Abstract
Primary arthrodesis is a thoroughly studied treatment option for end-stage pathologic
entities of the first metatarsophalangeal joint. It is a commonly accepted treatment
of many pathologic conditions, including hallux rigidus, severe hallux valgus, hallux
varus, and other conditions pertaining to the first ray. Numerous fixation techniques
are available for this procedure. Fixation constructs range from simple crossing Kirschner
wires to plate and screw fixation or, even, external fixation. We propose a simple
and cost-effective fixation technique using an intramedullary Steinmann pin with crossing
Kirschner wires. Similar fixation techniques have been described; however, minimal
data are available regarding this type of fixation. We present a series of 64 first
metatarsophalangeal joint fusion procedures performed on 60 patients using our technique.
A retrospective review with attention to several clinical and radiographic parameters
was performed. The mean follow-up time was 27 (range 6 to 56) months. This technique
resulted in a fusion rate of 90.6% (58 of 64 procedures). Despite the use of a large
intramedullary Steinmann pin across the interphalangeal joint (IPJ), only 6 of the
64 procedures (9%) resulted in hallux IPJ degeneration. Of these, only 3 (4.6%) were
symptomatic and required therapeutic measures. This suggests that violation of the
IPJ with this form of fixation contributes minimally to postoperative pathologic features
and is a viable alternative to traditional Association for Osteosynthesis/Association
for the Study of Internal Fixation techniques.
Level of Clinical Evidence
Keywords
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Article info
Footnotes
Financial Disclosure: None reported.
Conflict of Interest: None reported.
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© 2017 by the American College of Foot and Ankle Surgeons. All rights reserved.
