von Deimling C, Tondelli T, Brunner S, Andronic O, Graf AD. Achieving high union rates after first metatarsophalangeal joint arthrodesis: Radiographic outcomes and technical pitfalls. World J Orthop 2023; 14(6): 436-442 [PMID: 37377987 DOI: 10.5312/wjo.v14.i6.436]
Corresponding Author of This Article
Octavian Andronic, MD, Surgeon, Department of Orthopedic Surgery and Traumatology, Bürgerspital Solothurn, Schöngrünstrasse 42, Solothurn 4500, Switzerland. and_octavian@gmx.ch
Research Domain of This Article
Orthopedics
Article-Type of This Article
Observational Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Orthop. Jun 18, 2023; 14(6): 436-442 Published online Jun 18, 2023. doi: 10.5312/wjo.v14.i6.436
Achieving high union rates after first metatarsophalangeal joint arthrodesis: Radiographic outcomes and technical pitfalls
Christian von Deimling, Timo Tondelli, Samuel Brunner, Octavian Andronic, Alexander David Graf
Christian von Deimling, Timo Tondelli, Samuel Brunner, Octavian Andronic, Alexander David Graf, Department of Orthopedic Surgery and Traumatology, Bürgerspital Solothurn, Solothurn 4500, Switzerland
Author contributions: von Deimling C wrote the manuscript, performed the data acquisition; Tondelli T contributed to the statisics, data acquisition; Andronic O main responsibility for the study plan and design; Brunner S and Graf AD are senior author.
Institutional review board statement: This retrospective study was approved by the ethics commission board of northwest- and central- Switzerland and was conducted entirely at the authors institution: BASEC Nr 2021-00837.
Informed consent statement: All study participants or their legal guardian provided informed written consent about personal and medical data collection prior to study enrolment.
Conflict-of-interest statement: SB is in the advisory board of DePuy Synthes and receives advisory fees.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Octavian Andronic, MD, Surgeon, Department of Orthopedic Surgery and Traumatology, Bürgerspital Solothurn, Schöngrünstrasse 42, Solothurn 4500, Switzerland. and_octavian@gmx.ch
Received: December 28, 2022 Peer-review started: December 28, 2022 First decision: March 24, 2023 Revised: April 14, 2023 Accepted: May 15, 2023 Article in press: May 15, 2023 Published online: June 18, 2023 Processing time: 172 Days and 14 Hours
Abstract
BACKGROUND
Fusion of the first metatarsophalangeal (MTP1) joint is a common surgery performed to correct hallux rigidus, hallux rigidus et valgus and other painful degenerative diseases of the MTP1.
AIM
To assess outcomes of our surgical technique including non-union rates, accuracy and aims of correction.
METHODS
Between September 2011 and November 2020 a total 72 of MTP1 fusions were performed using a low profile, pre-contoured dorsal locking plate and a plantar compression screw. Union and revision rates were analyzed with a minimum clinical and radiological follow up of at least 3 mo (range 3-18 mo). The following parameters were evaluated on pre- and postoperative conventional radiographs: Intermetatarsal angle, Hallux-valgus angle, dorsal extension of the proximal phalanx (P1) in relation to the floor and the angle between the Metatarsal 1 and the P1 (MT1-P1 angle). Descriptive statistical analysis was performed. Pearson analysis was used to assess for correlations between radiographic parameters and achievement of fusion.
RESULTS
An overall union rate of 98.6% (71/72) was achieved. Two out of 72 patients did not primarily fuse with one patient suffering from a non-union, whilst the other demonstrating a radiological delayed union without clinical symptoms, with eventually complete fusion after 18 mo. There was no correlation between the measured radiographic parameters and the achievement of fusion. We believe the reason for the non-union was mainly attributed to the patient’s incompliance without wearing the therapeutic shoe leading to a fracture of the P1. Furthermore, we didn`t find any correlation between fusion and the degree of correction.
CONCLUSION
With our surgical technique, high union rates (98%) can be achieved using a compression screw and a dorsal variable-angle locking plate to treat degenerative diseases of the MTP1.
Core Tip: The most important findings in this study are that metatarsophalangeal joint fusion using a compressions screw and a dorsal plate can achieve union rates close to 100% even in patients that are diabetic or smoke. Furthermore, we didn't find any correlation between the degree of correction and risk of nonunion.
