Foot & Ankle Surgery: Techniques, Reports & Cases (Jan 2023)
Percutaneous first metatarsophalangeal joint arthrodesis: A retrospective review involving a single surgeon utilizing beveled head crossed compression screw fixation
Abstract
Arthrodesis of the first metatarsophalangeal joint is a reproducible and successful surgical approach to cure patients’ symptoms associated with first ray pathology while simultaneously improving their ambulatory function. The purpose of this study was to investigate clinical and radiographic outcomes of percutaneous first metatarsophalangeal joint arthrodesis using 4.0 mm beveled-head crossed compression screws. Primary outcomes included fusion rate, time to fusion, and millimeters of shortening of the first ray. Secondary outcomes included analysis of VAS scores preoperatively versus postoperatively, and perioperative complications. A total of 18 percutaneous first metatarsophalangeal joint arthrodeses using two 4.0 millimeter beveled-head crossed compression screws were included. Fusion of the first metatarsophalangeal joint was achieved in 88.9 % of the patients. The median time to radiographic union for the first metatarsophalangeal joint was 4.9 weeks. The median millimeters of shortening of the first ray from preoperative to postoperative was 5.1 mm. Immediate weightbearing was permitted with the median time to return to regular shoe gear being 6.1 weeks. The total complication rate was 11.1 %, including one delayed union and one nonunion. All 18 patients in the cohort demonstrated no surgical site infections, wound healing complications, malunion, transfer lesions, lesser capsulitis/metatarsalgia, hardware failures/removal, deep vein thrombosis or pulmonary emboli encountered postoperatively. This study demonstrates that the percutaneous approach yields an acceptable fusion rate without creating excessive shortening leading to postoperative clinical sequela. Additionally, this approach offers the benefits of immediate weightbearing, low hardware removal rates, and a statistically significant reduction in perioperative patient VAS pain scores.
