The First Metatarsophalangeal Arthrodesis with Screws Fixation / 대한족부족관절학회지

PURPOSE: The aim of this study was to retrospectively evaluate the clinical and radiological results of the first metatarsophalangeal joint arthrodesis with two crossed screws fixation. MATERIALS AND METHODS: We treated 23 patients (24 cases) with arthrodesis of the first metatarsophalangeal joint using two crossed screws fixation between December 2000 and May 2005. There were 3 male patients and 20 female patients. Ages ranged from 28 to 74 years (mean, 50 years). Follow-up ranged from 4.1 to 8.2 years (mean, 6.5 years). The American Orthopaedic Foot and Ankle Society (AOFAS) score and their satisfaction was evaluated clinically, foot anteroposterior and lateral radiograph, radiologically. RESULTS: Of the 24 cases, 6 had surgery for dorsal plate and screws fixation because of failure to acquire firm fixation with two crossed screws fixation. All 6 cases acquired bony union. Fusion of the hallux first metatarsophalangeal joint occurred in 16/18 cases (89%). Nonunion occurred in 2 cases (11%) and was asymptomatic. At last follow-up, hallux valgus angle ranged from 11 to 25 degrees(mean, 17.7 degrees), dorsiflexion ranged from 15 to 25 degrees (mean, 22 degrees).The mean preoperative AOFAS score of 37 points(range, 28 to 45 points) improved to a mean of 77 points (range, 65~90 points) postoperatively. The result of the procedure as rated subjectively by the patient was excellent for 5 cases, good for 11 cases and fair for 2. CONCLUSION: Comparatively, the arthrodesis of the first metatarsophalangeal joint with crossed screws fixation showed a satisfactory clinical results, we thought that require technical attention for firm fixation in operation.

Arthrodesis of the First Metatarsophalangeal Joint for Rheumatoid Hallux Valgus, using 2 Crossed Screws / 대한류마티스학회지

OBJECTIVE: To investigate the clinical results of the first metatarsophalangeal arthrodesis for treating the hallux valgus deformity of the rheumatoid arthritis, using the fixation method with 2 crossed screws. METHODS: 19 cases of the rheumatoid hallux valgus deformity were tried to treat with the first metatarsophalangeal arthrodesis, using 2 crossed screws. The follow-up period was averaged in 16 months. The subjective and objective findings were evaluated. Radiologically measurements for the hallux valgus angle, 1, 2 intermetatarsal angle and dorsiflexion angle were measured. RESULTS: Cases, of which the first metatarsophalangeal joint successfully fixated with 2 crossed screws, were 14 (73.7%). 5 failed fixations with 2 crossed screws due to breakage of the cortical bone were immediately refixed with fixation methods (the dorsal plating for three cases, additional K-wire fixation for one, and threaded Steinmann pins fixation for one case). After the arthrodesis of the first metatarsophalangeal joint, the subjective signs in pain, function and alignment were improved as all above fair grade. The radiological fusion was observed at average 8 weeks after the operation in all cases. The hallux valgus angle and 1, 2 intermetatarsal angle were reduced from 45.6+/-7.5degrees and 16.2+/-5.2degrees to 14.2+/-2.0degrees and 10.9+/-2.5degrees respectively. The dorsiflexion angle was measured in 20.5+/-2.2degrees after the fusion. CONCLUSION: To correct the rheumatoid hallux valgus deformity, the arthrodesis of the first metatarsophalangeal joint with 2 crossed screws is a method for the satisfactory results, once the fixation is achieved. However, other fixation procedures should be prepared in case of the failed fixation, which could be happened intraoperatively.

Arthrodesis Of The First Metsatarophalangeal Joint For Rheumatoid Arthritis And Hallux Valgus / 대한정형외과학회잡지

PURPOSE: We reviewed the result of metatarsophalangeal arthrodesis of the great toe in rheumatoid arthritis and severe hallux valgus. MATERIALS AND METHODS: From February 1994 to March 1997, 68 patients were operated on. The follow up averaged 2.8 years. We evaluated the subjective improvement with respect to pain, ability to stand and walk and shoe wear, the radiologic improvement with respect to hallux valgus angle, intermetatarsal angle and dorsiflexion angle. RESULTS: Arthrodesis of the first metatarsophalangeal joint was resulted in a good functional improvement in 91% of hallux valgus and 94% of rheumatoid arthritis with respect to pain relief. Preoperative hallux valgus angle in rheumatoid arthritis was 42.5o, and the postoperative hallux valgus angle 10.1o. Preoperative hallux valgus angle in severe hallux valgus was 38.2o, postoperative hallux valgus 8.7o. CONCLUSION: Arthrodesis of the first metatarsophalangeal joint was an excellent operation for correction of the rheumatoid arthritis and severe hallux valgus, and there were no different result between these two groups.