In vivo comparison of screw versus plate and screw fixation for first metatarsophalangeal arthrodesis: does augmentation of internal compression screw fixation using a semi-tubular plate shorten time to clinical and radiologic fusion of the first metatarsophalangeal joint (MTPJ)?

A retrospective analysis of first metatarsophalangeal joint fusion in 26 consecutive patients (34 feet), treated between April 1998 and February 2002, comparing single compression screw versus a compression screw supplemented with a dorsal quarter tubular plate, was undertaken. The study aimed to assess whether or not plate augmentation of the single interfragmental compression screw lead to an earlier fusion. There were 18 women and 8 men with a mean age of 54.6 +/- 11.02 years and a mean follow-up of 2.9 +/- 1.1 years. Successful fusion was determined clinically and radiologically by means of identifying transarticular trabeculation. The overall incidence of fusion was 97.06% (33/34 fusions). Observed complications included 4 cases of superficial wound infection, each of which resolved with antibiotic therapy; 3 cases of paraesthesia involving the dorsomedial aspect of the big toe; and 2 cases of transfer metatarsalgia. Statistical analyses did not reveal any significant associations between the type of fixation and time to fusion, patient satisfaction, and complications. In regard to the methods of osteosynthesis compared in this investigation, the choice of first metatarsophalangeal fusion fixation can be determined based on surgeon's preference. ACFAS Level of Clinical Evidence: 2c.