ABSTRACT
First metatarsophalangeal joint (MTPJ) fusion is a surgery to treat severe joint arthritis
and pain following failure of conservative treatment. A first MTPJ fusion can be performed
open or via a percutaneous approach with joint fixation achieved using various techniques
including dorsal plate and screw fixation. Variability in the angulation of the guide
wire used for reaming during joint resurfacing and the plate angulation can compromise
the amount of bony contact needed for successful fusion. The objective of the current
study was to utilize a 3-dimensional computational, geometric model to quantitatively
analyze the effects of guide wire placement and subsequent bone resurfacing on the
achievement of bony contact criteria using 3 dorsiflexion plates in joint fixation.
A superposed ideal hemisphere model of the joint interface following resurfacing of
the articulating surfaces was the basis for computational analysis. A custom-written
code quantified angular offset limits for selected conditions. The angular offset
from the central long axis of each bone represents initial guide wire placement error,
impacting subsequent fixation and union.For 60% bony contact achieved in the joint
interface for 0°, 5°, and 10° dorsiflexion plates angular offset limits for both the
sagittal and transverse planes were 21.6°, 20.3°, and 19.0°, respectively. These analyses
provide surgical guidance by quantifying the influence of dorsiflexion plate angles
for ambulation and guide wire placement on the success of a first MTPJ fusion. The
computational model presented can be readily adapted for varying joint geometries
and may facilitate the development of a surgical guide prototype.
Level of Clinical Evidence
Keywords
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Article info
Publication history
Published online: September 27, 2022
Footnotes
Financial Disclosure: This investigation was conducted with financial support from the Carilion Clinic Department of Orthopedic Surgery, Roanoke, VA.
Conflict of Interest: Logan N. Dickinson: None reported Vincent M. Wang: Receives research support from Coloplast Corporation. Jennifer S. Wayne: None reported John R. Clements: Associate Professor of Orthopedics Surgery at Virginia Tech Carilion School of Medicine, Institute for Orthopedics and Neurosciences, Co-Section Chief for Foot and Ankle.
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