A comparison of non-union rates following first metatarsophalangeal joint fusion with three dorsal plating systems

E.J. Bass, S. Sirikonda, C. Walker

Introduction: Techniques devised for 1st MTPJ arthrodesis have been described since 1979 when Humbert et al published a ‘tongue and trough’ technique. Common contemporary techniques include fixation with single or crossed screws, or dorsal plates and these are suitable for a variety of indications. All three contemporary techniques have demonstrated a wide range of fusion rates. This study reports a comparison of non-union rates of the 1st metatarsophalangeal joint (MTPJ) with the current Memometal AnchorageTM dorsal plate system and the previous Hallu-fixTM and CharlotteTM systems.

Methods: Between 01/2009 and 07/2012 174 consecutive 1st MTPJ fusions were performed for 153 patients (Mean age 62, range 42 to 83) by three surgeons at one University teaching hospital. 40 patients (23%) were male and 132 (77%) female. Patients without available radiographs were excluded from the study. 20 patients received Hallu-fixTM plates, 76 CharlotteTM plates and 76 Memometal AnchorageTM. Radiographs of the feet were taken from four weeks postoperatively and reviewed for incomplete bone bridging and increased radiolucency around screws.

Results: 12 (7.0%) non-unions were identified in total during followup. A single (5.0%) Hallu-fixTM system, 9 (11.8%) CharlotteTM systems and 2 (2.6%) Memometal AnchorageTM plating systems did not develop a satisfactory fusion. Typical followup in patients in whom there were no postoperative complications and who developed satisfactory bony union was 12 weeks. Those with non-unions were followed until revision procedures were successful.

Conclusion: The total non-union rate of this centre during the period compares favourably with published literature suggesting the technique is suitable for numerous indications in 1st MTPJ fusion. With a non-union rate of 5.0%, the Hallu-fixTM shows favourable results when compared authors using the same system. The CharlotteTM system demonstrated an 11.8% non-union rate, comparing poorly with published literature. The Memometal AnchorageTM system, with a non-union rate of 2.6%, demonstrated promising results.