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.

Ventral and Dorsal Stabilization of the Thoracolumbar Spine by Crossed-screw Fixation

For surgical stabilization of thoracolumbar instability either posterior transpedicular fixation or anterior interbody fixation is commonly performed. On some occasions, however, combined ventral and dorsal stabilization is needed, in which case surgery is usually performed in separate stages. To achieve this goal in a single operation, the authors used the crossed-screw fixation technique, with the pedicle screw-rod system, in eight patients. Their thoracolumbar instabilities were caused by trauma(n=6), tumor(n=1), and congenital deformity(n=1). In all patients, signs of myelo- and/or radiculopathy were present, and as this required extensive ventral and dorsal decompression, combined ventral and dorsal stabilizations was considered necessary. Surgery involved the lateral extracavitary approach: for dorsal stabilization, the conventional transpedicular fixation method, with pedicle screws of 5.5-mm diameter, was used. For ventral stabilization, interbody struts were grafted, using rib autograft or in the case of tumor fibula allograft, supplemented with transverse fixation of the vertebral body with pedicle screws of 7.5-mm diameter. The two stabilization systems, ventral and dorsal, were interconnected with cross-linking plates. Follow-up 12 to 26 (average 18) months after surgery revealed no hardware failures, and all patients showed improvement in their neurological functions during this period. Due to congenital deformity, graft dislodgement occurred in one patient. On the basis of these results the authors believe that the crossed-screw fixation technique is a viable option for three-dimensional stabilization of the thoracolumbar spine.