Introduction: Arthrodesis of 1st metatarsophalangeal joint is a reliable procedure for the treatment of symptomatic arthritis. Various techniques are in use to facilitate arthrodesis. We evaluated our results using a new and simple construct of two staples applied perpendicular to one another.

Material and Methods: Prospective observational study. A total of 29 patients (26 females, 3 males), Mean age 59yrs. 34 Hallux MTP joint fusions, 5 of them bilateral. Pre-operative diagnosis was Osteoarthritis in 27 and Rheumatoid arthritis in 2.

Technique: Medial incision, planar cuts using saw. Staples placed dorsoventrally and mediolaterally.

Patients: were mobilised in heel weight bearing post op shoe for 4–6 weeks. All patients had regular clinical and radiological assessment. Mean followup was 24 months.

Results: Pre-op mean AOFAS score was 31 (Modified AOFAS score, total value 90 Portion of MTP joint motion was not included). Post-op mean AOFAS (modified) score was 81. 26 patients were very satisfied with the outcome of surgery, 2 were satisfied with reservation and one patient was not satisfied. 28 out of 29 patients would recommend this procedure to others. Ability to wear shoes improved in 26, same in 2 and worse in one patient. There were two mal-unions, one superficial wound infection treated with antibiotics and 6 patients had prominent staples requiring removal. There was no radiological non-union

Conclusion: Our technique of 1st MTP joint arthrodesis using 2 staples applied perpendicular to each other provides a reliable and stable construct that does not require use of plaster post-operatively. This has resulted in painfree post-op period without any need for plaster thus saving time and avoiding complications of plaster i.e stiffness and DVT. We strongly recommend the use of this type of fixation.

We evaluated the long-term benefits of steroid injection in 20 consecutive patients (25 shoulders) with primary acromioclavicular arthritis using the Constant score. All patients were followed up for a minimum of 5 years. The average age of the patients was 55 years. The mean pre-injection Constant score was 61 points. At six months this improved to 81 points, (mean difference – 19.36) which was highly statistically significant (p< 0.01). There was further improvement at 12 months, on the 6-month score, mean 86 points that also showed a significant improvement on the 6-month score (p = 0.001). At 5 years the mean score was 81 points and this was a significant detoriation compared with the 12-month score (p=0.01) but still a significant improvement when compared to the preinjection scores (p< 0.0005). In addition, the younger the patients, the greater the improvement in the objective score which measures range of movement and power (r= − 0.47; p= 0.01). Female patients also had a greater improvement (r=0.405; p=0.05). We conclude that local steroid injection is an effective method of treatment for primary isolated acromioclavicular arthritis and improvement continues for at least 12 months and the benefit is felt up to 5 years though the pain relief tends to tail off long-term.