Abstract
Introduction:
Techniques devised for 1st MTPJ arthrodesis have been described since 1979 when Humbert et al published a ‘tongue and trough’ technique. Common contemporary techniques include fixation with single or crossed screws, or dorsal plates and these are suitable for a variety of indications. All three contemporary techniques have demonstrated a wide range of fusion rates. This study reports a comparison of non-union rates of the 1st metatarsophalangeal joint (MTPJ) with the current Memometal Anchorage™ dorsal plate system and the previous Hallu-fix™ and Charlotte™ systems.
Methods:
Between 01/2009 and 07/2012 174 consecutive 1st MTPJ fusions were performed for 153 patients (Mean age 62, range 42 to 83) by three surgeons at one University teaching hospital. 40 patients (23%) were male and 132 (77%) female. Patients without available radiographs were excluded from the study. 20 patients received Hallu-fix™ plates, 76 Charlotte™ plates and 76 Memometal Anchorage™. Radiographs of the feet were taken from four weeks postoperatively and reviewed for incomplete bone bridging and increased radiolucency around screws.
Results:
12 (7.0%) non-unions were identified in total during followup. A single (5.0%) Hallu-fix™ system, 9 (11.8%) Charlotte™ systems and 2 (2.6%) Memometal Anchorage™ plating systems did not develop a satisfactory fusion. Typical followup in patients in whom there were no postoperative complications and who developed satisfactory bony union was 12 weeks. Those with non-unions were followed until revision procedures were successful.
Conclusion:
The total non-union rate of this centre during the period compares favourably with published literature suggesting the technique is suitable for numerous indications in 1st MTPJ fusion. With a non-union rate of 5.0%, the Hallu-fix™ shows favourable results when compared authors using the same system. The Charlotte™ system demonstrated an 11.8% non-union rate, comparing poorly with published literature. The Memometal Anchorage™ system, with a non-union rate of 2.6%, demonstrated promising results.
