First MTP fusion (hallux rigidus): Dorsal approach with Synthes MTP fusion plate
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A 1st MTP joint fusion is an extremely successful operation with very high levels of patient satisfaction when done well. The function afterwards is excellent and even allows professional sports such as tennis or football.
The union and success rates are well above 90% and in general, the risks and complications are rare. Return to full daily activity is rapid after a few weeks, but high endurance or sports will only take a few months.
Its most commonly done for end stage arthritis or hallux rigidus and also for severe hallux valgus.
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 using the Synthes MTP fusion plate – its a Dorsal Locking Plate. This plate provides a very strong construct and allows comfortable walking early in the post op period. The Synthes locking plates are low profile, with variable angle locking holes & screws. This allows the screws to be positioned well and avoid any underlying metal work (often found in revision cases!). The plate profile is curved for strength and also to fit the anatomy well – this gives it a low profile and rarely needs removal. The plates come in 3 different angles – 0, 5 & 10 degrees of dorsiflexion and in 3 different lengths. I most often to use the middle length plate (42mm) in 0 degrees.
I prefer to prepare the joint with spherical reamers on the VA instrument set – these are cup and ball reamers of differing sizes. This allows completely versatile positioning of the hallux due to the “ball & socket” fusion surface. This also provides a large surface area of cancellous bone contact for rapid union. I particularly like the Synthes system of compression through the plates, using the combination of compression wires and a clamp – the final construct is secure enough that no lag screw is needed.
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Author:Pete Rosenfeld FRCS (Tr & Orth)
Institution: Imperial College and The Fortius Clinic, London, UK.