Arthrodesis of the First Metatarsophalangeal Joint Utilizing a Chamfered compression screw and low-profile dorsal locking plate

Abstract

Background: First Metatarsophalanageal Joint (MTPJ) fusion is a reliable treatment for end stage arthritis of the 1st MTPJ and is still considered the gold standard. Historically non-union and hardware removal rates are in the 5–10% range which can lead to need for revision surgery. We describe a technique utilizing a chamfered headless compression screw and low profile dorsal locking plate to evaluate hardware removal rates and time to osseous union. Methods: Retrospective radiographic review performed on 43 1st MTPJ fusions utilizing a chamfered headless compression screw and low profile dorsal locking plate. Patients were evaluated for time to union (days), complications, need for hardware removal, and non-union rates. Results: We demonstrated that the fusion rate at a mean time of 76.3 days was 93.1 percent. Three patients underwent revision surgery for non-union while no patients required revision surgery for painful hardware. Complications included 4 superficial infections that cleared with oral antibiotics, 1 contact dermatitis, 1 asymptomatic hardware lucency and 3 non-unions Conclusion: We found our technique utilizing a chamfered compression screw and low profile dorsal locking plate provides satisfactory union rates and low rates of hardware pain which may decrease the necessity for additional surgical procedures.