Technique tip: arthrodesis of the first metatarsophalangeal joint - prevention of excessive dorsiflexion.

摘要

Arthrodesis of the first metatarsophalangeal joint is an established treatment method for hallux rigidus and severe bunion deformities. Patient satisfaction after arthrodesis generally exceeds satisfaction after arthroplasty. Fixation without a plate can result in the first metatarsophalangeal joint having 10 to 40 degrees of dorsiflexion; dorsiflexion is defined as the angle between lines drawn through the proximal phalanx and the first metatarsal joint (Figures 1 and 2). The use of dorsal plates for arthrodesis is increasingly popular, and one study showed that treatment combining machined conical reaming of the joint surfaces and placement of an oblique interfragmentary lag screw and a dorsal plate provided the most stable construct. Another study showed that placement of a deliberately bent plate during arthrodesis produced a postoperative dorsiflexion angle range of 15 to 33 degrees (mean, 21.9 degrees; goal, 20 degrees).