Médecine et chirurgie du pied


Fixation of first metatarsophalangeal joint arthrodesis with shape-memory staples: results and complications. A report of a continuous series of 45 operated feet. Volume 35, issue 1, Mars 2019


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First metatarsophalangeal joint (MTPJ) arthrodesis represents a tried and proven solution in case of first metatarsophalangeal joint severe alteration. Depending on teams, various techniques are used. This prospective study aimed to assess the results of osteosynthesis based on the use of shape-memory staples in association with an oblique configuration such as screw or pin fixation. We have carried out a surgical procedure on 45 feet for over a period of 48 months. The devices used were a staple made of titanium-nickel alloys and a Scarf screw or a pin. Postoperative non-weight bearing period of the forefoot was 45 days. Mean AOFAS (American Orthopaedic Foot and Ankle Surgery) score reported good results. We did not find any case of first MTPJ pain or residual mobility. Radiological fusion was complete in 95.5% of the cases. We have reported two cases (4.5%) of tight, painless pseudoarthrosis without reintervention. We chose to use shape-memory staples for this arthrodesis because of three reasons: the device is not bulky, the technique is easy, and above all, the site is compressed due to the shape-memory effect. The choice to position the staple dorsally hinges on two reasons: the maximal resistance of the staple is located in the plane delimited by its two legs and the maximal constraints on the first MTPJ are situated in the plane of the flexion–extension, the arthrodesis is fixed in extension first MTPJ and the staple in this concave and dorsal area puts it at a distance from tendons and skin. A literature review shows that in most recent series, fusion rates are very close, regardless of the osteosynthesis type (90 to 96%). Arthrodesis for major hallux valgus has the highest rate of nonunion (14.3%). Bone fusion is better in case of rheumatoid arthritis than in case of arthrosis, better in case of arthrosis than in reintervention. In a meta-analysis gathering 2,656 cases of MTPJ arthrodesis for severe hallux valgus, hallux rigidus, rheumatoid arthritis or failure of prior surgery, the total rate of nonunion was 5.4%. First MTPJ arthrodesis with systematic use of shape-memory staples gives results as good as those obtained with other published techniques. The use of a single staple, versus two staples for the other published series, does not change the outcome of the fusion.