First Metatarsophalangeal Joint Arthrodesis: A Narrative Review of Fixation Constructs and Their Evolution

Abstract

First metatarsophalangeal (MTP) joint arthrodesis is a surgical procedure in which the first metatarsal head is fused to the proximal phalanx of the great toe in order to permanently stiffen the first MTP joint. It was originally proposed as a treatment for severe cases of hallux valgus deformity, but the procedure's indications and utilization have expanded since its initial development. Despite a wide variety of indications, first MTP arthrodesis has been shown to have reliable, satisfactory outcomes. As a result, the development of a wide array of surgical approaches, joint preparation techniques, and fixation devices used in the procedure has occurred. In this narrative review, we highlight the evolution of fixation constructs used in first MTP arthrodesis in order to provide a frame of reference for the various types of fixation constructs available.

Keywords: construct; first metatarsophalangeal arthrodesis; fixation; foot and ankle; fusion; orthopaedic surgery; plate; screw; staple.

Figure 1. Foot X-ray shows crossed-screw fixation of the first metatarsophalangeal joint.

Figure 1A and Figure 1B show anterior-posterior and oblique views of the foot, respectively. Figure 1C shows a lateral view of the foot.

Figure 2. Foot X-ray shows Kirschner wire fixation of the first metatarsophalangeal joint.

Figure 2A and Figure 2B show anterior-posterior and oblique views of the foot, respectively. Figure 2C shows a lateral view of the foot.

Figure 3. Foot X-ray shows dorsal locking plate fixation of the first metatarsophalangeal joint with supplementary lag screw fixation.

Figure 3A and Figure 3B show anterior-posterior and oblique views of the foot, respectively. Figure 3C shows a lateral view of the foot.

Figure 4. Foot X-ray shows dorsal locking plate fixation of the first metatarsophalangeal joint without a supplementary interfragmentary lag screw.

Figure 4A and Figure 4B show anterior-posterior and oblique views of the foot, respectively. Figure 4C shows a lateral view of the foot.

Figure 5. Foot X-ray shows memory compression staple fixation of the first metatarsophalangeal joint with supplementary interfragmentary lag screw fixation.

Figure 5A and Figure 5B show anterior-posterior and oblique views of the foot, respectively. Figure 5C shows a lateral view of the foot.

Figure 6. Foot X-ray shows hybrid dorsal locking plate with memory staple compression fixation of the first metatarsophalangeal joint.

Figure 6A and Figure 6B show anterior-posterior and oblique views of the foot, respectively. Figure 6C shows a lateral view of the foot.

Figure 7. Three-dimensional model compares the amount of disruption of the cancellous bone surface between interfragmentary lag screws and memory compression staples in first metatarsophalangeal arthrodesis.

Figure 7A shows a large amount of disruption caused by a lag screw passing directly through the first metatarsophalangeal joint. Figure 7B shows that memory compression staples can provide dynamic compression to the first metatarsophalangeal joint without any contact to the cancellous bone surface of the joint.