gms | German Medical Science

Objectives: Arthrodesis of the great toe is a succesfull treatment for different conditions like hallux rigidus or severe or recurrent hallus valgus. We conducted a retrospective study to compare the results of first metatarsophalangeal arthrodesis using crossed canulated screws compared to an intramedullary device. The device is supposed to deliver compression across the joint and offer the advantage of lower profile than screws or plates. We hypothesized that the results would be equivalent to the standard technique with crossed canulated screws.

Methods: We retrospectively reviewed the records of 40 patients operated on for arthrodesis of the first metatarsophalangeal joint using crossed canulated screws or an intramedullary device. Radiographic union was evaluated at 6 month and position of the arthrodesis was measured in the frontal and sagittal plane. Complications were analyzed and implant related costs were calculated.

Results and Conclusion: Of the 40 patients, 14 were operated using the intramedullary device and 26 using canulated screws. In the intramedullary group, 7 patients did not achieve bony fusion whereas 20 out of 26 did with canulated screws. The mean sagittal angle in the IM group was 28.0 degrees and 18.2 in the CS group. The mean costs for the intramedullary device reached 453.80 Euros (range, 453.80 to 640.30 Euros) whereas the canulated screws cost 138.40 Euros. Four patients in the IM group had to be re-operated for persistent pain due to plantar prominence of the lag screw. One patient presented with acute postoperative infection at 4 weeks. The rate of nonunion of 50% with the intramedullary device is not acceptable, even if the standard techniques reaches fusion in only 84% of our patients, which is lower than the 90 to 95% reported in recent literature. The intramedullary device has a steep learning curve and the related complications with important bone loss in case of removal make it unsuitable for first metatarsophalangeal arthrodesis.