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Higher nonunion rates found using locked plate constructs for hallux MTP fusion
Patients in the locked and nonlocked plate groups showed comparable satisfaction, pain relief scores.
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VANCOUVER, British Columbia — A recently presented study indicates a trend toward higher nonunion rates in patients with hallux metatarsophalangeal (MTP) arthrodesis who were treated with locking plates compared to nonlocking constructs, and shows higher nonunion rates overall for patients with rheumatoid arthritis.
“Locked plates had a higher nonunion rate compared to nonlocked plates for hallux MTP fusion in our series,” Kenneth J. Hunt, MD, said during his presentation at the 25th Annual Summer Meeting of the American Orthopaedic Foot and Ankle Society.
“It is important to recognize that the ideal fixation for certain types of fractures may be different than fixation for arthrodesis, where we really want compression across the joint and sufficient rigidity of the construct,” he said.
Subanalyses
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Image: Hunt KJ |
Hunt and his colleagues retrospectively compared the outcomes of 73 patients who underwent hallux MTP arthrodesis with a low-profile, precontoured, doral titanium locked plate to 107 patients who underwent the same procedure with a nonlocked, precontoured, dorsal stainless steel plate. The locked plate constructs used 2.7-mm screws while the nonlocked constructs used 2.7- and 3.2-mm screws. The investigators followed the groups for a minimum of 6 months.
Although they discovered a higher union rate in the nonlocked group compared to the locked group (88% vs. 78%, respectively), the difference between the groups was not statistically significant.
A subanalysis revealed comparable nonunion rates between patients with rheumatoid arthritis and those without the condition in the locked group. However, the investigators found a significantly higher nonunion rate for patients with rheumatoid arthritis compared to those without the condition in the nonlocked group.
The study also showed no significant differences between the groups regarding the nonunion rates of patients older than 60 years.
The investigators found no significant differences between the groups regarding hardware failures and the number of required additional procedures. In addition, the investigators discovered equivalent clinical outcomes between the groups regarding AOFAS, patient satisfaction and Visual Analog Scale pain scores.
Titanium, stainless steel
Hunt cited the retrospective design as a study limitation. In addition, “Our implants, in addition to being locked and unlocked, are made of different materials. This has implications relating to rigidity,” he said. The ideal study comparison would use the same material, plate thickness and screw length, Hunt said.
Saul G. Trevino, MD, a moderator for the paper session, asked Hunt about the patients’ postoperative management.
“In general, it is nonweight-bearing or heel weight-bearing for a couple of weeks in a postoperative sandal followed by weight-bearing at 3 to 6 weeks in a sandal, but we do not use casts.” Hunt said.
“The question is if you do not cast and you have a high nonunion rate, what would you anticipate 10 years ago would be the union rate using two screws?” Trevino asked.
Hunt responded that, based on the literature, it would likely be the same.
For more information:
- Kenneth J. Hunt, MD, can be reached at Stanford University Department of Orthopaedic Surgery, 450 Broadway St., Pavilion C, MC 6342 Redwood City, CA 94063; 650-468-1988; e-mail: kjhunt@stanford.edu.
- Saul G. Trevino, MD, can be reached at the Department of Orthopedic Surgery, University of Missouri-Columbia School of Medicine, 1 Hospital Dr, MC 213, Columbia, MO 65212; 409-747-9486 e-mail: trevinos@health.missouri.edu. They have no direct financial interest in any products or companies mentioned in this article.
Reference:
- Hunt KJ, Ellington K, Anderson RB, et al. Locked versus non-locked plate fixation for hallux MTP arthrodesis. Presented at the 25th Annual Summer Meeting of the American Orthopaedic Foot and Ankle Society. July 15-18, 2009. Vancouver, British Columbia.