Can A Reamer System Improve First MPJ Fusions?
- Volume 15 - Issue 11 - November 2002
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After we have prepared the joint surfaces, we’ll employ a Kirschner wire for temporary fixation axially through the hallux and into the metatarsal shaft. We then use the metal cover that comes with many screw sets to act as an intraoperative weightbearing surface. Then we manipulate the hallux into a position where the tuft is just off the weightbearing surface. When you squeeze the tuft of the hallux from medial to lateral, it touches the weightbearing surface. Rotate the nail plate until it faces up. You can determine the varus/valgus position by appearance and potential shoe gear. This method works quite well with most first MPJ arthrodesis procedures.
You can achieve subtle changes in hallux position quite easily with this method as opposed to joint resection, where you are left with two square
surfaces. The latter of these joint preparation techniques does not allow for such subtle changes of hallux position and subsequently, you will spend more time in the operating room attempting to obtain proper positioning.
What About Fixation?
Many forms of fixation are available and most often reflect the experiences of the surgeon. Buranosky, et. al., have tested the stability of fixation for first MPJ arthrodesis.4 The outcome of this study suggested a dorsal plate with an interfragmentary screw was the most stable construct when compared to two crossed screws. I prefer the crossed screw technique for speed, reliability and relative lack of prominence.
If fixation is solid, allow the patient to bear weight to tolerance in a cast brace. Obtain radiographs a week after the surgery and again at six to eight weeks postoperatively. Keep in mind that radiographic union of the arthrodesis site will not be complete for 12 weeks. Once you see satisfactory progression of the fusion process on plain films, you can gradually transition the patient into a shoe.
First MPJ arthrodesis is a proven surgical procedure for treating pathology in this region. The small joint reamers make preparation of the arthrodesis site faster and more congruous, which facilitates ease of positioning and the reliability of fusion.
Dr. Harrod practices in Richmond, Muncie and Indianapolis, IN. He received an AO Trauma Fellowship in Dresden, Germany.
Dr. Burks is a Fellow of the American College of Foot and Ankle Surgeons. He is board certified in foot surgery. Dr. Burks practices in Little Rock, Arkansas.
1. Howmedica, Inc. Rutherford, NJ.
2. Yu GV. First Metatarsophalangeal Joint Arthrodesis, in Comprehensive Textbook of Foot Surgery, 2nd edition p. 564.
3. Hansen Jr. ST. Arthrodesis of the First Metatarsophalangeal Joint, in Functional Reconstruction of the Foot and Ankle, p. 343-344.
4. Buranosky DJ, et. al. First metatarsophalangeal joint arthrodesis: quantitative mechanical testing of six-hole dorsal plate versus crossed screw fixation in cadaveric specimens. J Foot Ankle Surg 2001 Jul-Aug 40(4)208-13.
5. Coughlin MJ, Abdo RV. Arthrodesis of the First Metatarsophalangeal Joint with Vitallium Plate Fixation. Foot and Ankle Vol. 15 (1) Jan 1994.
6. Coughlin MJ. Technique for Metatarsophalangeal Arthrodesis Using Small Joint Reamers and Small Fixation Plates. Distributed by Howmedica, Inc.