not have a statistically significant (p = .3) effect on union in our study. The union rate of first MTPJ fusion with our technique was comparable to that of others, with the advantage of being simple and less expensive compared with the use of a plate.
ISSN:1067-2516
1542-2224
DOI:10.1053/j.jfas.2017.10.026