High reoperation rates following first metatarsophalangeal joint arthrodesis using a modern compression plating...

Arthrodesis of the first metatarsophalangeal (MTP) joint using a dorsal plate with compression screw, either separate to or incorporated into the plate, is an established technique for achieving satisfactory fusion with high union rates and low complication rates. The current study assesses the clinical and radiological outcomes following first MTP joint fusion using a modern plating system with a retrograde compression screw.

26 patients who underwent 29 first MTP joint arthrodeses using the Ortholoc 2 CrossCheck dorsal plating system, between December 2020 and December 2021 were prospectively evaluated. Functional health scores (EQ5D, MOXFQ and VAS pain/health scores) were recorded pre-operatively and at six and 12 months post-operatively. Union and complications were recorded.

The MOXFQ scores significantly improved in most domains at both six, and 12 months compared with baseline scores. Bony union was observed in 26 metatarsophalangeal joints (90%), while 3 metatarsophalangeal joints (10%) developed nonunion at 12 months. Metal work irritation was observed in 17% of cases (n = 5). Among them, 4 cases required plate removal. One patient required a revision fusion. In 6 patients who did not require further surgery, VAS scores were slightly higher at 12 months.

Whilst functional outcome scores overall were high, this evaluation study demonstrates that this plate system with a retrograde compression screw has relatively high reoperation rate, due to either nonunion or metalwork problems, likely due to bulky plate design, and relatively distal plate position.

therapeutic, Level 4 (Prospective case series).