Comparison of 4 different techniques in first metatarsophalangeal joint arthrodesis

AimsThe aim of this study was to evaluate outcomes and fusion rates of 4 different methods of first metatarsophalangeal joint (MTPJ) arthrodesis. Methods We performed a retrospective analysis of first MTPJ fusion using Bold (R) and Acutrak (R) compression screws, universal 1/3 tubular plate and Hallu (R)-S non-locking plate in 6 hospitals in Dublin over 4 years. A cohort of 300 patients (351 feet) was operated on by 3 feet and ankle fellowship trained orthopaedic surgeons (PK, MMS, JVMcK) over 4years. Mean age was 62.4 years. There were 261 females and 39 males. One hundred three patients had a fusion of first MTPJ using two Acutrak (R) screws and 90 with two Bold (R) screws. Sixty-five were fused with the Hallu-S (R) plate and 42 with the universal 1/3 tubular plate. Patients were evaluated clinically and radiographically at 6 weeks, 3 months and 12months. Results Functional outcome scores performed using Manchester-Oxford Foot Questionnaire (MOXFQ). Failure rate in those fused with the Hallu (R)-S plate was 0%, Acutrak (R) screws 2.4%, Bold (R) screws 9.5% and universal 1/3 tubular plate 12.5% (p>0.12). All treatment groups demonstrated significantly reduced MOXFQ scores (p value<0.05). Conclusion In this retrospective study for first MTPJ fusion, a low profile, pre-contoured plate in combination with a screw mode had the best results with no failure rates and improved MOXFQ scores.Level of clinical evidence: IV, retrospective study.