DOES THE TYPE OF IMPLANT HAVE ANY CORRELATION WITH CRITICAL FUSION TIME?

Abstract

Does the type of implant have any correlation with critical fusion time of hallux metatarsophalangeal joint? There are few cadaveric biomechanical studies published in the literature assessing the strength and rigidity of different fixation methods. Although it is still unclear whether the amount of metal affects the fusion rate, the aim of this study was to assess whether using a supplementary dorsal ¼ tubular plate in addition to a compression screw gives any added rigidity to the fusion area leading to an earlier fusion.

A retrospective analysis was conducted on the first metatarsophalangeal joint fusion in 26 consecutive patients (34 feet) between April 1998 to February 2002 comparing using single screw versus a screw supplemented with a dorsal ¼ tubular plate. There were 18 females and 8 males with a mean age of 51.5 years and a mean follow-up of 2.9 years. The final fusion was assessed clinically and radiologically by trans-articular trabeculation.

There was a fusion rate of 97%. All patients except one had solid fusion. One case had non-union. Four cases had superficial wound infection, which settled down with appropriate antibiotic therapy. Paraesthesia over the dorso-medial aspect of the big toe in three patients and transfer metatarsalgia in two patients were documented.

The type of implant did not show any direct correlation with the complication rate. There is no evidence to suggest in this study relating the amount of implant to final outcome. Therefore the choice of implant fixation can be at the discretion of the operating surgeon.