A novel technique of hallux metatarsophalangeal arthrodesis using intramedullary fixation

Paul Maloof, Sheldon Lin, Wayne Berberian, Brian G. Donley

Research output: Contribution to journalArticlepeer-review

Abstract

Arthrosis of the hallux metatarsophalangeal (MTP) joint and its various treatment strategies has been well described in the literature. Numerous options exist for both nonoperative and surgical management. Arthrodesis of the first MTP joint is a reliable, validated procedure that when performed correctly can produce excellent results with high patient satisfaction. Patients tolerate greater weight bearing on the hallux after MTP fusion and do not show observable differences in gait. Indications for fusion include hallux rigidus, severe hallux valgus, failed hallux valgus correction surgery, failed silicon implantation, previous septic arthritis, osteoarthritis, rheumatoid arthritis, and neuromuscular disorders. Various techniques have been described earlier for arthrodesis of the first MTP joint. These techniques include percutaneous pinning, screw fixation using a crossed construct, plate fixation, external fixation, Herbert screw fixation, parallel screws, and combinations thereof. Joint surface preparation has been described using flat cuts, a notch-and-tongue configuration, and most recently spherical ball and cup-type cuts using reamers to create surfaces which allow the surgeon to "dial in" the correct position of arthrodesis. Arthrodesis using internal fixation has become the gold standard for surgical treatment of end-stage MTP arthritis with the reported rates of fusion of greater than 95% common. Fortunately, nonunions are often fibrous and result in a painless outcome. Until now, all types of described fixation used for hallux MTP arthrodesis have been a variation of percutaneous or open screw fixation with or without the use of a dorsally applied plate. Recently, a new method of intramedullary fixation using the HalluX system (Extremity Medical, Parsippany, NJ) has been developed. On the basis of the widely accepted mechanical and biological advantages of intramedullary fixation, this technique provides significant advantages over traditional fixation options.

Original languageEnglish (US)
Pages (from-to)87-91
Number of pages5
JournalTechniques in Foot and Ankle Surgery
Volume10
Issue number2
DOIs
StatePublished - Jun 1 2011

All Science Journal Classification (ASJC) codes

  • Surgery
  • Orthopedics and Sports Medicine

Keywords

  • HalluX
  • arthrodesis
  • hallux metatarsophalangeal joint
  • intramedullary fixation
  • osteoporotic bone

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