First MTP fusion (hallux rigidus): Dorsal approach with Synthes MTP fusion plate


Subscribe to get full access to this operation and the extensive Foot Surgery Atlas.


Learn the First MTP fusion (hallux rigidus): Dorsal approach with Synthes MTP fusion plate 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 (hallux rigidus): Dorsal approach with Synthes MTP fusion plate surgical procedure.

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.

Readers will also find of interest the following OrthOracle techniques:

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

First MTP Fusion (using Stryker Anchorage MTP arthrodesis plate )for Hallux Varus .

First MTP Fusion: Revision of failed Kellers using DocPrice plate and vascularised allograft.

First MTP Fusion-Crossed screws technique.

Bone block first MTP fusion using the Wright Ortholoc plate



Author:Pete Rosenfeld FRCS (Tr & Orth)

Institution: Imperial College and The Fortius Clinic, London, 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.
  • On successful completion of each quiz you will receive validated CPD points that add to the certificate in your CPD folder.
  • Your dashboard also will contain a record of the time you have spent logged onto and using the site.
  • The timer suspends after 5 minutes though if there is no activity.
  • When you restart you will resume at the same point in the module.
  • Once you have completed each quiz you will need to feedback on the module first then click “submit” and your paper will be marked.
    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.
  • Once you have passed the quiz you can return at a future stage & resit .

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.


  • Did you find this technique helpful?
  • YesNo

Lessons Status


Logo Logo Logo Logo Logo Logo Logo

Associates & Partners

Logo Logo Logo Logo Logo Logo