First Metatarsophalangeal Joint Arthrodesis: A Retrospective Comparison of Crossed-screws, Locking and Non-Locking Plate Fixation with Lag Screw.

Background: Locking plate fixation is increasingly used for first metatarsophalangeal joint (MTP-I) arthrodesis. There are still few comparable clinical data regarding this procedure. In this study we aimed to compare the clinical and radiographical outcomes of crossed-screws, locking and non-locking plate fixation with lag screw for first metatarsophalangeal joint arthrodesis.

Methods: A total of 60 patients who had undergone arthrodesis of the MTP-I between January 2008 and June 2010 were retrospectively evaluated. Locking plate fixation with lag screw as well as arthrodesis with crossed-screws or with a non-locking plate with lag screw was performed on three groups of 20 patients.

Results: There were four non-unions in patients with crossed-screws and one in non-locked plate group. All patients in locking plate group achieved union. 90% of the patients were completely or mildly satisfied in locking plate group, whereas this rate was 80% for patients in both crossed-screws and non-locking plate groups.

Conclusion: Use of dorsal plating for arthrodesis of MTP-I joint, either locking or non-locking, were associated with high union rate and acceptable and comparable functional outcome. Although the rate of nonunion was higher with two crossed-screws, however, the functional outcome was not significantly different compared to dorsal plating.