Aims: The results of arthrodesis of the þrst metatarso-phalangeal joint as salvage procedures after failure in bunion surgery are well documented in the medical literature. Usually, the results may be equivalent to those of primary arthrodeses. On the other hand, joint conserving methods in case of recurrence have not the same reputation in respect to arthrodesis which appears as the gold standard

Methods: We reviewed 27 patients (28 feet) with a mean follow-up of 6.5 years (range: 1–18 years) after treatment for recurrence after bunion surgery. The patients were submitted to a joint conserving procedure on grounds of absence of degenerative condition on the metatarsophalangeal joint. The procedure corrected point by point all the characteristics of the deformity: lateral release, mobilisation of the joint, tightening of the medial capsule and osteotomies on the þrst ray.

Results: Preoperatively valgus of the great toe was on average of 38.9û. At time of follow-up (6.5 years on average) after revisional procedure, valgus of the great toe was on average 21.3û. Postoperatively 23 out of 27 patients were satisþed. The result was considered as good in 20 cases, fair in one, and poor in 7 cases.

Conclusions: In spite of technical difþculties, these results can equal those of primary bunion procedure, if all the morphological disorders are corrected. Conservative methods may be rational when the joint remains ßexible with no pain and when the morphological particularities on the forefoot are sufþciently indisputable so that their correction could cure the patient

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.