Abstract
Purpose: In reports of arthrodesis of the metatarso-phalangeal joint of the great toe, differences in fusion rates have generally been determined as a function of the osteosynthe-sis material used. We studied the incidence of the type of avivement used in a group of patients fused with the same material.
Material and methods: We reviewed at six years 110 patients who underwent metatarso-phalangeal arthrodesis between 1988 and 1999. Two-thirds of the patients (77 patients) had had a simple avivement with osteosynthesis with a proximo-distal axial screw and pin. The same osteosynthesis was also performed in 33 patients who had joint resection between two parallel saw lines. Bone healing was studied on the loaded AP views.
Results: Fusion was obtained in 78% of the cases in the first group (simple avivement) and in 97% of the second within two to six months. The difference was significant, favouring parallel saw lines.
Discussion: The patients in the two groups had comparable indications for arthrodesis: advanced hallux valgus, osteoarthritis, recurrent hallux valgus after surgical treatment, inflammation. Non-fusion of metatarso-phalangeal arthrodesis of the great toe is usually well tolerated. The difference in the rate of non-fusion could be related to better stability obtained between the two parallel saw lines and to potentially more extensive vascular injury with conventional manual or motorised avivement.
Conclusion: If compatible with the anatomic characteristics of the foot, we recommend avivement by joint resection between two parallel saw lines for metatarso-phalangeal arthrodesis.
The abstracts were prepared by Pr. Jean-Pierre Courpied (General Secretary). Correspondence should be addressed to him at SOFCOT, 56 rue Boissonade, 75014 Paris, France
