Salvage First Metatarsophalangeal Joint Fusion with a Three-Dimensional-Printed Implant for Osseous Defects: A Case Series.

BACKGROUND: In this study, we aimed to describe a case series of revision first metatarsophalangeal joint fusion with a three-dimensional (3-D)-printed implant for osseous deficits of the first metatarsophalangeal joint. Bone defects of the first ray are a common problem in foot and ankle surgery. Etiologies include nonunion, avascular necrosis, osteomyelitis, failed first metatarsophalangeal joint implant arthroplasty, and failed hemijoint resection arthroplasty. Treatment options include acute shortening, block allograft, block autograft, distraction osteogenesis, vascularized free fibula, Masquelet technique, and partial first-ray amputation. Three-dimensional printing provides an opportunity to improve outcomes, with less donor site morbidity and less extensive recovery time than an external fixation device. It has been used in other facets of foot and ankle surgery with encouraging results. METHODS: Three patients (four feet) underwent revision first metatarsophalangeal joint fusion with a 3-D-printed implant. Reasons for revision included avascular necrosis after distal metatarsal osteotomy in one patient and bone deficit after failed first metatarsophalangeal joint implant in two patients. RESULTS: All patients had a minimum follow up of 12 months. Two patients had painful hardware and had to undergo revision due to implant design. At most recent follow up all patients were pain free with improved pain scores. CONCLUSIONS: In revisional first metatarsophalangeal joint surgery with osseous deficits, the goal is to restore length and alignment, which improves function of the medial column. Custom 3-D-printed implants for first metatarsophalangeal joint revision can provide an opportunity for improved outcomes and healing.

The Role of Bone Marrow Aspirate in Osseous and Soft Tissue Pathology.

Bone marrow aspirate (BMA) is an emerging therapy that is gaining popularity for orthoplastic reconstruction. The stem cells collected are multipotent and regenerative in nature. In addition to stem cells, other biological components collected augment the mitogen of local cells, proliferation, and angiogenesis, and inhibit proinflammatory cytokine and bacteria to optimize an environment to heal. The most common site for harvest is the iliac crest. Techniques for harvesting BMA are simple to perform, financially modest, and associated with low morbidity. Additional research is needed to evolve and standardize the technology; however, BMA is proven to be advantageous for tissue repair.

Type IV Cell-Mediated Hypersensitivity Reaction Caused by Titanium Implant Following Double Calcaneal Osteotomy and First Metatarsal-Cuneiform Arthrodesis: A Case Report and Review of the Literature.

Because of their inert character and desired biocompatibility, titanium implants have been universally accepted as safer alternatives to the conventional stainless steel orthopedic implants; however, recent emergence of type IV hypersensitivity reactions to titanium have included eczema, contact dermatitis, a prolonged febrile state, sterile osteonecrosis, and impaired fracture and wound healing. This report presents a patient with postoperative incision dehiscence and devascularization of surfaces in contact with titanium hardware after undergoing a double calcaneal osteotomy and a first metatarsal-cuneiform arthrodesis using titanium alloy implants. Titanium hypersensitivity was confirmed in this case through standard allergy patch testing by a board-certified immunologist. Complete healing occurred after diagnosis of the titanium allergy and hardware explant. To our knowledge, this is one of a few known allergies to titanium implants after foot and ankle surgery.

A simple method of intramedullary fixation for proximal interphalangeal arthrodesis.

Lesser digital arthrodesis has become one of the most widely used techniques in foot and ankle surgery. When performing digital arthrodesis, surgeons have an abundance of options for implantable devices. We provide information on a simple method of achieving successful arthrodesis. An intramedullary Kirschner wire is implanted into the proximal phalanx with the intermediate phalanx compressed over the wire for rigid internal fixation to avoid the use of an external device. We have had results similar to those from the published data of more expensive implants.