Abstract
Introduction: TMTJ fusion is performed for arthritis or painful deformity. First TMTJ fusion may be performed for Hallux valgus deformity. K-wire and trans-articular screws are usually used to stabilize the joints. We present our audit of experience with LP for TMTJ fusion.
Patients and Methods: 33 TMTJ in 19 patients were fused and stabilised using LP between January and September 2008. The procedure was performed for Lisfranc arthritis in 13 and Lapidus procedure in 6. Two out of 6 were revisions after failed fusion using transarticular screws. Iliac crest bone autograft was used in 26 joints in 12 patients. All patients post-operatively had below knee plaster immobilization and protected weight bearing walking for first 6 weeks. Clinical and radiological surveillance continued until bone union. AOFAS mid-foot scale was also used as an outcome measure.
Results: There were 7 male and 12 female patients with average age of 51 (14–68). AOFAS midfoot scale showed 42% improvement in pain, 30% improvement in function and 53% improvement in alignment. Average total AOFAS score improved from 30 preoperative to 67 postoperative.
All except 1 joint in one patient had clinical and radiological fusion of their joints. 1 patient needed removal of metalwork and 4 had delayed wound healing. Average satisfaction score was 7/10. 86% Patients would recommend it to a friend and 91% would have it again.
Discussion: Locking plates have been recently introduced for ankle and foot surgery. Biomechanical studies have shown plates are not as strong or stiff as trans-articular screw fixation however they are easy to use, have more flexibility for realignment and can act as a buttress for bone graft. In our review all patients except one had bone union without loss of alignment.
Conclusion: TMTJ fusion improves pain and function. Locking plates provide satisfactory stability for TMTJ fusion
The abstracts were prepared by Mr Matt Costa and Mr Ben Ollivere. Correspondence should be addressed to Mr Costa at Clinical Sciences Research Institute, University of Warwick, Clifford Bridge Road, Coventry CV2 2DX, UK.
