Monday, July 25, 2011

Locked Versus Nonlocked Plate Fixation For Hallux MTP Arthrodesis

Authors: Kenneth J. Hunt, MD; J. Kent Ellington, MD, MS; Robert B. Anderson, MD; Bruce E. Cohen, MD.

Dorsal plate fixation is used commonly for arthrodesis of the hallux
first metatarsophalangeal (MTP) joint. Custom dorsal plates
incorporating locking technology have been developed recently for
applications in the foot to provide relative ease of application and
theoretically superior mechanical properties. The purpose of this study
is to compare the radiographic and clinical outcomes of patients
undergoing hallux MTP joint arthrodesis using a locked plate, or a
nonlocked plate. Materials and Methods: We compared consecutive
patients who underwent hallux MTP arthrodesis for a variety of
diagnoses with either a precontoured locked titanium dorsal plate
(Group 1) or a precontoured, nonlocked stainless steel plate (Group 2).
All patients were evaluated with radiographs, visual analog pain scale,
American Orthopaedic Foot and Ankle Society (AOFAS) hallux score, and a
detailed patient satisfaction survey. Results: There were 73 feet in
Group 1 and 107 feet in Group 2. There was a trend toward a higher
nonunion rate in Group 1 compared to Group 2. When considering
only patients without rheumatoid arthritis (RA), the union rate was
significantly higher in Group 2 compared to Group 1. Hardware failure
and the overall complication rate was equivalent between the two
Groups. Conclusion: As locked plate technology continues to gain
popularity for procedures in the foot, it is important that clinical
outcomes are reported. Locked titanium plates were associated with
higher nonunion rates. Improved plate design, patient selection, and an
understanding of plate biomechanics in this unique loading environment
may optimize future outcomes for hallux MTP arthrodesis.

Level of Evidence: III, Retrospective Comparative Study

Key Words: Hallux Arthrodesis; Hallux Valgus; Hallux Rigidus; Locked
Plate; Arthritis

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