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Higher nonunion rates seen with locked plates for hallux MTP fusion

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VANCOUVER, British Columbia — A recent study indicates a trend toward higher nonunion rates in patients with hallux metatarsophalangeal (MTP) arthrodesis who were treated with locking plates compared to non-locking constructs, and shows higher nonunion rates overall for patients with rheumatoid arthritis.

“Locked plates had a higher nonunion rate compared to non-locked 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, here.

“Patients with rheumatoid arthritis had a higher nonunion rate overall, and it is important to recognize that fixation for fractures may be different than fixation for fusion, where we really want compression across the joint and sufficient rigidity of the construct,” he said.

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 non-locked, precontoured, dorsal stainless steel plate. The investigators followed the groups for a minimum of 6 months.

Although they discovered a higher union rate in the non-locked 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 non-locked group.

The study also showed no significant differences between the groups regarding the nonunion rates of patients older than 60 years.

The investigators also found no significant differences between the groups regarding hardware failures and the number of required additional procedures. In addition, they discovered equivalent clinical outcomes between the groups regarding AOFAS, patient satisfaction and Visual Analog Scale pain scale scores.

Hunt cited the retrospective design as a study limitation. In addition, “Our implants, other than just being locked and unlocked, are made of different materials, which have implications relating to rigidity,” he said.

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.