Emilio Wagner1, Pablo Wagner1, Cristian Ortiz1. 1. Clíinica Alemana de Santiago, Av. Vitacura 5951, Vitacura, Santiago, Chile 7650568. E-mail address for E. Wagner: ewagner@alemana.cl. E-mail address for P. Wagner: pwagner@alemana.cl. E-mail address for C. Ortiz: cortiz@alemana.cl.
Abstract
INTRODUCTION: Arthrodesis of the first metatarsophalangeal joint is the most reliable surgical option, with a low complication rate, for hallux rigidus from end-stage osteoarthritis. STEP 1 SURGICAL APPROACH: Make a medial approach, following the mid-axis of the joint. STEP 2 JOINT PREPARATION: Using a cup-cone configuration provides excellent bone exposure, construct stability, and metatarsophalangeal joint congruity. STEP 3 POSITIONING OF ARTHRODESIS: Fix the toe in 5° to 10° of valgus and elevated 5 mm from the floor to achieve desired dorsiflexion. STEP 4 APPLICATION OF IMPLANTS: Achieve a stable construct with a crossed lag screw and a dorsal locking plate (a hybrid construct). STEP 5 CLOSURE: Perform a standard soft-tissue closure. STEP 6 POSTOPERATIVE CARE: Allow weight-bearing as tolerated after two weeks and impact exercises only after bone healing has been shown on radiographs, which can take up to ten weeks. RESULTS: Arthrodesis of the metatarsophalangeal joint in the hallux provides good results in terms of patient satisfaction and function, as demonstrated in many studies, most of them retrospective.IndicationsContraindicationsPitfalls & Challenges.
INTRODUCTION: Arthrodesis of the first metatarsophalangeal joint is the most reliable surgical option, with a low complication rate, for hallux rigidus from end-stage osteoarthritis. STEP 1 SURGICAL APPROACH: Make a medial approach, following the mid-axis of the joint. STEP 2 JOINT PREPARATION: Using a cup-cone configuration provides excellent bone exposure, construct stability, and metatarsophalangeal joint congruity. STEP 3 POSITIONING OF ARTHRODESIS: Fix the toe in 5° to 10° of valgus and elevated 5 mm from the floor to achieve desired dorsiflexion. STEP 4 APPLICATION OF IMPLANTS: Achieve a stable construct with a crossed lag screw and a dorsal locking plate (a hybrid construct). STEP 5 CLOSURE: Perform a standard soft-tissue closure. STEP 6 POSTOPERATIVE CARE: Allow weight-bearing as tolerated after two weeks and impact exercises only after bone healing has been shown on radiographs, which can take up to ten weeks. RESULTS: Arthrodesis of the metatarsophalangeal joint in the hallux provides good results in terms of patient satisfaction and function, as demonstrated in many studies, most of them retrospective.IndicationsContraindicationsPitfalls & Challenges.
Authors: Dimitri J van Doeselaar; Petra J C Heesterbeek; Jan Willem K Louwerens; Bart A Swierstra Journal: Foot Ankle Int Date: 2010-08 Impact factor: 2.827
Authors: Kenneth J Hunt; J Kent Ellington; Robert B Anderson; Bruce E Cohen; W Hodges Davis; Carroll P Jones Journal: Foot Ankle Int Date: 2011-07 Impact factor: 2.827