Surgical technique tip: Using reaming systems for joint surface preparation for first metatarsophalangeal joint arthrodesis

摘要

Various techniques have been described for joint preparation when performing a first metatarsophalangeal joint arthrodesis. These include power saw resection of the cartilage and subchondral bone, curettage, rongeur, osteotome, and power joint reamers. The reaming systems have the advantage of maintaining the convexity of the first metatarsal head and the concavity of the base of the proximal phalanx of the hallux. Unfortunately, these systems have been the target of criticism in that they can be quite aggressive leading to overzealous bone resection causing excessive shortening and possible fractures, especially in the presence of osteopenic bone. We present a technique tip which will offer the surgeon more control of the power instrumentation and subsequently less risk of intraoperative complications.