Artrodesis Metatarsofalángica del Hallux con placa anatómica y tornillo interfragmentario como tratamiento del Hallux Rigidus. Serie de casos

Abstract

Background: Degenerative arthritis of the first metatarsophalangeal joint (MPJ) is hallux rigidus; which may be associated with pain, deformities, functional limitation and neuropathic pain. Operative treatment is indicated when patients do not improve after non-operative treatment. Currently, the first MPJ fusion is considered the standard of care for patients who require operative treatment. However, there are a variety of fixation options and the evidence on the effectiveness is limited. Aim: To describe the effectiveness, in terms of pain improvement, and short-term complications of the first MTP joint fusion fixed with a combined method which includes a dorsal locking plate and an interfragmentary compression screw for treatment of symptomatic hallux rigidus. Methodology: We retrospectively identified 20 cases of MTP joint fusion fixed with the described method performed in a tertiary hospital between 2012 and 2017. The demographic characteristics, the radiologic grade of arthrosis and treatments received before surgery were collected to characterize this group of patients. The primary outcome was the patient-reported improvement of pain at the MTP joint, measured with a numerical verbal scale from 0 to 10 at a minimum 1-year follow-up. T Student was applied, all statistical analysis was made with Stata software®. Secondary outcomes included the rate of radiological union evaluated in postoperative radiographs, and the rate of complications and reintervention. Results: The study included 11 women (12 cases) and 7 men (8 cases) with an average age of 58 years (Range 21-75 years). Radiologically, the degree of preoperative osteoarthritis was classified as grade II in 2 cases (10%), grade III in 12 cases (60%) and grade IV in 6 cases (30%). Before surgery, 35% of the cases had failed to non-surgical management, while 65% of the cases had not had any treatment. All cases reported pain with movement before surgery, while only 7 cases (35%) reported pain at rest. After an average follow-up of 58 months (range 26-75 months), there was a statistically significant decrease in pain from 6.7 ± 2.3 points preoperatively to 0.3 ± 0.2 points postoperatively (p <0.001). During the same follow-up time, no patient required reintervention, and there were no reported complications. Only one case (5%) reported discomfort in other areas of the foot due to bunionette development at the little toe. Of seven cases who reported performing sports before surgery, six (86%) returned to sports without pain after surgery. In 15 of the 20 cases, radiological follow-up was completed at an average time of 14 months (range 05-58 months). In all of these cases, radiological signs of arthrodesis union with no signs of complications were identified. Conclusion: In patients requiring first MPJ fusion for the management of symptomatic hallux rigidus, fixation with an anatomical dorsal plate and an interfragmentary compression screw is a method that results in a significant improvement in pain with a high rate of union and a low rate of complications. However, further prospective studies comparing this fixation technique with other techniques of fixation of the first MPJ fusion are required.