Abstract
Complex hammer digit deformity is commonly associated with instability of the metatarsophalangeal
joint. Restoring joint stability is critical for digit alignment and function and
can be challenging and unpredictable. Lesser metatarsophalangeal joint fusion might
be an alternative treatment to the current soft tissue balancing, repair, and extra-articular
osseous procedures used to treat joint instability. The present study was a retrospective
chart and radiographic review of the pooled outcomes of 31 consecutive lesser metatarsophalangeal
joint fusion procedures performed by 3 independent surgeons from May 2004 to September
2009. The clinical and radiographic outcomes were analyzed with descriptive and inferential
statistics. The overall interval to radiographic union was 8.69 ± 1.7 weeks (range
6 to 12 and 95% confidence interval 7.9 to 9.4). The overall period to clinical union
was 10.25 ± 4.5 weeks (range 4 to 22 and 95% confidence interval 8.5 to 11.9). The
mean duration of non–weight-bearing was 4.71 ± 1.74 weeks, followed by 5.09 ± 2.8
weeks of guarded weight-bearing with a brace. Complications included nonunion in 4
(12.90%), hardware breakage in 2 (6.45%), and soft tissue infection in 1 (3.23%).
Patients demonstrated a statistically significant reduction in pain (p = .035) and improved digit alignment after the procedure that enabled full return
to unrestricted weight-bearing activities without limitations or the need for orthoses.
These findings support metatarsophalangeal joint fusion as an alternative treatment
of lesser digit metatarsophalangeal joint instability associated with hammer digit
deformities that obviate the need for concomitant soft tissue procedures such as plantar
plate repair or tendon balancing procedures.
Level of Clinical Evidence
Keywords
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Article info
Publication history
Published online: November 07, 2011
Footnotes
Financial Disclosure: None reported.
Conflict of Interest: None reported.
Identification
Copyright
© 2012 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.
