Arthrodesis of the Second and Third Tarsometatarsal Joints: Comparison of Clinical Results Using Combined or Individual Plating Techniques

Abstract

Category: Midfoot/Forefoot; Other Introduction/Purpose: Arthrodesis is an effective treatment of midfoot arthritis in reducing pain and improving function. However, there is a known risk of non-union. Our aim was to compare the outcomes of individual plating versus dual plating for combined fusion of the 2nd and 3rd tarsometatarsal joints (TMTJs). Our primary outcome was bone healing and secondary outcomes include patient reported outcome measures. Methods: All cases underwent primary arthrodesis of the 2nd and 3rd TMTJs. Arthrodesis was performed using either a single ‘H- shaped’ plate (combined plating group) or using two separate plates (individual plating group). The outcome measures were bony union and the Manchester-Oxford Foot Questionnaire score. Results: Forty-five procedures were undertaken with a mean follow-up of 527 days. The combined plating group had 28 cases and individual plating group had 17 cases. There were 10 cases (35.71%) of non-union in the combined plating group and 2 cases (11.76%) in the individual plating group. Muti-variate regression analysis showed a significant relationship of non-union with use of the combined plating group (p =.047, OR 5.822). Patients who had also undergone 1st TMTJ fusion had an increase chance of union (p=.043, OR 9.896). No other factors showed significance. MOX-FQ scores were superior in the individual group at 6 months post-surgery although this significance was lost when the non- unions were excluded. Conclusion: This study is the first to report a difference in union between combined plating and individual plating techniques in arthrodesis of the 2nd and 3rd TMTJs. We believe that individual plates permit a more anatomical reduction and greater compression at the site of arthrodesis as compared to a dual plate technique. Achieving union results in a better functional outcome.