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Learn the First MTP Fusion-Crossed screws technique surgical technique with step by step instructions on OrthOracle. Our e-learning platform contains high resolution images and a certified CME of the First MTP Fusion-Crossed screws technique surgical procedure.

A 1st MTP (metatarsophalangeal ) joint fusion  is a highly versatile operation both in terms of the conditions which can be treated as well as in terms of the function possible after successful fusion.

A union rate of 90% plus is recorded in most series using current techniques. Success defined in terms of patient satisfaction rates though can be slightly lower than those of radiographic union of the fusion.

The keys to operative success are careful joint preparation, positioning and appropriate fixation as well as appropriate patient selection and expectation management.

There are various ways of fixing the fusion, most commonly  a single axial compressive screw combined with  a dorsal neutralising or compression plate. The technique detailed in this operation is a “crossed-screws” technique which differs only in the final mode of fixation.

Similar techniques shown on OrthOracle are the use of Coughlin reamers for the joint preparation

https://www.orthoracle.com/library/first-mtp-fusion-coughlin-reamer-preparation-and-orthosolutions-cannulated-4mm-screws/  

also detailed on the platform is corrective MTP fusion of a hallux varus using a Stryker Anchorage plate

https://www.orthoracle.com/library/hallux-varus-correction-stryker-anchorage-mtp-arthrodesis-plate/

and the technique of bone block distraction MTP fusion for a short first ray

https://www.orthoracle.com/library/bone-block-first-mtp-fusion-using-the-wright-ortholoc-plate/

Author: Mark Herron FRCS.

Institution: The Wellington Hospital, London, UK.

Clinicians should seek clarification on whether any implant demonstrated is licensed for use in their own country.

In the USA contact: fda.gov
In the UK contact: gov.uk
In the EU contact: ema.europa.eu