First MTP Fusion :Coughlin reamer preparation and Orthosolutions Cannulated 4mm screws


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Learn the First MTP Fusion :Coughlin reamer preparation and Orthosolutions Cannulated 4mm screws 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 :Coughlin reamer preparation and Orthosolutions Cannulated 4mm screws 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.

Successful union of requires adequate preparation of the articular surfaces to expose subchondral bone, and rigid internal fixation. The technique described uses reciprocal dome shaped reamers to provide a congruent ‘ball and socket’ interface for fusion, this allows more versatility in aligning the toe optimally than flat cuts, provides a large surface area for fusion, and can be used to correct concomitant hallux interphalangeus.

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.

Author : Mr Nick Cullen FRCS (Tr & Orth)

Institution :The Royal National Orthopaedic Hospital ,Stanmore ,UK.

  • Each operation and the questions associated become a named course in the CPD section
  • The operative technique itself is read as a lesson as is any company implant information if this is being assessed.
  • You’ll need to tick the box to confirm this has been done and can do this immediately if you have already read the op tech.
  • The vast majority of operations have a 10-15 MCQ quiz covering all aspects of the decision making and the technique
  • There are four possible answers of which one is correct (or on occasion more correct) than the others.
  • There are additional quiz modules on the surgical steps, the implants and problem cases being added continually
  • The course is completed once all the lessons are read and quizzes submitted and passed.
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  • The timer suspends after 5 minutes though if there is no activity.
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    The pass mark is 75%.
  • If you fall below this level you will be directed back to re-read the slides where you’ve tripped up.
  • Once these have been read you can re-do just the questions you failed on.
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CPD Points:

  • Operation Quiz – 1 CPD point
  • Surgical steps Quiz – 1/4 CPD point
  • Implants Quiz – 1/4 CPD point
  • Problem case Quiz – 1/2 CPD point

One CPD point equates to one hour of academic activity


Welcome to the Professional Development question section. The objective of taking these tests is to demonstrate that you have understood all aspects of the assessment and management of patients requiring surgical intevention. On successful completion you will receive a certificate accredited by both the Royal College of Surgeons of both England and Edinburgh as well as the British Orthopaedic Association.

Our content is designed for both Surgeons in independent practice and Surgeons in training.


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