Immediate Weightbearing Following First Metatarsal Phalangeal Joint Arthrodesis With 2 Nickel Titanium Alloy Staples.

The use of staples has been shown to be a reasonable fixation technique to achieve stability of a first MTPJ arthrodesis. Although it has been shown to be a weaker construct than crossed screws or plate and screw combinations, their ease of insertion, low profile, and stability make them a desirable choice for first MTPJ arthrodesis fixation. However, because of this relative weakness, the question remains whether immediate weightbearing when using staples is advisable. The aim of this study is to determine whether the use of 2 nickel-titanium alloy (NITINOL) staples, placed at 90 degrees to one another is a stable enough construct to support full, immediate weightbearing following first MTPJ arthrodesis. We performed a retrospective chart review of patients undergoing first MTPJ arthrodesis by a single surgeon utilizing 2 NITINOL staples placed at 90 degrees to one another. Patients were allowed to be fully weightbearing immediately postoperatively. Forty-seven of 50 (94%) patients achieved complete radiologic consolidation of fusion at 12 weeks, with only 3 requiring revision surgery for nonunion. All of the patients requiring revision surgery for nonunion, had preoperative diagnosis of hallux abducto valgus. We concluded that the use of 2 NITINOL staples placed at 90 degrees to one another is a viable option for first MTPJ arthrodesis, and immediate weightbearing does not increase rate of nonunion or incidence of revision surgery when compared to other fixation techniques.

The offset V osteotomy versus the modified Austin with a longer plantar arm: a comparison of mechanical stability.

Several studies have tested the strength and various fixation modalities of the long dorsal arm offset V osteotomy, and have proven it to be a stable construct when fixated properly. We believe that a modification of the traditional Austin cuts, with a slightly longer plantar arm, lends itself to greater stability because instead of ground reactive forces applying a distraction moment on the osteotomy, the ground actually compresses the osteotomy leading to greater stability and less chance of failure. We compared the mechanical stability of the long dorsal offset V osteotomy to the slightly longer plantar arm osteotomy using 20 sawbone models, 10 in each study group. The offset V osteotomies were all fixated with two 2.7-mm stainless steel screws through the dorsal arm of the osteotomy, and the longer plantar arm osteotomies were fixated with one 2.4-mm stainless steel screw through the plantar arm of the osteotomy. Results of testing with the 858 Mini Bionix materials testing device, showed a mean load at failure of the long dorsal arm osteotomies of 142.26 N (range 53.16-235.45 N). Mean load at failure of the longer plantar arm osteotomies was 280.07 N (range 184.91-337.39 N). There was a significant difference in the ultimate load at failure between the 2 groups (P < .0001). There was no significant difference in displacement (P = .18) or stiffness (P = .54). The results of our study indicate that the slightly longer plantar arm osteotomy is a more stable construct than the long dorsal arm offset V osteotomy.

The unreliability of the intermetatarsal angle in choosing a hallux abducto valgus surgical procedure.

Conventional thinking holds that high intermetatarsal and hallux abductus angles (>15° and >25°, respectively) are associated with a hypermobile first ray and require a Lapidus procedure to achieve satisfactory correction for the treatment of hallux valgus. However, normal first ray motion may be misinterpreted as hypermobility, and it is possible to take advantage of this motion to correct some portion of a large hallux abductovalgus deformity with distal procedures, such as the Austin or first metatarsophalangeal joint fusion. We retrospectively examined radiographs of 61 patients with first intermetatarsal and hallux abductus angles greater than 15° and greater than 25°, respectively, who had undergone hallux abductovalgus correction via Lapidus, Austin, or first metatarsophalangeal joint fusion. Preoperative and postoperative radiographic measurements of the intermetatarsal and hallux abductus angles were made. The results revealed no statistically significant differences in the amount of correction achieved by any of the 3 procedures in comparison with the others. We concluded that, given appropriate patient selection, an Austin or first MTPJ fusion could reliably correct large intermetatarsal and hallux abductus angles that, in the hands of many surgeons, are often treated by means of Lapidus arthrodesis.