First Metatarsophalangeal Arthrodesis Fixation with an Intramedullary System

Abstract

Category: Midfoot/Forefoot Introduction/Purpose: Artrhrodesis is a commonly and successfully used procedure to deal with advanced hallux rigidus, severe hallux valgus, inflammatory and posttraumatic arthritis and as a salvage of previous failed surgeries. Many different techniques, in terms of joint preparation and fixation constructs, have been reported. The purpose of this study is to evaluate our short time results with an intramedullary device to perform the first metatarsophalangeal (MTP) arthrodesis. Methods: A descriptive observational study with prospective follow-up was developed. We included 21 arthrodesis using an Intramedullary Fusion Device, which consists in a 6.5 mm intramedullary metatarsal implant and a hooked 4.0 mm lag screw. The indications were hallux rigidus grade 4 in 10 cases, severe hallux valgus in 7, two patients with hallux varus and two cases of salvage surgery of a previous Keller Brandes. Clinical outcomes were assessed with American College of Foot and Ankle Surgeons (ACFAS) scoring scale preoperatively and at the time of the radiological fusion. The degree of satisfaction of patients was also evaluated using the Coughlin and Mann scale. Results: Fusion was achieved at five to twelve weeks in 19 patients. The grade of satisfaction was excellent and good in 18 patients. In two cases, implant breakage occurred. ACFAS score improved 40 points respect to preoperative status. No complications related to infection were reported. Conclusion: Dorsal plate fixation augmented with plantar lag screw fixation is nowadays the reference technique to perform first MTP arthrodesis, nevertheless titanium staples and crossed screws have also reported good results. In these constructs, sometimes is necessary a second surgery to remove some disturbing material. An intramedullary device would avoid the soft tissue irritation due to the underlying material and seems reliable to provide a strong fixation to achieve early MTP fusion with good short-term evolution.